目的:本系统评价的目的是总结国家和国际指南,为监测诊断为低风险癌症的患者提供建议。它评估了指南的质量,并确定指南是否充分识别了患者进行监测,指定要使用的测试,定义的监视间隔,并说明了进一步干预的触发因素。然后,它评估了支持每个建议的证据。
方法:遵循系统评价和荟萃分析的首选报告项目,我们在PubMed和将研究转化为实践数据库中搜索了国家和国际指南,这些指南是用英语编写的,并在2012年至2023年期间开发或更新.使用AGREEII工具评估各个指南的质量。
结果:在已发布的41个指南中,确定了48种不同的建议:15种(31%)用于前列腺癌,11(23%)为肾癌,6(12.5%)甲状腺癌,10(21%)为血癌。其余6例(12.5%)用于大脑,胃肠,口腔,骨和嗜铬细胞瘤和副神经节瘤癌。当结合所有准则时,48(100%)说明哪些患者有资格接受监测,31(65%)指定使用哪些测试,25(52%)提供了监测间隔的建议,23(48%)概述了启动干预的触发因素。在所有癌症部位,有强烈的积极趋势,更高水平的证据与建议具有特异性的可能性增加相关(P=0.001),间隔的证据基于专家意见或其他指导.
结论:除前列腺癌外,低危癌症监测的证据基础薄弱,因此临床指南中的建议不一致.文献中缺乏支持监测建议的直接证据,使指南开发者依赖于专家意见,替代准则,或间接或非特异性证据。
OBJECTIVE: The aim of this systematic review was to summarize national and international
guidelines that made recommendations for monitoring patients diagnosed with low-risk cancer. It appraised the quality of
guidelines and determined whether the
guidelines adequately identified patients for monitoring, specified which tests to use, defined monitoring intervals, and stated triggers for further intervention. It then assessed the evidence to support each recommendation.
METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses, we searched PubMed and Turning Research into Practice databases for national and international guidelines\' that were written in English and developed or updated between 2012 and 2023. Quality of individual
guidelines was assessed using the AGREE II tool.
RESULTS: Across the 41 published
guidelines, 48 different recommendations were identified: 15 (31%) for prostate cancer, 11 (23%) for renal cancer, 6 (12.5%) for thyroid cancer, and 10 (21%) for blood cancer. The remaining 6 (12.5%) were for brain, gastrointestinal, oral cavity, bone and pheochromocytoma and paraganglioma cancer. When combining all guidelines, 48 (100%) stated which patients qualify for monitoring, 31 (65%) specified which tests to use, 25 (52%) provided recommendations for surveillance intervals, and 23 (48%) outlined triggers to initiate intervention. Across all cancer sites, there was a strong positive trend with higher levels of evidence being associated with an increased likelihood of a recommendation being specific (P = 0.001) and the evidence for intervals was based on expert opinion or other guidance.
CONCLUSIONS: With the exception of prostate cancer, the evidence base for monitoring low-risk cancer is weak and consequently recommendations in clinical guidelines are inconsistent. There is a lack of direct evidence to support monitoring recommendations in the literature making
guideline developers reliant on expert opinion, alternative guidelines, or indirect or nonspecific evidence.