Biometric Research Branch and Cancer Diagnosis Program, National Cancer Institute, Bethesda, MD 20892-7434, USA.
J Clin Oncol. 2012 Dec 1;30(34):4223-32. doi: 10.1200/JCO.2012.42.6858. Epub 2012 Oct 15.
Clinical management decisions for patients with cancer are increasingly being guided by prognostic and predictive markers. Use of these markers should be based on a sufficiently comprehensive body of unbiased evidence to establish that benefits to patients outweigh harms and to justify expenditure of health care dollars. Careful assessments of the clinical utility of markers by using comparative effectiveness research methods are urgently needed to more rigorously summarize and evaluate the evidence, but multiple factors have made such assessments difficult. The literature on tumor markers is plagued by nonpublication bias, selective reporting, and incomplete reporting. Several measures to address these problems are discussed, including development of a tumor marker study registry, greater attention to assay analytic performance and specimen quality, use of more rigorous study designs and analysis plans to establish clinical utility, and adherence to higher standards for reporting tumor marker studies. More complete and transparent reporting by adhering to criteria such as BRISQ [Biospecimen Reporting for Improved Study Quality] criteria for reporting details about specimens and REMARK [Reporting Recommendations for Tumor Marker Prognostic Studies] criteria for reporting a multitude of aspects relating to study design, analysis, and results, is essential for reliable assessment of study quality, detection of potential biases, and proper interpretation of study findings. Adopting these measures will improve the quality of the body of evidence available for comparative effectiveness research and enhance the ability to establish the clinical utility of prognostic and predictive tumor markers.
癌症患者的临床管理决策越来越多地受到预后和预测标志物的指导。这些标志物的使用应该基于充分全面的无偏见证据,以确定对患者的益处大于危害,并证明医疗保健支出是合理的。迫切需要使用比较有效性研究方法来对标志物的临床实用性进行仔细评估,以更严格地总结和评估证据,但有多个因素使得此类评估变得困难。肿瘤标志物的文献存在未发表的偏倚、选择性报告和不完整报告等问题。讨论了几种解决这些问题的措施,包括开发肿瘤标志物研究登记处、更加关注分析性能和标本质量、使用更严格的研究设计和分析计划来确定临床实用性,以及遵守报告肿瘤标志物研究的更高标准。通过遵守报告标本详细信息的 BRISQ(生物样本报告以提高研究质量)标准和报告与研究设计、分析和结果相关的多个方面的 REMARK(肿瘤标志物预后研究报告建议)标准等标准进行更完整和透明的报告,对于可靠评估研究质量、检测潜在偏差以及正确解释研究结果至关重要。采用这些措施将提高比较有效性研究中可用证据的质量,并增强确定预后和预测性肿瘤标志物的临床实用性的能力。