Dahm Philipp, Kunz Regina, Schünemann Holger
Department of Urology, College of Medicine, University of Florida, Gainesville, Florida 32610-0247, USA.
Curr Opin Urol. 2007 May;17(3):200-7. doi: 10.1097/MOU.0b013e3280eb1121.
Clinical practice guidelines are being increasingly recognized as critically important to an evidence-based practice. This article reviews the different approaches used by leading urological organizations to the development of prostate cancer guidelines. It further introduces the recommendations of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group as a unified approach to guideline development.
Clinical guidelines on the management of prostate cancer demonstrate major methodological differences. Most notably, considerable discrepancies with regards to the systems used to grade the quality of the evidence and the strength of recommendation exist. The GRADE approach classifies the quality of evidence as high, moderate, low or very low, according to factors that include study design and execution, and the consistency of the results. It subsequently classifies recommendations as strong or weak, according to the balance between benefits and downsides and the degree of confidence in estimates of the downsides.
There is an urgent need to standardize processes used to develop clinical guidelines for the management of patients with prostate cancer by leading urological organizations. Adoption of the GRADE approach would offer considerable rewards in terms of efficiency, guideline credibility and optimal clinical decision-making.
临床实践指南对于循证医学实践的重要性日益得到认可。本文回顾了主要泌尿外科组织在制定前列腺癌指南时采用的不同方法。它还介绍了推荐分级、评估、制定与评价（GRADE）工作组的建议，作为指南制定的统一方法。
前列腺癌管理的临床指南显示出主要的方法学差异。最显著的是，在用于对证据质量和推荐强度进行分级的系统方面存在相当大的差异。GRADE方法根据包括研究设计与实施以及结果一致性等因素，将证据质量分为高、中、低或极低。随后，根据利弊平衡以及对不利因素估计的置信度，将推荐分为强或弱。
迫切需要规范主要泌尿外科组织用于制定前列腺癌患者管理临床指南的流程。采用GRADE方法在效率、指南可信度和最佳临床决策方面将带来可观的益处。
