Chyou Po-Huang
Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI 54449, USA.
Clin Med Res. 2012 Nov;10(4):219-23. doi: 10.3121/cmr.2012.1068. Epub 2012 May 25.
Meta-analysis is a powerful tool to estimate measures of associations or effects based on published or unpublished reports. However, problems exist in many meta-analyses, particularly related to study heterogeneity. This article proposes a way of concluding meta-analysis results using P values, taking heterogeneity into account. There is little published research focused on evaluating conclusiveness of summary results of reported meta-analyses. Generally, a P value is directly linked to the test statistic z=b/s(b) following a standard normal distribution with mean zero and unit variance, where b is an estimator of β and s(b) is the estimated standard error of b for any study included in a meta-analysis. This forms the basis of the proposed method for deriving overall test statistics and corresponding P values used for comparing results of meta-analyses. Two published meta-analyses were chosen and specific software was applied. Results are consistent with the two published meta-analysis reports in terms of P values for significance and direction of summary measure of treatment effect. This proposed method can be utilized to safeguard against improper conclusions of published meta-analyses due to heterogeneity. Exploring more sophisticated statistical methods for situations when the key assumption applied to this proposed method is violated could be pursued and could expand the scope of applications beyond this method.
荟萃分析是一种基于已发表或未发表报告来估计关联度或效应量的强大工具。然而,许多荟萃分析存在问题,特别是与研究异质性有关的问题。本文提出了一种考虑异质性,使用P值来总结荟萃分析结果的方法。目前针对已发表荟萃分析总结结果的结论性评估的公开研究较少。一般来说,P值与遵循均值为零、方差为1的标准正态分布的检验统计量z = b/s(b)直接相关,其中b是β的估计值,s(b)是荟萃分析中任何一项研究中b的估计标准误差。这构成了用于推导总体检验统计量和相应P值以比较荟萃分析结果的所提方法的基础。选择了两项已发表的荟萃分析并应用了特定软件。在治疗效应汇总指标的显著性P值和方向方面,结果与两项已发表的荟萃分析报告一致。所提方法可用于防止因异质性导致已发表荟萃分析得出不当结论。对于该所提方法的关键假设被违反的情况,探索更复杂的统计方法并扩大该方法的应用范围是值得追求的。