Department of Urology, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China.
Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, No. 169, Donghu Road, Wuchang District, Wuhan, 430071, China.
BMC Cancer. 2019 Nov 6;19(1):1054. doi: 10.1186/s12885-019-6304-y.
Bladder cancer (BC) has become a major worldwide public health issue, especially non-muscle-invasive bladder cancer (NMIBC). A flood of related clinical practice guidelines (CPGs) have emerged; however, the quality and recommendations of the guidelines are controversial. We aimed to appraise the quality of the CPGs for NMIBC within the past 5 years and compare the similarities and differences between recommendations for therapies.
A systematic search to identify CPGs for NMIBC was performed using electronic databases (including PubMed, Embase, Web of Science), guideline development organizations, and professional societies from January 12, 2014 to January 12, 2019. The Appraisal of Guidelines Research & Evaluation (AGREE) II instrument was used to evaluate the quality of the guidelines. Intraclass correlation coefficient (ICC) analysis was performed to assess the overall agreement among reviewers.
Nine CPGs were included. The overall agreement among reviewers was excellent. The interquartile range (IQR) of scores for each domain were as follows: scope and purpose 69.44% (35.42, 85.42%); stakeholder involvement 41.67% (30.56, 75.00%); rigour of development 48.96% (27.08, 65.63%); clarity and presentation 80.56% (75.00, 86.11%); applicability 34.38% (22.92, 40.63%) and editorial independence 70.83% (35.42, 85.42%). The NICE, AUA, EAU and CRHA/CPAM clinical practice guidelines consistently scored well in most domains. It was generally accepted that the transurethral resection of bladder tumour (TURBT) and intravesical chemotherapy should be performed in the management of bladder cancer. The application of chemotherapy was highly controversial in high risk NMIBC. The courses of BCG maintenance were similar and included 3 years of therapy at full maintenance doses.
The quality of NMIBC guidelines within the past 5 years varied, especially regarding stakeholders, rigour and applicability. Despite many similarities, the recommendations had some inconsistencies in the details.
膀胱癌（BC）已成为一个重大的全球公共卫生问题，尤其是非肌肉浸润性膀胱癌（NMIBC）。大量相关的临床实践指南（CPGs）已经出现；然而，指南的质量和建议存在争议。我们旨在评估过去 5 年内 NMIBC 的 CPG 质量，并比较治疗建议的相似之处和差异。
系统检索了 2014 年 1 月 12 日至 2019 年 1 月 12 日电子数据库（包括 PubMed、Embase、Web of Science）、指南制定组织和专业协会中用于 NMIBC 的 CPG，使用 Appraisal of Guidelines Research & Evaluation（AGREE） II 工具评估指南的质量。采用组内相关系数（ICC）分析评估评审员之间的总体一致性。
纳入了 9 项 CPG。评审员之间的总体一致性非常好。每个领域的四分位间距（IQR）评分如下：范围和目的 69.44%（35.42，85.42%）；利益相关者参与 41.67%（30.56，75.00%）；制定的严谨性 48.96%（27.08，65.63%）；清晰度和呈现 80.56%（75.00，86.11%）；适用性 34.38%（22.92，40.63%）和编辑独立性 70.83%（35.42，85.42%）。NICE、AUA、EAU 和 CRHA/CPAM 临床实践指南在大多数领域的得分都很好。普遍认为，经尿道膀胱肿瘤切除术（TURBT）和膀胱内化疗应在膀胱癌的治疗中进行。在高危 NMIBC 中，化疗的应用存在很大争议。BCG 维持治疗的疗程相似，包括 3 年的全维持剂量治疗。
过去 5 年内 NMIBC 指南的质量存在差异，特别是在利益相关者、严谨性和适用性方面。尽管有许多相似之处，但在细节上的建议存在一些不一致。
