PDF(Pubmed)
Abstract：
UNASSIGNED: The European Society for Medical Oncology (ESMO) guidelines are among the most comprehensive and widely used clinical practice guidelines (CPGs) globally. However, the level of scientific evidence supporting ESMO CPG recommendations has not been systematically investigated. This study assessed ESMO CPG levels of evidence (LOE) and grades of recommendations (GOR), as well as their trends over time across various cancer settings.
UNASSIGNED: We manually extracted every recommendation with the Infectious Diseases Society of America (IDSA) classification from each CPG. We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.
UNASSIGNED: Among the 1,823 recommendations in the current CPG, 30% were classified as LOE I, and 43% were classified as GOR A. Overall, there was a slight decrease in LOE I (-2%) and an increase in the proportion of GOR A (+1%) in the current CPG compared to previous versions. The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials (LOE I-II) shows a decrease (71% vs. 63%, p = 0.009) while recommendations based on lower levels of evidence (LOE III-V) show an increase (29% vs. 37%, p = 0.01) between previous and current version. In the current versions, the highest proportion of LOE I (42%) was found in recommendations related to pharmacotherapy, while the highest proportion of GOR A recommendations was found in the areas of pathology (50%) and diagnostic (50%) recommendations. Significant variability in LOE I and GOR A recommendations and their changes over time was observed across different cancer types.
UNASSIGNED: One-third of the current ESMO CPG recommendations are supported by the highest level of evidence. More well-designed randomized clinical trials are needed to increase the proportion of LOE I and GOR A recommendations, ultimately leading to improved outcomes for cancer patients.
UNASSIGNED: We manually extracted every recommendation with the Infectious Diseases Society of America (IDSA) classification from each CPG. We examined the distribution of LOE and GOR in all available ESMO CPG guidelines across different topics and cancer types.
UNASSIGNED: Among the 1,823 recommendations in the current CPG, 30% were classified as LOE I, and 43% were classified as GOR A. Overall, there was a slight decrease in LOE I (-2%) and an increase in the proportion of GOR A (+1%) in the current CPG compared to previous versions. The proportion of GOR A recommendations based on higher levels of evidence such as randomized trials (LOE I-II) shows a decrease (71% vs. 63%, p = 0.009) while recommendations based on lower levels of evidence (LOE III-V) show an increase (29% vs. 37%, p = 0.01) between previous and current version. In the current versions, the highest proportion of LOE I (42%) was found in recommendations related to pharmacotherapy, while the highest proportion of GOR A recommendations was found in the areas of pathology (50%) and diagnostic (50%) recommendations. Significant variability in LOE I and GOR A recommendations and their changes over time was observed across different cancer types.
UNASSIGNED: One-third of the current ESMO CPG recommendations are supported by the highest level of evidence. More well-designed randomized clinical trials are needed to increase the proportion of LOE I and GOR A recommendations, ultimately leading to improved outcomes for cancer patients.
摘要：
■欧洲医学肿瘤学会（ESMO）指南是全球最全面和广泛使用的临床实践指南（CPG）之一。然而,支持ESMOCPG建议的科学证据水平尚未得到系统调查.本研究评估了ESMOCPG证据水平（LOE）和建议等级（GOR），以及它们在各种癌症环境中的趋势。
■我们从每个CPG中手动提取了美国传染病学会（IDSA）分类的每个建议。我们在所有可用的ESMOCPG指南中检查了LOE和GOR在不同主题和癌症类型中的分布。
■在当前CPG的1,823项建议中，30%被归类为LOEI，43%被归类为GORA。总体而言，与以前的版本相比,当前CPG中LOEI略有下降(-2%),GORA的比例增加(+1%).基于较高水平证据（如随机试验（LOEI-II））的GORA建议的比例有所下降（71％vs.63%,p=0.009），而基于较低水平证据的建议（LOEIII-V）显示增加（29％vs.37%,以前版本和当前版本之间的p=0.01）。在当前版本中,在与药物治疗相关的建议中发现LOEI的比例最高(42%)，而GORA推荐比例最高的是病理学(50%)和诊断(50%)推荐.在不同的癌症类型中观察到LOEI和GORA建议的显着变异性及其随时间的变化。
■当前ESMOCPG建议的三分之一得到了最高级别的证据支持。需要更精心设计的随机临床试验来增加LOEI和GORA建议的比例，最终改善癌症患者的预后。
■我们从每个CPG中手动提取了美国传染病学会（IDSA）分类的每个建议。我们在所有可用的ESMOCPG指南中检查了LOE和GOR在不同主题和癌症类型中的分布。
■在当前CPG的1,823项建议中，30%被归类为LOEI，43%被归类为GORA。总体而言，与以前的版本相比,当前CPG中LOEI略有下降(-2%),GORA的比例增加(+1%).基于较高水平证据（如随机试验（LOEI-II））的GORA建议的比例有所下降（71％vs.63%,p=0.009），而基于较低水平证据的建议（LOEIII-V）显示增加（29％vs.37%,以前版本和当前版本之间的p=0.01）。在当前版本中,在与药物治疗相关的建议中发现LOEI的比例最高(42%)，而GORA推荐比例最高的是病理学(50%)和诊断(50%)推荐.在不同的癌症类型中观察到LOEI和GORA建议的显着变异性及其随时间的变化。
■当前ESMOCPG建议的三分之一得到了最高级别的证据支持。需要更精心设计的随机临床试验来增加LOEI和GORA建议的比例，最终改善癌症患者的预后。
