The need for core outcome sets in urological cancer research

摘要

Choosing outcomes relevant to patients and healthcare professionals is essential if clinical trial results are to be translated into practice. A frequent frustration encountered in summarising the clinical effectiveness of treatments for urological cancers is heterogeneity in the outcomes reported. This refers to two interrelated problems: inconsistency, where different outcomes are reported across different studies, and variability, where the same outcomes are reported across studies but are defined or measured differently. Outcome inconsistency and variability make comparing, contrasting, synthesising and interpreting the results of different studies on the same topic more complicated than it ought to be. The implications of outcome reporting heterogeneity come into sharp relief in systematic reviews of interventions. For instance, in a cohort of Cochrane systematic reviews, 40% of reviewers noted problems due outcome inconsistency (1). This problem is of particular importance when meta-analysis (the statistical pooling of aggregated data from two or more studies, providing more power and precision) is either not possible, or worse, done inappropriately regardless. Systematic reviews are a cornerstone of the Evidence Based Medicine (EBM) movement and are an essential component in creating clinical practice guideline (CPG) recommendations—which inform patient, clinician and policy decision-making. To arrive at CPG treatment recommendations, urology guideline making bodies such as the European Association of Urology (EAU) rely on published or commissioned systematic reviews, ideally of RCTs, but frequently incorporating various study designs. There are numerous examples of outcome reporting heterogeneity hindering guideline panels from making evidence-based recommendations throughout urology oncology and some examples from prostate and bladder cancer are outlined below.