Randomized controlled trial (RCT) are considered the "gold standard" for evaluating the causal effects of interventions on outcome measures. However, due to high research costs and ethical constraints, conducting RCT in clinical practice, especially in the surgical field, faces numerous challenges such as difficulties in subject recruitment, implementation of blinding, and standardization of interventions. In such cases, using real-world data to perform causal inference under the framework of target trial emulation (TTE), based on the principles of RCT design, helps to identify and reduce biases arising from design flaws in traditional observational studies, such as immortal time bias, confounding, selection bias, or collider bias. This approach can produce high-quality evidence comparable to that of RCT, thereby enhancing the clinical guidance value of real-world data studies. However, TTE has limitations, such as the inability to completely eliminate confounding, high quality requirements for source data, and the current lack of reporting standards. Therefore, researchers should be fully aware of these limitations to avoid making incorrect causal inferences. This article intends to provide an overview of the TTE framework, implementation points, application scope, application cases, and advantages and disadvantages of the framework.
In the fields of medicine and public health, when randomized controlled trials are impractical, observational studies serve as a key alternative approach. However, the results of observational studies are often susceptible to bias. Target trial emulation (TTE) enhances the reliability and interpretability of results through structured design, rigorous analytical methods, and adjustment for confounding factors. The absence of a unified reporting guideline, however, has somewhat limited the reliability and reproducibility of TTE results. To address this gap, an international collaborative team developed the Transparent Reporting of Observational Studies Emulating a Target Trial (TARGET) reporting guideline, which aims to improve the transparency and methodological rigor of TTE. This study presents a Chinese translation and interpretation of the TARGET reporting guideline, with the goal of promoting its adoption and application in China.