■由免疫检查点抑制剂引起的肺毒性是临床医生的一个突出问题。临床实践指南（CPG）对于管理这些毒性至关重要。
■2022年10月对检查点相关肺毒性（ca-PT）的CPG进行了系统搜索。PubMed,Embase,科克伦图书馆,CINAHL,搜索了WebofScience。AGREEII和AGREE-REX用于评估CPG和建议的质量，分别。描述性统计，组内相关系数，Kruskal-Wallis(H)试验,和Spearman的相关性用于分析。P值<0.05被认为具有统计学意义。矩阵用于确定CPG之间的推荐差异。该研究的设计基于PRISMA2020清单进行系统评价。协议注册号：CRD42022358435。
■八个CPG（两个高质量，三个中等质量，和三个低质量)被确定。所有CPGs承保肺炎。一个CPG覆盖了胸腔积液和肺炎/SARs-CoV-2感染。三个CPG涵盖了结节病样反应。CPGs用于肺纤维化，气道疾病,细支气管炎,弥漫性肺泡损伤,不可用。没有基于前瞻性研究的CPG建议，没有一个被评价为高质量的。此外，建议并非针对组织病理学亚型.同意II的严格发展，“评估指南在收集科学证据方面的方法论方法和策略的领域，与AGREE-REX的“总体质量”肺炎建议密切相关，r=.952；P<.01。在高质量的CPG之间，大约73％的肺炎建议相似。大约16％至74％的低质量CPG与高质量CPG推荐的相似。
■迫切需要针对所有类型的ca-PT及其组织病理学亚型进行前瞻性设计的研究项目。由于现有CPG中缺乏高质量的建议，高质量CPG之间治疗建议的差异，以及高质量和低质量CPG之间存在的建议的相似性，在制定ca-PT治疗策略时,临床医师应全面评估和负责任地评价所有可用的CPG建议.
UNASSIGNED: Pulmonary toxicities caused by immune checkpoint inhibitors are a prominent concern for clinicians. Clinical Practice
Guidelines (CPGs) are critical for managing these toxicities.
UNASSIGNED: A systematic search of CPGs on checkpoint-associated pulmonary toxicities (ca-PT) was conducted in October 2022. PubMed, Embase, Cochrane Library, CINAHL, and Web of Science were searched. AGREE II and AGREE-REX were used to appraise CPGs and recommendations quality, respectively. Descriptive statistics, intraclass correlation coefficient, Kruskal-Wallis (H) test, and Spearman\'s correlation were used for analyses. P-values < .05 were considered statistically significant. Matrices were used to determine recommendation differences between CPGs. The study\'s design was based on the PRISMA 2020 checklist for systematic reviews. Protocol registration number: CRD42022358435.
UNASSIGNED: Eight CPGs (two high-quality, three moderate-quality, and three low-quality) were identified. All CPGs covered pneumonitis. One CPG covered pleural effusions and pneumonitis/SARs-CoV-2-infection. Three CPGs covered sarcoidosis-like-reactions. CPGs for pulmonary fibrosis, airway disease, bronchiolitis, and diffuse alveolar damage, were unavailable. No CPG recommendation was based on a prospective study, and none were appraised as high-quality. Also, recommendations were not specific to histopathologic subtypes. AGREE II\'s \"rigor of development,\" the domain that evaluates a
guideline\'s methodological approach and strategies in gathering scientific evidence, correlated strongly with AGREE-REX\'s \"overall quality\" pneumonitis recommendations, r = .952; P < .01. Approximately 73% of recommendations on pneumonitis were similar between high-quality CPGs. About 16% to 74% of low-quality CPGs were similar to those recommended by high-quality CPGs.
UNASSIGNED: Prospectively designed research projects focusing on all types of ca-PT and their histopathologic subtypes are urgently needed. Due to the lack of high-quality recommendations in available CPGs, the disparities in treatment recommendations between high-quality CPGs, and the similarities in recommendations that exists between high-quality and low-quality CPGs, clinicians should thoroughly assess and responsibly appraise all available CPG recommendations in formulating treatment strategies for ca-PT.
PDF(Pubmed)