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北京大学学报（医学版） ›› 2019, Vol. 51 ›› Issue (3): 548-555. doi: 10.19723/j.issn.1671-167X.2019.03.026

• 论著 • 上一篇    下一篇

全球结直肠癌筛查指南的质量评价

高乐1,于树青1,杨继春1,马峻岭2,詹思延1,3,孙凤1△()   

  1. 1. 北京大学公共卫生学院流行病与卫生统计学系,北京 100191
    2. 北京大学肿瘤医院暨北京市肿瘤防治研究所流行病学研究室,北京 100142
    3. 北京大学循证医学中心,北京 100191
  • 收稿日期:2019-03-18 出版日期:2019-06-18 发布日期:2019-06-26
  • 作者简介:孙凤,北京大学公共卫生学院流行病与卫生统计学系副教授,北京大学循证医学中心秘书,北京大学医学部药品上市后安全性评价中心副教授,2012年在北京大学药学院完成临床药学和药物流行病学方面的博士后研究,2016—2017年在国家留学基金委员会的支持下,以访问学者的身份访问哈佛大学。主要研究方向为药物流行病学与循证医学,特别是使用新方法进行疗效比较研究。
    主持国家自然科学青年基金1项、面上项目1项、北大种子基金1项、兵团博士基金1项、部委委托课题4项、校级课题5项,参与过药物流行病学、循证医学、慢性病流行病学等领域的10余项纵向科研课题,2013年获得亚太药物流行病学协会“学术之星”称号,以第一作者或通信作者发表SCI文章17篇、中文文章30余篇,主编书籍1部。现任中国医师协会循证医学专业委员会副主任委员、常务委员、青年委员会常务副主任委员,中国药学会药物流行病学专业委员会委员、青年委员会副主任委员,全国高等学校循证医学教材编写委员会常务委员(兼任学术秘书),并担任《中国循证医学杂志》《药物流行病学杂志》《中国循证心血管医学杂志》等杂志编委。
    研究方向有流行病学传统方法及其衍生方法在药品上市后安全有效性评价中的应用,主要涉及不良反应信号识别、信号检测和证据整合等方法学领域,多处理比较meta分析在药物安全性与有效性领域的探索与应用等。目前的在研项目有国家自然科学基金项目——构建中国肿瘤筛查的循证评价方法学体系及运用,利用基于医院或区域数据库的大数据在药物流行病学领域进行模型开发和评估等。
  • 基金资助:
    国家自然科学基金(71673003)

Quality assessment of global guidelines on colorectal cancer screening

Le GAO1,Shu-qing YU1,Ji-chun YANG1,Jun-ling MA2,Si-yan ZHAN1,3,Feng SUN1△()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Department of Cancer Epidemiology, Peking University Cancer Hospital & Institute, Beijing 100142, China;
    3. Center of Evidence-based Medicine and Clinical Research, Peking University, Beijing 100191, China
  • Received:2019-03-18 Online:2019-06-18 Published:2019-06-26
  • Supported by:
    Supported by the National Natural Science Foundation of China(71673003)

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摘要： 目的 对全球范围内现有结直肠癌筛查指南进行系统梳理和质量评价。方法 采用系统综述的方法,对CNKI、万方、VIP、SinoMed、PubMed、Embase、Web of Science等中、英文数据库进行系统检索,检索时间截至2018年6月20日,同时检索了指南制订机构网站和主要搜索引擎,检索时间为2018年8月3日。对所有文献采用双人独立筛选、信息提取,由4名经培训的评价者使用AGREE Ⅱ(Appraisal of Guidelines for Research & Evaluation)工具对纳入指南进行质量评价。结果 共纳入符合标准的结直肠癌筛查指南46部,发布年代为1994—2018年,来自10个国家,5个地区。AGREE Ⅱ工具的评价结果显示,各指南质量在领域1(范围及目的)与领域4(表述清晰性)方面较高,在领域2(参与人员)方面中等,在领域3(过程严谨性)、领域5(适用性)和领域6(独立性)差异较大,循证指南(基于WHO指南制定标准进行定义)的质量总体优于一般指南。我国大陆现有结直肠癌筛查指南5部,均非循证指南,质量总体较低。结论 全球范围内结直肠癌筛查指南总体呈现数量多、质量较低的现状,中国大陆现有指南均不是循证指南,因此需要根据我国国情,建立高质量的结直肠筛查指南,为公共卫生实践提供可行的指导。

关键词: 结直肠癌, 筛查, 指南, 系统综述, AGREE Ⅱ

Abstract: Objective: To systematically review and assess the quality of guidelines on colorectal cancer screening worldwide to provide guidance for the development of high-quality colorectal cancer screening guidelines in mainland China.Methods: CNKI, WanFang Data, VIP, SinoMed, PubMed, Embase, and Web of Science were systematically searched to identify guidelines on colorectal cancer screening from inception to Jun. 20 th, 2018, and so were some websites and major search engines about the deve-lopment of the guidelines from the existing literature (search date: Aug. 3 rd, 2018). Two experienced reviewers independently examined these abstracts and then extracted information, and the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) were used to evaluate the methodological quality of these guidelines by four well trained reviewers. Results: In this study, 46 guidelines published from 1994 to 2018 were finally included in our analysis from 10 countries and 5 regions, among which 5 were from mainland China. The quality of these guidelines was relatively high in domain 1 (scope and purpose) and domain 4 (clarity of presentation), and medium in domain 2 (stakeholder involvement). While in the other three domains (domain 3: rigour of development; domain 5: applicability; domain 6: editorial independence), the results were quite different among these guidelines. The quality of evidence-based guidelines (defined by the criteria based on World Health Organization guideline development handbook) was generally higher than that of the common guidelines. Existing guidelines from mainland China were not evidence-based guidelines, which were of low quality.Conclusion: The colorectal cancer screening guidelines all over the world are generally large in number, low in quality, different in statements, and so are the guidelines in China. There are no evidence-based guidelines in mainland China, which cannot provide effective guidance for colorectal cancer screening, so we need to pay more attention to the establishment of guidelines with high quality and high credibility for colorectal cancer screening as well as for cancer screening based on the national condition, in order to provide reasonable guidance for practice in public health and improve the health conditions in our society.

Key words: Colorectal cancer, Screening, Guideline, Systematic review, AGREE Ⅱ

中图分类号: 

  • R181.2

图1

文献纳入、排除流程图"

表1

纳入研究的基本信息"

No. Name of guideline Publishing organization Country/
region		 Year Update Evidence-based
guideline
1 Cascade colorectal cancer screening guidelines a global conceptual model World Gastroenterology Organization (WGO) Global 2011 NO

表2

结直肠癌筛查指南质量评价结果"

No. Domain scores/% Overall quality Recommendation ICC
1 2 3 4 5 6 Yes Yes, with modifications No
1 61 25 16 71 14 73 3.00 0 1 3 0.95
2 56 44 2 57 1 0 2.25 0 0 4 0.96
3 75 68 58 85 21 71 4.75 3 1 0 0.97
4 83 74 65 89 58 73 5.50 4 0 0 0.95
5 61 24 7 76 11 0 2.75 0 0 4 0.97
6 69 50 18 56 21 0 2.75 0 1 3 0.95
7 72 36 38 75 5 29 3.75 0 3 1 0.94
8 65 63 60 75 34 29 4.50 1 3 0 0.92
9 61 24 22 82 0 17 2.75 0 1 3 0.96
10 76 75 46 85 38 79 4.75 2 2 0 0.95
11 71 67 58 83 11 73 4.50 2 2 0 0.93
12 78 51 32 82 29 29 3.75 0 3 1 0.95
13 79 69 79 88 46 94 5.50 3 1 0 0.91
14 72 25 14 76 19 0 3.00 0 1 3 0.98
15 72 44 20 76 33 75 3.50 0 3 1 0.97
16 76 65 23 82 20 77 3.75 0 4 0 0.94
17 74 65 24 82 32 29 3.75 0 3 1 0.97
18 57 32 40 78 22 0 3.25 0 3 1 0.95
19 64 29 19 72 16 0 3.00 0 1 3 0.93
20 57 40 2 17 1 21 2.25 0 0 4 0.97
21 67 49 16 74 30 0 3.00 0 1 3 0.96
22 65 21 13 75 13 0 2.75 0 1 3 0.97
23 56 13 2 42 1 0 2.00 0 0 4 0.97
24 54 24 6 61 7 0 2.25 0 0 4 0.96
25 57 33 7 76 8 19 2.50 0 0 4 0.97
26 68 19 18 69 0 33 2.75 0 0 4 0.96
27 40 3 3 26 2 0 1.75 0 0 4 0.96
28 67 39 12 61 27 27 3.25 0 2 2 0.96
29 56 6 11 65 11 0 2.25 0 0 4 0.96
30 67 38 16 74 24 8 3.00 0 2 2 0.95
31 68 36 10 64 1 0 2.75 0 1 3 0.97
32 58 53 52 60 20 71 4.25 0 4 0 0.93
33 64 44 1 33 1 0 2.25 0 0 4 0.97
34 71 63 51 76 32 44 4.25 1 3 0 0.87
35 76 74 76 86 45 65 5.00 3 1 0 0.87
36 68 51 56 61 33 85 4.50 1 3 0 0.91
37 40 19 20 58 13 31 2.50 0 0 4 0.97
38 74 63 59 78 18 60 4.50 1 3 0 0.95
30 Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups (update from 2002) British Society of Gastroenterology (BSG), Association of Coloproctology for Great Britain and Ireland (ACPGBI) UK 2010 2002 UNa, b
31 Suggested screening guidelines for familial colorectal cancer UK Cancer Family Study Group UK 1995 NO
32 S3 guidelines for colorectal carcinoma: results of an evidence-based consensus conference on February 6/7, 2004 and June 8/9, 2007 (for the topics Ⅳ, Ⅵ and Ⅶ) German Society for Digestive and Metabolic Diseases (DGVS), German Cancer Society (DKG) Germany 2010 UNa
33 Colorectal cancer screening for men and women aged 60 to 69 Cancer Society of Finland Finland 2018 NO
34 SIGN 126·Diagnosis and management of colorectal cancer Scottish Intercollegiate Guidelines Network (SIGN) Scotland 2016 YES
35 Clinical practice guidelines for the prevention, early detection and management of colorectal cancer National Health and Medical Research Council (NHMRC) Australia 2016 YES
36 An updated Asia Pacific Consensus recommendations on colorectal cancer screening Asia Pacific Working Group Asia 2015 2008 YES
37 Cancer prevention in Asia: resource-stratified guidelines from the Asian Oncology Summit 2013 Fifth Asian Oncology Summit Asia 2013 NO
38 Korean guidelines for colorectal cancer screening and polyp detection Korean Multi-Society Take Force Korea 2012 YES
39 Clinical practice guidelines: management of colorectal carcinoma Malaysia Health Technology Assessment Section (MaHTAS) Malaysia 2017 UNc
40 National guidelines for colorectal cancer screening in Saudi
Arabia with strength of recommendations and quality of
evidence		 Saudi Society of Colon & Rectal Surge-ry, etc. Saudi 2015 YES
41 中国结直肠肿瘤早诊筛查策略专家共识 中国抗癌协会大肠癌专业委员会 China 2018 NO
42 中国临床肿瘤学会:结直肠癌诊疗指南2017版 中国临床肿瘤学会 China 2017 NO
43 中国早期结直肠癌及癌前病变筛查与诊治共识 中华医学会多协作组 China 2015 NO
44 中国早期结直肠癌筛查及内镜诊治指南 中华医学会消化内镜学分会联合中国抗癌协会肿瘤内镜学专业委员会 China 2015 NO
45 中国大肠肿瘤筛查、早诊早治和综合预防共识意见 中华医学会消化病学分会 China 2011 NO
46 Recommendations on prevention and screening for colorectal cancer in Hong Kong Cancer Expert Working Group on Can-cer Prevention and Screening (CEWC) Hong
Kong		 2018 NO
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