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Abstract：
BACKGROUND: Hepatocellular carcinoma is the second leading cause of cancer-related mortality worldwide. Multiple guidelines have been developed to assist clinicians in its management. We aimed to explore methodological quality of these guidelines focusing on treatment of intermediate hepatocellular carcinoma by transarterial chemoembolization.
METHODS: A systematic search was performed for Clinical Practice Guidelines and Consensus statements for hepatocellular carcinoma management. Guideline quality was appraised using the Appraisal of Guidelines Research and Evaluation II instrument, which rates guideline development processes across 6 domains: \'Scope and purpose\', \'Stakeholder involvement\', \'Rigour of development\', \'Clarity of presentation\', \'Applicability\' and \'Editorial independence\'. Thematic analysis of guidelines was performed to map differences in recommendations.
RESULTS: Quality of 21 included guidelines varied widely, but was overall poor with only one guideline passing the 50% mark on all domains. Key recommendations as (contra)indications and technical aspects were inconsistent between guidelines. Aspects on side effects and health economics were mainly neglected.
CONCLUSIONS: Methodological quality of guidelines on transarterial chemoembolization in hepatocellular carcinoma management is poor. This results in important discrepancies between guideline recommendations, creating confusion in clinical practice. Incorporation of the Appraisal of Guidelines Research and Evaluation II instrument in guideline development may improve quality of future guidelines by increasing focus on methodological aspects.
METHODS: A systematic search was performed for Clinical Practice Guidelines and Consensus statements for hepatocellular carcinoma management. Guideline quality was appraised using the Appraisal of Guidelines Research and Evaluation II instrument, which rates guideline development processes across 6 domains: \'Scope and purpose\', \'Stakeholder involvement\', \'Rigour of development\', \'Clarity of presentation\', \'Applicability\' and \'Editorial independence\'. Thematic analysis of guidelines was performed to map differences in recommendations.
RESULTS: Quality of 21 included guidelines varied widely, but was overall poor with only one guideline passing the 50% mark on all domains. Key recommendations as (contra)indications and technical aspects were inconsistent between guidelines. Aspects on side effects and health economics were mainly neglected.
CONCLUSIONS: Methodological quality of guidelines on transarterial chemoembolization in hepatocellular carcinoma management is poor. This results in important discrepancies between guideline recommendations, creating confusion in clinical practice. Incorporation of the Appraisal of Guidelines Research and Evaluation II instrument in guideline development may improve quality of future guidelines by increasing focus on methodological aspects.
摘要：
背景：肝细胞癌是全球癌症相关死亡率的第二大原因。已经制定了多种指南来帮助临床医生进行管理。我们旨在探讨这些指南的方法学质量，重点是通过经动脉化疗栓塞治疗中间肝细胞癌。
方法：对肝细胞癌管理的临床实践指南和共识声明进行了系统搜索。准则质量采用《准则研究与评估II》评估工具进行评估，对6个领域的指南开发过程进行评级：“范围和目的”，\'利益相关者参与\'，\'发展的严谨\',\'演示文稿的清晰度\',\'适用性\'和\'编辑独立性\'。对指南进行了主题分析，以绘制建议的差异。
结果：包含的21条指南的质量差异很大，但总体很差，只有一个指南在所有领域都通过了50%的标记。作为（相反）适应症和技术方面的关键建议在指南之间不一致。副作用和卫生经济学方面主要被忽视。
结论：肝动脉化疗栓塞治疗肝细胞癌指南的方法学质量较差。这导致了指导方针建议之间的重要差异，在临床实践中造成混乱。将准则评估研究和评估II工具纳入准则制定中，可以通过更加关注方法学方面来提高未来准则的质量。
方法：对肝细胞癌管理的临床实践指南和共识声明进行了系统搜索。准则质量采用《准则研究与评估II》评估工具进行评估，对6个领域的指南开发过程进行评级：“范围和目的”，\'利益相关者参与\'，\'发展的严谨\',\'演示文稿的清晰度\',\'适用性\'和\'编辑独立性\'。对指南进行了主题分析，以绘制建议的差异。
结果：包含的21条指南的质量差异很大，但总体很差，只有一个指南在所有领域都通过了50%的标记。作为（相反）适应症和技术方面的关键建议在指南之间不一致。副作用和卫生经济学方面主要被忽视。
结论：肝动脉化疗栓塞治疗肝细胞癌指南的方法学质量较差。这导致了指导方针建议之间的重要差异，在临床实践中造成混乱。将准则评估研究和评估II工具纳入准则制定中，可以通过更加关注方法学方面来提高未来准则的质量。
