The strengths and limitations of meta-analyses based on aggregate data.
The strengths and limitations of meta-analyses based on aggregate data.
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DOI：
10.1186/1471-2288-5-14
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发表时间：
2005-04-25
影响因子：
4
通讯作者：
Kuderer NM
中科院分区：
文献类型：
--
作者：
Lyman GH;Kuderer NM
许多人认为，适当进行的系统综述和荟萃分析代表了解决重要临床问题的最高水平证据。很少有人会不同意基于个体患者数据（IPD）的荟萃分析提供了几个优势，并代表了所有其他系统性评价应该比较的标准。Medline中引用的所有癌症相关荟萃分析均基于总体或个体患者数据进行分类。然后对所有报告进行审查，比较使用汇总或个体患者数据进行荟萃分析的比较优势和局限性。大多数已发表的荟萃分析基于汇总或汇总患者数据（APD）。提出的原因包括IPD荟萃分析所需的大量资源、多年研究以及广泛的国际合作。IPD和APD荟萃分析均讨论了系统性综述的许多最重要特征，包括正式荟萃分析。对于两种方法，定义明确和相关临床问题、彻底检索全部证据、细致和无偏倚的数据转移或提取、评估研究间异质性以及使用适当的统计方法估计汇总效应指标的需求基本相同。IPD具有优势，在可行的情况下，应将其视为总结多项研究结果的最佳机会。然而，此类研究所需的资源、时间和合作将继续限制其在临床医学的许多重要领域的使用，这些领域可以通过适当进行APD荟萃分析进行有意义和具有成本效益的处理。APD荟萃分析仍然是美国预防服务工作组、科克伦协作组和许多专业协会用于支持临床实践指南的系统性综述的主要内容。
Properly performed systematic reviews and meta-analyses are thought by many to represent among the highest level of evidence addressing important clinical issues. Few would disagree that meta-analyses based on individual patient data (IPD) offer several advantages and represent the standard to which all other systematic reviews should be compared. All cancer-related meta-analyses cited in Medline were classified as based on aggregate or individual patient data. A review was then undertaken of all reports comparing the comparative strengths and limitations of meta-analyses using either aggregate or individual patient data. The majority of published meta-analyses are based on summary or aggregate patient data (APD). Reasons suggested for this include the considerable resources, years of study and often, broad international cooperation required for IPD meta-analyses. Many of the most important features of systematic reviews including formal meta-analyses are addressed by both IPD and APD meta-analyses. The need for defining an explicit and relevant clinical question, exhaustively searching for the totality of evidence, meticulous and unbiased data transfer or extraction, assessment of between study heterogeneity and the use of appropriate statistical methods for estimating summary effect measures are essentially the same for the two approaches. IPD offers advantages and, when feasible, should be considered the best opportunity to summarize the results of multiple studies. However, the resources, time and cooperation required for such studies will continue to limit their use in many important areas of clinical medicine which can be meaningfully and cost-effectively approached by properly performed APD meta-analyses. APD meta-analyses continue to be the mainstay of systematic reviews utilized by the US Preventive Services Task Force, the Cochrane Collaboration and many professional societies to support clinical practice guidelines.