國內外肺癌臨床指南循證評價_《中國循證醫學雜志》

作者：

 劉麗華 ¹ , 馮丹 ¹ , 張黎黎 ² , 龍莉艷 ¹ , 楊帆 ¹ , 徐文煥 ¹ , 張桂云 ¹ , 周丹 ¹ , 李幼平 ³

1. 解放軍總醫院循證醫學中心（北京 100853）；2. 中國醫學科學院醫學信息研究所（北京 100020）；3. 四川大學華西醫院中國循證醫學中心（成都 610041）;

關鍵詞：

肺癌臨床指南循證評價

DOI：

10.7507/1672-2531.20080215

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目的　了解國內外肺癌臨床指南的發布現狀，為我國的研究工作提供借鑒。
方法　檢索PubMed 等6個數據庫（截至2008 年6 月）和相關網站有關肺癌臨床指南的所有中英文文獻，按既定的納入與排除標準，篩選文獻、納入國內外公開發布的國內外肺癌臨床指南，而后采用自擬的方法對其數量分布、內容質量進行評價。
結果　 ① 共檢出相關文獻208篇，其中符合納入和排除標準的133篇，后者按原創與更新分類分別是78篇和55篇；按是否提供研究方法分類，分別是86篇和47篇。② 現有指南主要由美國（39.85%）、加拿大（24.81%）和法國（8.27%）等14個國家和地區發布，最早的指南1984年由美國發布。③ 腫瘤/胸科等專業機構發布指南數125篇，未指明或非專業協會發布指南8篇。④ 133篇指南關注的臨床問題包括綜合類（24篇）、多項類（21篇）和專項類（88篇）三方面內容。⑤ 質量評價結果：總體平均分72.09分，1996 年最高（83.50 分），1997最低（66.80分）；法國平均分最高（79.80分），日本最低（48.00分）；非小細胞肺癌、肺癌、小細胞肺癌、支氣管肺癌指南平均分分別是73.54、65.74、74.72、76.00分。
結論　 ① 指南發布數量呈上升趨勢，主要集中在發達國家。② 綜合指南關注的臨床問題日趨廣泛，包括了從預防到臨終關懷20 個方面的條目。③ 指南的制定或更新有不斷打破國家地區界限的趨勢，在分型分期研究上也呈現不斷細化的趨勢。④ 循證方法已經逐漸成為各國研究制定臨床指南的趨勢，但目前尚未查詢到應用衛生技術評估方法的指南。⑤ 我國僅發布了兩部原創指南，研究方法分別是綜述和專家意見。⑥ 受文獻語言和獲取全文內容及缺乏權威性、特異性評價技術方案的限制，本研究評價結果僅供參考。

引用本文： 劉麗華,馮丹,張黎黎,龍莉艷,楊帆,徐文煥,張桂云,周丹,李幼平. 國內外肺癌臨床指南循證評價. 中國循證醫學雜志, 2008, 08(11): 959-971. doi: 10.7507/1672-2531.20080215 復制

1.	王吉耀. 從循證醫學觀點評估和應用臨床指南. 中華消化雜志, 2004, 24(7): 385-386.
2.	Field MJ, Lohor KN. Clinical Practice Guidelines: Directions for a New Program. Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine.National Academy Press Washington D. C.1990.
3.	龐麗麗, 馮莉, 趙娜, 等. 肝移植缺血再灌注對肝內膽管上皮細胞損傷機制的研究現狀. 中國循證醫學雜志, 2008, 8(6): 443-455.
4.	陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
5.	陳君超, 劉建平, 吳文婷. 指南研究與評價的評審工具. 循證醫學, 2007, 7(5): 291-294.
6.	Schu?nemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 1. Guidelines for guidelines. Health Res Policy Syst, 2006, 4: 13.
7.	中國肺癌臨床指南. 中國抗癌協會肺癌專業委員會. 2003.
8.	2005中國肺癌臨床指引. 中國抗癌協會肺癌專業委員會. 2005.
9.	2007中國肺癌臨床指南. 中國抗癌協會肺癌專業委員會. 2007.
10.	NCCN非小細胞肺癌臨床實踐指南(中國版). NCCN非小細胞肺癌臨床實踐指南(中國版專家組). 2006.
11.	NCCN非小細胞肺癌臨床實踐指南(中國版). NCCN非小細胞肺癌臨床實踐指南(中國版專家組). 2007.
12.	American College of Chest Physicians. Chemotherapeutic management of stage IV non-small cell lung cancer. 2003.
13.	American College of Chest Physicians. Treatment of stage I nonsmall cell lung carcinoma. 2003.
14.	American College of Chest Physicians. Treatment of stage II nonsmall cell lung cancer. 2003.
15.	Provincial Lung Cancer Disease Site Group. Unresected stage III non-small-cell lung cancer. 1997.
16.	Provincial Lung Cancer Disease Site Group. Use of preoperative chemotherapy with or without postoperative radiotherapy in technically resectable stage IIIA non-small-cell lung cancer. 1998.
17.	American College of Chest Physicians .Treatment of stage IIIA nonsmall cell lung cancer. 2003.
18.	American College of Chest Physicians. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
19.	American College of Chest Physicians. Guidelines on treatment of stage IIIB non-small cell lung cancer. 2003.
20.	American College of Chest Physicians.Treatment of non-small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
21.	Provincial Lung Cancer Disease Site Group. Provincial Systemic Treatment Disease Site Group. The use of gemcitabine in non-smallcell lung cancer. 1999.
22.	Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. Management of unresected stage III non-small cell lung cancer: a clinical practice guideline. 1997.
23.	American Society of Clinical Oncology. Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. 1997.
24.	Provincial Lung Cancer Disease Site Group. Adjuvant radiotherapy and chemotherapy for stage II or IIIA non-small-cell lung cancer after complete resection. 1997.
25.	Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. Postoperative radiotherapy in stage II or IIIA completely resected non-small cell lung cancer: a systematic review and practice guideline. 2004.
26.	Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. Postoperative adjuvant radiation therapy in stage II or IIIA completely resected non-small cell lung cancer. 1997.
27.	Provincial Lung Disease Site Group. Chemotherapy in stage IV (metastatic) non-small-cell lung cancer. 1997.
28.	American College of Chest Physicians.Treatment of non-small cell lung cancer, stage IV: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
29.	American College of Chest Physicians. Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
30.	American College of Radiology - Medical Specialty Society.Induction and adjuvant therapy for N2 non-small-cell lung cancer. 1999.
31.	Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care. Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a systematic review and practice guideline. 2006.
32.	Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. European t rends in preoperat ive and intraoperative nodal staging: ESTS guidelines. 2007.
33.	Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. The role of taxanes in first-line therapy of advanced non-small cell lung cancer. 2004.
34.	Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care. Taxanes as first-line therapy for advanced non-small cell lung cancer: a systematic review and practice guideline. 2005.
35.	Noble J. Second- line or susbeqent systemic therapy for recurrent or progressive non - small cell lung cancer: A systematic review and practice guideline. Journal of Thoracic Oncology, 2006, 1(9): 1042-1058.
36.	劉曉晴. 肺癌患者的希望——分子靶向治療. 中國健康月刊, 2007, (2): 32-33.
37.	楊德昌. 世界上每隔30秒就有一人死于肺癌肺癌90%與吸煙有關. 醫藥與保健, 2004, 9.
38.	林深. 戒煙與美國肺癌發病率的變遷. 人口與計劃生育, 1993, 1.
39.	THE GLOBAL BURDEN OF DISEASE. http://www.who.int/topics/ global_burden_of_disease/en.
40.	董碧蓉, 岳冀蓉, 徐英. 制定循證指南的原則. 中國循證醫學雜志, 2006, 6(2): 80-83.
41.	鄧可剛. 國外制定循證臨床實踐指南的進展. 中國循證醫學雜志, 2005, 5(4): 335-339.

1. 王吉耀. 從循證醫學觀點評估和應用臨床指南. 中華消化雜志, 2004, 24(7): 385-386.
2. Field MJ, Lohor KN. Clinical Practice Guidelines: Directions for a New Program. Committee to Advise the Public Health Service on Clinical Practice Guidelines, Institute of Medicine.National Academy Press Washington D. C.1990.
3. 龐麗麗, 馮莉, 趙娜, 等. 肝移植缺血再灌注對肝內膽管上皮細胞損傷機制的研究現狀. 中國循證醫學雜志, 2008, 8(6): 443-455.
4. 陳耀龍, 李幼平, 杜亮, 等. 醫學研究中證據分級和推薦強度的演進. 中國循證醫學雜志, 2008, 8(2): 127-133.
5. 陳君超, 劉建平, 吳文婷. 指南研究與評價的評審工具. 循證醫學, 2007, 7(5): 291-294.
6. Schu?nemann HJ, Fretheim A, Oxman AD. Improving the use of research evidence in guideline development: 1. Guidelines for guidelines. Health Res Policy Syst, 2006, 4: 13.
7. 中國肺癌臨床指南. 中國抗癌協會肺癌專業委員會. 2003.
8. 2005中國肺癌臨床指引. 中國抗癌協會肺癌專業委員會. 2005.
9. 2007中國肺癌臨床指南. 中國抗癌協會肺癌專業委員會. 2007.
10. NCCN非小細胞肺癌臨床實踐指南(中國版). NCCN非小細胞肺癌臨床實踐指南(中國版專家組). 2006.
11. NCCN非小細胞肺癌臨床實踐指南(中國版). NCCN非小細胞肺癌臨床實踐指南(中國版專家組). 2007.
12. American College of Chest Physicians. Chemotherapeutic management of stage IV non-small cell lung cancer. 2003.
13. American College of Chest Physicians. Treatment of stage I nonsmall cell lung carcinoma. 2003.
14. American College of Chest Physicians. Treatment of stage II nonsmall cell lung cancer. 2003.
15. Provincial Lung Cancer Disease Site Group. Unresected stage III non-small-cell lung cancer. 1997.
16. Provincial Lung Cancer Disease Site Group. Use of preoperative chemotherapy with or without postoperative radiotherapy in technically resectable stage IIIA non-small-cell lung cancer. 1998.
17. American College of Chest Physicians .Treatment of stage IIIA nonsmall cell lung cancer. 2003.
18. American College of Chest Physicians. Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
19. American College of Chest Physicians. Guidelines on treatment of stage IIIB non-small cell lung cancer. 2003.
20. American College of Chest Physicians.Treatment of non-small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
21. Provincial Lung Cancer Disease Site Group. Provincial Systemic Treatment Disease Site Group. The use of gemcitabine in non-smallcell lung cancer. 1999.
22. Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. Management of unresected stage III non-small cell lung cancer: a clinical practice guideline. 1997.
23. American Society of Clinical Oncology. Clinical practice guidelines for the treatment of unresectable non-small-cell lung cancer. 1997.
24. Provincial Lung Cancer Disease Site Group. Adjuvant radiotherapy and chemotherapy for stage II or IIIA non-small-cell lung cancer after complete resection. 1997.
25. Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-Based Care. Postoperative radiotherapy in stage II or IIIA completely resected non-small cell lung cancer: a systematic review and practice guideline. 2004.
26. Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. Postoperative adjuvant radiation therapy in stage II or IIIA completely resected non-small cell lung cancer. 1997.
27. Provincial Lung Disease Site Group. Chemotherapy in stage IV (metastatic) non-small-cell lung cancer. 1997.
28. American College of Chest Physicians.Treatment of non-small cell lung cancer, stage IV: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
29. American College of Chest Physicians. Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). 2007.
30. American College of Radiology - Medical Specialty Society.Induction and adjuvant therapy for N2 non-small-cell lung cancer. 1999.
31. Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care. Second-line or subsequent systemic therapy for recurrent or progressive non-small cell lung cancer: a systematic review and practice guideline. 2006.
32. Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium. European t rends in preoperat ive and intraoperative nodal staging: ESTS guidelines. 2007.
33. Program in Evidence-based Care - State/Local Government Agency [Non-U.S.]. The role of taxanes in first-line therapy of advanced non-small cell lung cancer. 2004.
34. Lung Cancer Disease Site Group of Cancer Care Ontario’s Program in Evidence-based Care. Taxanes as first-line therapy for advanced non-small cell lung cancer: a systematic review and practice guideline. 2005.
35. Noble J. Second- line or susbeqent systemic therapy for recurrent or progressive non - small cell lung cancer: A systematic review and practice guideline. Journal of Thoracic Oncology, 2006, 1(9): 1042-1058.
36. 劉曉晴. 肺癌患者的希望——分子靶向治療. 中國健康月刊, 2007, (2): 32-33.
37. 楊德昌. 世界上每隔30秒就有一人死于肺癌肺癌90%與吸煙有關. 醫藥與保健, 2004, 9.
38. 林深. 戒煙與美國肺癌發病率的變遷. 人口與計劃生育, 1993, 1.
39. THE GLOBAL BURDEN OF DISEASE. http://www.who.int/topics/ global_burden_of_disease/en.
40. 董碧蓉, 岳冀蓉, 徐英. 制定循證指南的原則. 中國循證醫學雜志, 2006, 6(2): 80-83.
41. 鄧可剛. 國外制定循證臨床實踐指南的進展. 中國循證醫學雜志, 2005, 5(4): 335-339.

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國內外肺癌臨床指南循證評價

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《中國循證醫學雜志》

國內外肺癌臨床指南循證評價

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