Systematic review of guidelines for management of intermediate hepatocellular carcinoma using the Appraisal of Guidelines Research and Evaluation II instrument

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• 作者：Tom Holvoet^a ; ¹ ; Sarah Raevens^a ; ¹ ; Yves-Paul Vandewynckel^a ; ¹ ; Wim Van Biesen^b ; ^c ; Karen Geboes^a ; Hans Van Vlierberghe^a ; ^{Hans.VanVlierberghe@UGent.be" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Appraisal of Guidelines Research and Evaluation II instrument ; Clinical practice guidelines ; Hepatocellular carcinoma ; Transarterial chemoembolization
• 刊名：Digestive and Liver Disease
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：47
• 期：10
• 页码：877-883
• 全文大小：1230 K

文摘

Hepatocellular carcinoma is the second leading cause of cancer-related mortality worldwide. Multiple guidelines have been developed to assist clinicians in its management. We aimed to explore methodological quality of these guidelines focusing on treatment of intermediate hepatocellular carcinoma by transarterial chemoembolization.

Methods

A systematic search was performed for Clinical Practice Guidelines and Consensus statements for hepatocellular carcinoma management. Guideline quality was appraised using the Appraisal of Guidelines Research and Evaluation II instrument, which rates guideline development processes across 6 domains: ‘Scope and purpose’, ‘Stakeholder involvement’, ‘Rigour of development’, ‘Clarity of presentation’, ‘Applicability’ and ‘Editorial independence’. Thematic analysis of guidelines was performed to map differences in recommendations.

Results

Quality of 21 included guidelines varied widely, but was overall poor with only one guideline passing the 50% mark on all domains. Key recommendations as (contra)indications and technical aspects were inconsistent between guidelines. Aspects on side effects and health economics were mainly neglected.

Conclusions

Methodological quality of guidelines on transarterial chemoembolization in hepatocellular carcinoma management is poor. This results in important discrepancies between guideline recommendations, creating confusion in clinical practice. Incorporation of the Appraisal of Guidelines Research and Evaluation II instrument in guideline development may improve quality of future guidelines by increasing focus on methodological aspects.