Cochrane系统评价方法对神经母细胞瘤分子与生物标记物的Meta分析

目的针对神经母细胞瘤已报道的生物标记进行系统评价及Meta分析,评价他们在筛查、诊断、预后以及检测治疗中的临床价值。方法对1990￣2007年的相关文献应用定义明确的检索策略进行文献检索。运用Cochrane系统评价方法,检索Cochrane图书馆临床对照试验资料库(2007年第2期)、PubMed(1990～2007年)、Embase(1990～2007年)和Cancerlit,应用RevMan4.2软件进行统计分析。结果共有536篇研究论文,报道208种不同的肿瘤标记,涉及筛查、诊断、检测及预后等4种临床相关的研究领域。样本量小,统计报告质量差,异质性大以及出版偏倚等是研究报告中存在的主要问题,限制了数据抽出合并等定量分析处理过程。预后研究文献量相对较大,进行Meta分析显示,MYCN、染色体1p、CD44及多药耐药等13种标记是潜在的重要预后判断工具。结论系统评价是神经母细胞瘤肿瘤标记的重要研究方法,可进一步确定一些重要的肿瘤标记,在将来的研究及治疗策略中需引起重视。另外,通过系统评价可以突出显示原始肿瘤标记研究中存在的普遍问题,例如报告的异质性及质量较差。这些问题需要更适当的临床研究提供证据。肿瘤研究...

Full-scale investigation of tumor markers in neuroblastoma using systematic review

Objective The aim of this study was to conduct a systematic review, and if possible meta - analyses, of biological tumor markers described in neuroblastoma and to evaluate their clinical value for the screening, diagnosis, prognosis, and monitoring of patients. Methods A well-defined, reproducible search strategy was used to identify the relevant literatures from 1990 to February 2007 within Cochrane library and the three on-line bibliographic databases Medline, Embase, Cancerlit. Results A total of 536 papers studying the use of 208 different tumor markers in neuroblastoma were identified. Small sample sizes, poor statistical reporting, large heterogeneity across studies, and publication bias limited meta-analysis to conduct but the area of prognosis. There are 13 markers including MYCN, chromosome 1p, and multidrug resistance identified as potentially important prognostic tools. Conclusions This systematic review has identified some general problems in particular poor and heterogeneous reporting across tumor marker studies up to now. The review also highlighted some of the prognostic markers in neuroblastoma, which should be considered in future research and need to conduct better clinical interpretation and enable more appropriate evidence-based reviews in the future. In order to enable bigger sample sizes collaboration of cancer research groups is needed, standardize methods of analysis and reporting is the most important methods and criteria during the collaboration.