Holmes Jonathan, Herrmann David, Koller Chelsea, Khan Sarah, Umberham Blake, Worley Jody A, Vassar Matt
Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma (Holmes, Herrmann, Koller, Khan, Umberham, Vassar) and the University of Oklahoma, Norman, Oklahoma (Worley).
Proc (Bayl Univ Med Cent). 2017 Apr;30(2):163-166. doi: 10.1080/08998280.2017.11929568.
Systematic reviews synthesize data across multiple studies to answer a research question, and an important component of the review process is to evaluate the heterogeneity of primary studies considered for inclusion. Little is known, however, about the ways that systematic reviewers evaluate heterogeneity, especially in clinical specialties like oncology. We examined a sample of systematic reviews from this body of literature to determine how meta-analysts assessed and reported heterogeneity. A PubMed search of 6 oncology journals was conducted to locate systematic reviews and meta-analyses. Two coders then independently evaluated the manuscripts for 10 different elements based on an abstraction manual. The initial PubMed search yielded 337 systematic reviews from 6 journals. Screening for exclusion criteria (nonsystematic reviews, genetic studies, individual patient data, etc.) found 155 articles that did not meet the definition of a systematic review. This left a final sample of 182 systematic reviews across 4 journals. Of these reviews, 50% (91/182) used varying combinations of heterogeneity tests, and of those, 16% (15/91) of review authors noted excessive heterogeneity and opted to not perform a meta-analysis. Of the studies that measured heterogeneity, 51% (46/91) used a random-effects model, 7% (8/91) used a fixed-effects model, and 43% (39/91) used both. We conclude that use of quantitative and qualitative heterogeneity measurement tools are underused in the 4 oncology journals evaluated. Such assessments should be routinely applied in meta-analyses.
系统评价综合多项研究的数据以回答一个研究问题，而评价过程的一个重要组成部分是评估纳入的原始研究的异质性。然而，对于系统评价者评估异质性的方式知之甚少，尤其是在肿瘤学等临床专业领域。我们检查了该文献中的一部分系统评价样本，以确定荟萃分析者如何评估和报告异质性。在PubMed上搜索了6种肿瘤学期刊以查找系统评价和荟萃分析。然后，两名编码员根据一份摘要手册独立评估了10个不同元素的手稿。最初在PubMed上的搜索从6种期刊中获得了337篇系统评价。筛选排除标准（非系统评价、基因研究、个体患者数据等）后，发现155篇文章不符合系统评价的定义。这留下了来自4种期刊的182篇系统评价的最终样本。在这些评价中，50%（91/182）使用了不同组合的异质性检验，其中，16%（15/91）的评价作者指出异质性过大，选择不进行荟萃分析。在测量异质性的研究中，51%（46/91）使用随机效应模型，7%（8/91）使用固定效应模型，43%（39/91）两者都使用。我们得出结论，在评估的4种肿瘤学期刊中，定量和定性异质性测量工具的使用未得到充分利用。此类评估应在荟萃分析中常规应用。
