Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK; Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France.
Mod Pathol. 2024 Jan;37(1):100357. doi: 10.1016/j.modpat.2023.100357. Epub 2023 Oct 20.
The hierarchy of evidence is a fundamental concept in evidence-based medicine, but existing models can be challenging to apply in laboratory-based health care disciplines, such as pathology, where the types of evidence and contexts are significantly different from interventional medicine. This project aimed to define a comprehensive and complementary framework of new levels of evidence for evaluating research in tumor pathology-introducing a novel Hierarchy of Research Evidence for Tumor Pathology collaboratively designed by pathologists with help from epidemiologists, public health professionals, oncologists, and scientists, specifically tailored for use by pathologists-and to aid in the production of the World Health Organization Classification of Tumors (WCT) evidence gap maps. To achieve this, we adopted a modified Delphi approach, encompassing iterative online surveys, expert oversight, and external peer review, to establish the criteria for evidence in tumor pathology, determine the optimal structure for the new hierarchy, and ascertain the levels of confidence for each type of evidence. Over a span of 4 months and 3 survey rounds, we collected 1104 survey responses, culminating in a 3-day hybrid meeting in 2023, where a new hierarchy was unanimously agreed upon. The hierarchy is organized into 5 research theme groupings closely aligned with the subheadings of the WCT, and it consists of 5 levels of evidence-level P1 representing evidence types that merit the greatest level of confidence and level P5 reflecting the greatest risk of bias. For the first time, an international collaboration of pathology experts, supported by the International Agency for Research on Cancer, has successfully united to establish a standardized approach for evaluating evidence in tumor pathology. We intend to implement this novel Hierarchy of Research Evidence for Tumor Pathology to map the available evidence, thereby enriching and informing the WCT effectively.
证据层级是循证医学的一个基本概念，但现有的模型在基于实验室的医疗保健学科（如病理学）中应用具有挑战性，因为这些学科的证据类型和背景与干预医学有很大的不同。本项目旨在为肿瘤病理学研究评估定义一个全面和互补的新证据层级框架——引入一种新的肿瘤病理学研究证据层级，由病理学家与流行病学家、公共卫生专业人员、肿瘤学家和科学家共同设计，专门为病理学家设计，并帮助生成世界卫生组织肿瘤分类（WCT）证据差距图。为实现这一目标，我们采用了改良 Delphi 方法，包括迭代在线调查、专家监督和外部同行评审，以确定肿瘤病理学证据的标准，确定新层级的最佳结构，并确定每种证据类型的置信度级别。在 4 个月和 3 轮调查的时间跨度内，我们共收集了 1104 份调查回复，最终于 2023 年举行了为期 3 天的混合会议，会上一致同意采用新的层级。该层级组织成 5 个研究主题分组，与 WCT 的副标题紧密对应，共包含 5 个证据级别——P1 级代表最值得高度信任的证据类型，P5 级则反映了最大的偏倚风险。国际癌症研究机构支持的病理专家国际合作首次成功地联合起来，为肿瘤病理学的证据评估建立了一个标准化方法。我们计划实施这种新的肿瘤病理学研究证据层级，以绘制现有的证据图谱，从而有效地丰富和为 WCT 提供信息。
