Warner Jeremy, Yang Peter, Alterovitz Gil
Department of Medicine, Division of Hematology & Oncology, Vanderbilt University, Nashville, TN, USA.
Stud Health Technol Inform. 2013;192:62-6.
Cytotoxic treatments for cancer remain highly toxic, expensive, and variably efficacious. Many chemotherapy regimens are never directly compared in randomized clinical trials (RCTs); as a result, the vast majority of guideline recommendations are ultimately derived from human expert opinion. We introduce an automated network meta-analytic approach to this clinical problem, with nodes representing regimens and edges direct comparison via RCT(s). A chemotherapy regimen network is visualized for the primary treatment of chronic myelogenous leukemia (CML). Node and edge color, size, and opacity are all utilized to provide additional information about the quality and strength of the depicted evidence. Historical versions of the network are also created. With this approach, we were able to compactly compare the results of 17 CML regimens involving RCTs of 9700 patients, representing the accumulation of 45 years of evidence. Our results closely parallel the recommendations issued by a professional guidelines organization, the National Comprehensive Cancer Network (NCCN). This approach offers a novel method for interpreting complex clinical data, with potential implications for future objective guideline development.
癌症的细胞毒性治疗仍然具有高毒性、高成本且疗效不一。许多化疗方案从未在随机临床试验（RCT）中进行直接比较；因此，绝大多数指南建议最终都来自专家意见。我们针对这一临床问题引入了一种自动化的网络荟萃分析方法，其中节点代表治疗方案，边代表通过RCT进行的直接比较。我们展示了一个用于慢性粒细胞白血病（CML）初始治疗的化疗方案网络。节点和边的颜色、大小及不透明度均用于提供有关所呈现证据的质量和强度的额外信息。同时还创建了该网络的历史版本。通过这种方法，我们能够紧凑地比较17种CML治疗方案的结果，这些方案涉及9700例患者的RCT，代表了45年证据的积累。我们的结果与专业指南组织国家综合癌症网络（NCCN）发布的建议高度一致。这种方法为解释复杂的临床数据提供了一种新方法，对未来客观指南的制定具有潜在意义。
