Arandjelović Ognjen
University of St Andrews, St Andrews, UK.
Biomark Insights. 2023 May 14;18:11772719231174746. doi: 10.1177/11772719231174746. eCollection 2023.
The focus of the present Letter is on the large and seemingly fertile body of work captured under the umbrella of 'patient stratification'.
I identify and explain a fundamental methodological flaw underlying the manner in which the development of an increasingly large number of new stratification strategies is approached.
I show an inherent conflict between the assumptions made, and the very purpose of stratification and its application in practice.
I analyse the methodological underpinnings of stratification as presently done and draw parallels with conceptually similarly flawed precedents which are now widely recognized.
The highlighted flaw is shown to undermine the overarching ultimate goal of improved patient outcomes by undue fixation on an ill-founded proxy.
I issue a call for a re-think of the problem and the processes leading to the adoption of new stratification strategies in the clinic.
本信函的重点是“患者分层”这一范畴下大量且看似丰富的研究成果。
我识别并解释在越来越多新分层策略的开发方式中存在的一个基本方法缺陷。
我展示了所做假设与分层的实际目的及其在实践中的应用之间存在的内在冲突。
我分析了当前分层的方法基础，并将其与现在已被广泛认可的概念上类似的有缺陷先例进行类比。
所强调的缺陷表明，过度关注一个毫无根据的替代指标会破坏改善患者预后这一总体最终目标。
我呼吁重新思考该问题以及导致在临床中采用新分层策略的过程。
