口腔癌早期筛查方法的系统评价证据

EVIDENCE OF SYSTEMATIC REVIEWS ON THE EARLY DETECTION OF ORAL CANCER

目的评价口腔癌早期诊断的系统评价证据及纳入系统评价的临床随机对照试验(RCT)的方法学质量。方法文献检索Cochrane Library(2010年第4期)和Medline中有关口腔癌早期诊断的系统评价,并对系统评价纳入RCT的方法学质量进行评价。结果共检索到Cochrane系统评价1篇,其他系统评价1篇,Cochrane系统评价对临床观察、甲苯胺蓝染色法、荧光检查及刷拭活检等四种早期筛查方法的效果进行了评价,另一篇系统评价主要是基于社区,对临床观察、荧光检查、刷拭活检、复方碘溶液和神经网络软件等方法的筛查效果进行评价。结论两个系统评价结果均显示目前缺少足够强度的证据来比较各种早期筛查方法的效果。建议推行临床试验透明化,实施临床试验注册制度,按照CONSORT声明严格规范RCT的报告,以便于总结口腔癌早期诊断的临床证据,提高口腔癌早期诊断水平。

Objective：To assess the evidence of systematic reviews on the early detection and prevention of oral cancer as well as the methodological quality of all randomized controlled trials（RCTs） of the included systematic reviews.Methods：Electronic databases（MEDLINE and the Cochrane Library 2010,Issue 4） were searched for systematic reviews on the early detection of oral cancer.The risk of bias was assessed independently by two authors.Results：Two systematic reviews were included.One was the Cochrane systematic review which assessed the effectiveness of visual examination,toluidine blue,fluorescence imaging or brush biopsy in screening for oral cancer or precursor oral lesions,the other systematic review which assessed the effectiveness of community-based oral cancer screening programs including the visual examination and the adjunctive techniques.Conclusion：The overall quality of RCTs about the early detection of oral cancer is generally low.To improve the quality of the reporting of RCTs,clinical trial registration and the revised Consolidated Standards of Reporting Trials（CONSORT） statement should be introduced into the trial design and strictly followed.