肌肉骨骼肿瘤学会年会 podium 展示的证据水平随时间有变化吗？
Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time?
作者信息
Lerman Daniel M, Cable Matthew G, Thornley Patrick, Evaniew Nathan, Slobogean Gerard P, Bhandari Mohit, Healey John H, Randall R Lor, Ghert Michelle
机构信息
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA.
Sarcoma Services, Primary Children's Hospital & Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
出版信息
Clin Orthop Relat Res. 2017 Mar;475(3):853-860. doi: 10.1007/s11999-016-4763-x.
BACKGROUND
Level of evidence (LOE) framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias. Improvements in LOE have been demonstrated throughout orthopaedics, prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind.
QUESTIONS/PURPOSES: (1) Has the LOE presented at the Musculoskeletal Tumor Society (MSTS) annual meeting improved over time? (2) Over the past decade, how do the MSTS and Orthopaedic Trauma Association (OTA) annual meetings compare regarding LOE overall and for the subset of therapeutic studies?
METHODS
We reviewed abstracts from MSTS and OTA annual meeting podium presentations from 2005 to 2014. Three independent reviewers evaluated a total of 1222 abstracts for study type and LOE; there were 577 abstracts from MSTS and 645 from OTA. Changes in the distributions of study type and LOE over time were evaluated by Pearson chi-square test.
RESULTS
There was no change over time in MSTS LOE for all study types (p = 0.13) and therapeutic (p = 0.36) study types during the reviewed decade. In contrast, OTA LOE increased over this time for all study types (p < 0.01). The proportion of Level I therapeutic studies was higher at the OTA than the MSTS (3% [14 of 413] versus 0.5% [two of 387], respectively), whereas the proportion of Level IV studies was lower at the OTA than the MSTS (32% [134 of 413] versus 75% [292 of 387], respectively) during the reviewed decade. The proportion of controlled therapeutic studies (LOE I through III) versus uncontrolled studies (LOE IV) increased over time at OTA (p < 0.021), but not at MSTS (p = 0.10).
CONCLUSIONS
Uncontrolled case series continue to dominate the MSTS scientific program, limiting progress in evidence-based clinical care. Techniques used by the OTA to improve LOE may be emulated by the MSTS. These techniques focus on broad participation in multicenter collaborations that are designed in a comprehensive manner and answer a pragmatic clinical question.
背景
证据水平（LOE）框架是一种根据临床研究受偏倚影响的可能性对其进行分类的工具。在整个骨科领域，证据水平已有改进，促使我们对骨肿瘤学研究的证据水平进行评估，以确定其在类别上是否发生了变化。
问题/目的：（1）在肌肉骨骼肿瘤学会（MSTS）年会上展示的证据水平是否随时间有所提高？（2）在过去十年中，肌肉骨骼肿瘤学会和骨科创伤协会（OTA）年会在总体证据水平以及治疗性研究子集方面如何比较？
方法
我们回顾了2005年至2014年肌肉骨骼肿瘤学会和骨科创伤协会年会讲台展示的摘要。三位独立评审员共评估了1222篇摘要的研究类型和证据水平；其中肌肉骨骼肿瘤学会有577篇摘要，骨科创伤协会有645篇摘要。通过Pearson卡方检验评估研究类型和证据水平分布随时间的变化。
结果
在回顾的十年中，肌肉骨骼肿瘤学会所有研究类型（p = 0.13）和治疗性（p = 0.36）研究类型的证据水平均未随时间变化。相比之下，在此期间骨科创伤协会所有研究类型的证据水平有所提高（p < 0.01）。在回顾的十年中，骨科创伤协会I级治疗性研究的比例高于肌肉骨骼肿瘤学会（分别为3%[413篇中的14篇]和0.5%[387篇中的2篇]），而骨科创伤协会IV级研究的比例低于肌肉骨骼肿瘤学会（分别为32%[413篇中的134篇]和75%[387篇中的292篇]）。骨科创伤协会对照治疗性研究（证据水平I至III）与非对照研究（证据水平IV）的比例随时间增加（p < 0.021），而肌肉骨骼肿瘤学会则没有（p = 0.10）。
结论
非对照病例系列在肌肉骨骼肿瘤学会科学项目中仍占主导地位，限制了循证临床护理的进展。肌肉骨骼肿瘤学会可以效仿骨科创伤协会用于提高证据水平的技术。这些技术侧重于广泛参与全面设计并回答实用临床问题的多中心合作。
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