Reporting of prognostic markers: current problems and development of guidelines for evidence-based practice in the future
Reporting of prognostic markers: current problems and development of guidelines for evidence-based practice in the future
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DOI：
10.1038/sj.bjc.6600886
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发表时间：
2003-04-22
影响因子：
8.8
通讯作者：
Burchill, SA
中科院分区：
文献类型：
--
作者：
Riley, RD;Abrams, KR;Burchill, SA
预后标志物有助于通过识别具有不同结局风险（例如疾病复发）的患者来对患者进行分层以进行治疗，并且是管理癌症和许多其他疾病的重要工具。需要系统回顾和荟萃分析方法来确定最有价值的预后标志物，因为与标志物相关的证据（有时相互矛盾）经常在许多研究中发表。为了研究这种方法的实用性，进行了一项神经母细胞瘤肿瘤标志物系统评价的实证研究;确定了260项预后标志物研究，其中考虑了130种不同的标志物，这些研究的报告往往不充分，在统计分析和介绍方面，许多重要的临床/统计因素存在相当大的异质性。这些问题限制了数据的提取和荟萃分析的结果从主要的研究，限制了循证方法的可行性，在癌症和其他疾病的主要预后标志物研究的结果报告的指导方针，给出了为了促进个人研究的解释和系统评价，荟萃分析，并最终，循证实践的承诺。全面提供个体患者数据是向前迈出的必要一步，将克服遇到的大多数问题，包括汇总统计数据报告不足以及截止水平、评估的结局和使用的调整因素的变异性。这也将限制报告偏倚的问题，尽管在研究被前瞻性注册之前，发表偏倚仍将是一个令人担忧的问题。实践中的这些变化将有助于进行重要的循证审查，以建立最合适的临床预后标志物，最终改善患者护理。(C)2003年英国癌症研究。
Prognostic markers help to stratify patients for treatment by identifying patients with different risks of outcome (e.g. recurrence of disease), and are important tools in the management of cancer and many other diseases. Systematic review and meta-analytical approaches to identifying the most valuable prognostic markers are needed because (sometimes conflicting) evidence relating to markers is often published across a number of studies. To investigate the practicality of this approach, an empirical investigation of a systematic review of tumour markers for neuroblastoma was performed; 260 studies of prognostic markers were identified, which considered 130 different markers.The reporting of these studies was often inadequate, in terms of both statistical analysis and presentation, and there was considerable heterogeneity for many important clinical/statistical factors. These problems restricted both the extraction of data and the meta-analysis of results from the primary studies, limiting feasibility of the evidence-based approach.Guidelines for reporting the results of primary prognostic marker studies in cancer, and other diseases, are given in order to facilitate both the interpretation of individual studies and the undertaking of systematic reviews, meta-analysis and, ultimately, evidence-based practice. General availability of full individual patient data is a necessary step forward and would overcome the majority of problems encountered, including poorly reported summary statistics and variability in cutoff level, outcome assessed and adjustment factors used. It would also limit the problem of reporting bias, although publication bias will remain a concern until studies are prospectively registered. Such changes in practice would help important evidence-based reviews to be conducted in order to establish the most appropriate prognostic markers for clinical use, which should ultimately improve patient care. (C) 2003 Cancer Research UK.