Tsuchiya Kazuaki, Akisue Toshihiro, Ehara Shigeru, Kawai Akira, Kawano Hirotaka, Hiraga Hiroaki, Hosono Ako, Hutani Hiroyuki, Morii Takeshi, Morioka Hideo, Nishida Yoshihiro, Oda Yoshinao, Ogose Akira, Shimose Shoji, Yamaguchi Takehiko, Yamamoto Tetsuji, Yoshida Masahiro
Department of Orthopaedic Surgery, Toho University of Medicine, Japan.
Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Japan.
J Orthop Sci. 2025 Jan;30(1):1-17. doi: 10.1016/j.jos.2023.11.007. Epub 2024 Jul 12.
In Japan, there are currently no general guidelines for the treatment of primary malignant bone tumors. Therefore, the Japanese Orthopaedic Association established a committee to develop guidelines for the appropriate diagnosis and treatment of primary malignant bone tumors for medical professionals in clinical practice.
The guidelines were developed in accordance with "Minds Clinical Practice Guideline Development Handbook 2014″ and "Minds Clinical Practice Guideline Development Manual 2017". The Japanese Orthopaedic Association's Bone and Soft Tissue Tumor Committee established guideline development and systematic review committees, drawing members from orthopedic specialists leading the diagnosis and treatment of bone and soft tissue tumors. Pediatricians, radiologists, and diagnostic pathologists were added to both committees because of the importance of multidisciplinary treatment. Based on the diagnosis and treatment algorithm for primary malignant bone tumors, important decision-making points were selected, and clinical questions (CQ) were determined. The strength of recommendation was rated on two levels and the strength of evidence was rated on four levels. The recommendations published were selected based on agreement by 70% or more of the voters.
The guideline development committee examined the important clinical issues in the clinical algorithm and selected 22 CQs. The systematic review committee reviewed the evidence concerning each CQ and a clinical value judgment was added by experts. Eventually, 25 questions were published and the text of each recommendation was determined.
Since primary malignant bone tumors are rare, there is a dearth of strong evidence based on randomized controlled trials, and recommendations cannot be applied to all the patients. In clinical practice, appropriate treatment of patients with primary malignant bone tumors should be based on the histopathological diagnosis and degree of progression of each case, using these guidelines as a reference.
在日本，目前尚无原发性恶性骨肿瘤的通用治疗指南。因此，日本骨科协会成立了一个委员会，为临床实践中的医学专业人员制定原发性恶性骨肿瘤的恰当诊断和治疗指南。
这些指南是根据“2014年Minds临床实践指南制定手册”和“2017年Minds临床实践指南制定手册”制定的。日本骨科协会的骨与软组织肿瘤委员会设立了指南制定和系统评价委员会，成员来自主导骨与软组织肿瘤诊断和治疗的骨科专家。由于多学科治疗的重要性，两个委员会均增加了儿科医生、放射科医生和诊断病理学家。根据原发性恶性骨肿瘤的诊断和治疗算法，选择重要的决策点，并确定临床问题（CQ）。推荐强度分为两个级别，证据强度分为四个级别。发布的推荐是根据70%或更多投票者的一致意见选定的。
指南制定委员会审查了临床算法中的重要临床问题，选择了22个CQ。系统评价委员会审查了每个CQ的相关证据，并由专家进行临床价值判断。最终，发布了25个问题，并确定了每项推荐的文本。
由于原发性恶性骨肿瘤罕见，缺乏基于随机对照试验的有力证据，且推荐不能适用于所有患者。在临床实践中，原发性恶性骨肿瘤患者的恰当治疗应根据每个病例的组织病理学诊断和进展程度，以这些指南为参考。
