Gale R P, Park R E, Dubois R, Bitran J D, Buzdar A, Hortobagyi G, Jones S E, Lazar G S, Spitzer G, Swain S M, Vaughn C B, Vogel C E, Martino S
Salick Health Care, Inc., Los Angeles, CA, USA.
Clin Transplant. 2000 Feb;14(1):32-41. doi: 10.1034/j.1399-0012.2000.140107.x.
There is controversy whether high-dose chemotherapy and a blood cell or bone marrow autotransplant is a better treatment than conventional-dose chemotherapy for women with local/regional or metastatic breast cancer. Subject selection and time-to-treatment biases make definitive comparison impossible. Recent results of randomized trials are contradictory.
Determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow autotransplant in women with breast cancer. PANELISTS: Nine breast cancer experts from diverse geographic sites and practice settings.
Boolean MEDLINE searches of 'breast cancer' and 'chemotherapy' and/or 'blood cell' or 'bone marrow transplants'.
We used a modified Delphi-panel group judgement process. Clinical variables were permuted to define 2058 clinical settings. Each panelist rated appropriateness of high-dose therapy and an autotransplant versus conventional therapy on a 9-point ordinal scale (1: most inappropriate, 9: most appropriate). An appropriateness index was developed based on median rating and amount of disagreement. The relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning.
In women with local/regional breast cancer autotransplants were rated: 1) appropriate in those with > or = 10 cancer-involved lymph nodes; 2) uncertain in those with 4-9 cancer-involved nodes; and 3) inappropriate in women with < or = 3 cancer-involved lymph nodes. In women with metastatic breast cancer autotransplants were rated: 1) appropriate in those with metastases to 'favorable' sites (skin, lymph node, pleura) and a complete or partial response to chemotherapy; 2) uncertain in women with metastases to 'unfavorable' sites (lung, liver, or central nervous system) and a complete response to chemotherapy or those with bone metastases and a complete or partial response or stable disease after chemotherapy; and 3) inappropriate in other settings.
对于局部/区域或转移性乳腺癌女性患者，大剂量化疗联合血细胞或骨髓自体移植是否比传统剂量化疗效果更佳存在争议。受试者选择和治疗时间偏差使得无法进行明确的比较。随机试验的近期结果相互矛盾。
确定大剂量化疗联合血细胞或骨髓自体移植在乳腺癌女性患者中的适用性。
来自不同地理位置和执业环境的9位乳腺癌专家。
通过布尔逻辑在MEDLINE中检索“乳腺癌”以及“化疗”和/或“血细胞”或“骨髓移植”。
我们采用了改良的德尔菲专家小组判断过程。对临床变量进行排列组合以定义2058种临床情况。每位专家小组成员按照9分序数量表（1：最不适用，9：最适用）对大剂量治疗联合自体移植与传统治疗的适用性进行评分。基于中位数评分和分歧程度制定了适用性指数。通过方差分析和递归划分来考虑适用性指数与排列组合后的临床变量之间的关系。
对于局部/区域乳腺癌女性患者，自体移植的适用性评级为：1）在有≥10个癌累及淋巴结的患者中适用；2）在有4 - 9个癌累及淋巴结的患者中不确定；3）在有≤3个癌累及淋巴结的女性患者中不适用。对于转移性乳腺癌女性患者，自体移植的适用性评级为：1）在转移至“有利”部位（皮肤、淋巴结、胸膜）且对化疗有完全或部分缓解的患者中适用；2）在转移至“不利”部位（肺、肝或中枢神经系统）且对化疗有完全缓解的患者中，或在有骨转移且化疗后有完全或部分缓解或病情稳定的患者中不确定；3）在其他情况下不适用。
