Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Guangzhou, Guangdong, People's Republic of China.
Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan, USA.
Oncologist. 2019 Apr;24(4):498-504. doi: 10.1634/theoncologist.2017-0655. Epub 2018 Nov 20.
The National Comprehensive Cancer Network (NCCN) guidelines are among the most widely used guidance in oncology. It is critical to understand the extent to which the recommendations in these guidelines are supported by evidence and to investigate whether these recommendations have been influenced by payments from industry to authors.
We examined the quality and consistency of evidence, as scored by guidelines authors, for systemic treatment incorporated in the NCCN guidelines. Payments data in 2015 were manually abstracted using the Open Payments database, which discloses all payments between the industry and American physicians. Correlations between the percentage of authors who received payments and the proportion of recommendations developed from low-level evidence per guideline were calculated using Spearman rank correlation.
In total, 1,782 recommendations were identified in 29 guidelines, of which 1,282 (71.9%) were based on low-quality or low-consistency evidence (low-level evidence), including "case reports or clinical experience only" (18.9%). A substantial proportion (31/143, 21.7%) of category 1 (the highest level) recommendations were based on low-level evidence. The majority of authors (87.1%) received payments from industry. However, no association was found between the prevalence of payments among authors and the percentage of recommendations developed from low-level evidence per guideline.
The majority of systemic treatment recommendations in the NCCN guidelines are based on low-level evidence, including more than one in five category 1 recommendations. Payments from industry were prevalent among authors. However, industrial payments among authors were not associated with inclusion of regimen/agent for which there is no conclusive evidence in the guidelines.
The authors found that the majority (71.9%) of systemic treatment recommendations issued in the current National Comprehensive Cancer Network guidelines were based on low-level evidence. Physicians should remain cautious when using current guidelines as the sole source guiding patient care decisions.
国家综合癌症网络（NCCN）指南是肿瘤学领域最广泛使用的指南之一。了解这些指南中的建议在多大程度上得到证据的支持，以及调查这些建议是否受到行业向作者支付款项的影响，这一点至关重要。
我们检查了 NCCN 指南中纳入的系统治疗的指南作者评分的证据质量和一致性。使用公开支付数据库手动提取 2015 年的支付数据，该数据库披露了行业与美国医生之间的所有支付。使用 Spearman 等级相关系数计算了作者收到的支付比例与每个指南中基于低水平证据制定的建议比例之间的相关性。
共确定了 29 项指南中的 1782 条建议，其中 1282 条（71.9%）基于低质量或低一致性证据（低水平证据），包括“仅病例报告或临床经验”（18.9%）。相当一部分（31/143，21.7%）的 1 类（最高级别）建议基于低水平证据。大多数作者（87.1%）从行业获得了支付。然而，作者中支付的普遍程度与每个指南中基于低水平证据制定的建议比例之间没有关联。
NCCN 指南中大多数系统治疗建议都是基于低水平证据，包括五分之一以上的 1 类建议。作者中来自行业的支付很普遍。然而，作者中来自行业的支付与指南中纳入没有确凿证据的治疗方案/药物无关。
作者发现，目前国家综合癌症网络指南中发布的大多数（71.9%）系统治疗建议是基于低水平证据。医生在仅将当前指南作为指导患者护理决策的唯一来源时应保持谨慎。
