Azienda Ospedaliera di Treviglio-Caravaggio, Piazzale Ospedale 1, 24047, Treviglio, Bergamo, Italy.
IRCCS Casa Sollievo della Sofferenza, Via Cappuccini, 71013 San Giovanni Rotondo, Foggia, Italy.
Lung Cancer. 2015 Nov;90(2):234-42. doi: 10.1016/j.lungcan.2015.08.005. Epub 2015 Aug 19.
Clinical practice guidelines represent a key tool to improve quality and reduce variability of cancer care. In 2004, Italian Association of Medical Oncology (AIOM) launched the RIGHT (research for the identification of the most effective and highly accepted clinical guidelines for cancer treatment) program. The third step, RIGHT-3, evaluated the concordance between AIOM lung cancer guidelines and Italian clinical practice.
RIGHT-3 was a retrospective observational study, conducted in 53 Italian centers treating lung cancer. Sampling from AIOM database of 230 centers was stratified by presence of thoracic surgery and geographic distribution. To describe the adherence to AIOM guidelines (2009 edition), 11 indicators regarding diagnostic and treatment procedures were identified. Patients with non-small-cell lung cancer (NSCLC) diagnosis who had first visit in 2010 were divided into 3 groups, based on TNM stage: I-II-IIIA (5 indicators), IIIB (3 indicators) and IV (3 indicators).
708 patients were enrolled; 680 were eligible: 225 patients in stage I-II-IIIA; 156 patients in stage IIIB; 299 patients in stage IV. Cyto-histological diagnosis was available in 96%, 97%, 96% of stage I-II-IIIA, IIIB, IV respectively. Positron-emission tomography was performed in 64% of stage I-II-IIIA and 46% of stage IIIB. 88% of stage I-II patients eligible for surgery underwent lobectomy; after surgery, 61% of stage II and 57% of stage IIIA patients received adjuvant chemotherapy. Among stage IIIB patients who received combined chemo- radiotherapy, sequential approach was more common than concomitant treatment (86% vs. 14%). Among stage IV patients, 87% received platinum-based first-line treatment, and 70% received second-line.
The RIGHT-3 study showed that, in 2010, adherence to Italian NSCLC guidelines was high for many indicators (including those related to treatment of stage IV patients), but lower for some diagnostic procedures. Guidelines adherence monitoring can be useful to reduce variability in cancer care.
临床实践指南是提高癌症治疗质量和降低变异性的重要工具。2004 年，意大利肿瘤医学协会（AIOM）启动了 RIGHT（研究以确定最有效和最被广泛接受的癌症治疗临床指南）计划。第三步 RIGHT-3 评估了 AIOM 肺癌指南与意大利临床实践之间的一致性。
RIGHT-3 是一项回顾性观察研究，在 53 家治疗肺癌的意大利中心进行。通过 AIOM 数据库的 230 个中心的抽样，根据胸外科和地理分布进行分层。为了描述对 AIOM 指南（2009 年版）的依从性，确定了 11 个关于诊断和治疗程序的指标。2010 年首次就诊的非小细胞肺癌（NSCLC）患者根据 TNM 分期分为三组：I-II-IIIA（5 个指标）、IIIB（3 个指标）和 IV（3 个指标）。
共纳入 708 例患者，其中 680 例符合条件：I-II-IIIA 期 225 例，IIIB 期 156 例，IV 期 299 例。I-II-IIIA、IIIB 和 IV 期的细胞组织学诊断分别为 96%、97%和 96%。正电子发射断层扫描在 I-II-IIIA 期的比例为 64%，在 IIIB 期的比例为 46%。符合手术条件的 I-II 期患者中有 88%接受了肺叶切除术；手术后，2 期和 3A 期患者中有 61%和 57%接受了辅助化疗。在接受联合化疗放疗的 IIIB 期患者中，序贯治疗更为常见（86%比 14%）。在 IV 期患者中，87%接受了基于铂的一线治疗，70%接受了二线治疗。
RIGHT-3 研究表明，2010 年，意大利 NSCLC 指南在许多指标（包括与 IV 期患者治疗相关的指标）上的依从性较高，但在一些诊断程序上的依从性较低。指南依从性监测有助于降低癌症治疗的变异性。
