Spaeth Dominique, Casadevall Nicole, Daouphars Mikaël, Marchal Christian, Marec-Berard Perrine, Fabre Nicolas, Haugh Margaret
Oncologue médical, Centre Alexis Vautrin, Nancy.
Bull Cancer. 2004 Feb;91(2):179-88.
The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery.
To update the Standards, Options and Recommendations clinical practice guidelines for the use of recombinant erythropoietin (epoietin alpha and beta darbepoietin-alpha, EPO) in the management of anaemia in oncology. To define, on the basis of the critical appraisal of the best available evidence and expert agreement, the clinical situations in which the administration of rHuEPO is indicated, and those in which it is not indicated, except in the setting of randomised controlled trial.
The working group identified the questions requiring up-dating from the previous guideline. Medline and Embase were searched using specific search strategies from January 1999 to October 2002. Literature monitoring was performed to identify randomised clinical trials published between October 2002 to November 2003. In addition several Internet sites were searched in October 2002.
A total of 36 new references, corresponding to 30 randomised clinical trials, were identified. The role of rHuEPO is certain when the haemoglobin concentration is below 10 g/dL, but remains uncertain when the concentration is between 10 g/dL and 12 g/dL. When the haemoglobin concentration is between 12 g/dL and 14 g/dL there is no justification to use rHuEPO to prevent anaemia, except in the setting of autologous blood transfusion programmes before major surgery. No anti-anaemic treatment is justified if the haemoglobin concentration is higher than 14 g/dL, except in the setting of a randomised clinical trial.
“标准、选项与建议”（SOR）项目始于1993年，是法国癌症中心联合会（FNCLCC）、20家法国癌症中心以及法国公立大学、综合医院和私立诊所的专家之间的合作项目。主要目标是制定临床实践指南，以提高医疗保健质量和癌症患者的治疗效果。该方法基于多学科专家小组的文献综述和批判性评估，并结合癌症护理专家的反馈意见。
更新关于重组促红细胞生成素（促红细胞生成素α、β和达贝泊汀-α，EPO）在肿瘤学贫血管理中应用的标准、选项与建议临床实践指南。基于对现有最佳证据的批判性评估和专家共识，确定使用重组人促红细胞生成素（rHuEPO）的临床情况以及不适用的情况，但随机对照试验除外。
工作组从先前的指南中确定需要更新的问题。使用特定检索策略在1999年1月至2002年10月期间检索了Medline和Embase数据库。进行文献监测以识别2002年10月至2003年11月期间发表的随机临床试验。此外，2002年10月还检索了几个互联网网站。
共识别出36篇新参考文献，对应30项随机临床试验。当血红蛋白浓度低于10 g/dL时，rHuEPO的作用是确定的，但当浓度在10 g/dL和12 g/dL之间时，其作用仍不确定。当血红蛋白浓度在12 g/dL和14 g/dL之间时，除了在大手术前的自体输血计划中，没有理由使用rHuEPO预防贫血。如果血红蛋白浓度高于14 g/dL，除了在随机临床试验中，没有抗贫血治疗的合理性。
