Quality assessment of the guidelines for the management of malignant pleural effusions and ascites
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(2020) 18:331
REVIEW
Open Access
Quality assessment of the guidelines for the management of malignant pleural effusions and ascites Jia-Xi Li1, Yan-Mei Shi2†, Li-Ya An1†, Jin-Xu Yang1, Yu-Xing Qi1, Ting Yang1, Yun-Yun Cen1*, Yue-Ying Lin1* and Da-Li Sun1*
Abstract Objectives: To fully assess the quality of the guidelines for the management of malignant pleural effusions (MPE) and ascites and reveal the heterogeneity of recommendations and possible reasons among guidelines. Methods: A systematic search was performed in the database to obtain guidelines for the management of MPE and ascites. The AGREE IIGtool was used to assess the quality of these guidelines. The Measurement Scale of Rate of Agreement (MSRA) was introduced to assess the scientific agreement of formulated recommendations for the management of MPE and ascites among guidelines, and evidence supporting these recommendations was extracted and analyzed. Results: Nine guidelines were identified. Only 4 guidelines scored more than 60% and are worth recommending. Recommendations were also heterogeneous among guidelines for the management of MPE, and the main reasons were the different emphases of the recommendations for the treatment of MPE, the contradictions in recommendations, and the unreasonably cited evidence for MPE. Conclusions: The quality of the management guidelines for patients with MPE and malignant ascites was highly variable. Specific improvement of the factors leading to the heterogeneity of recommendations will be a reasonable and effective way for developers to upgrade the recommendations in the guidelines for MPE. Keywords: Malignant pleural effusion, Malignant ascites, Guideline appraisal
Background Malignant pleural effusion and malignant ascites are common complications of malignant tumors, often indicating that malignant tumors have reached an advanced stage and thus leading to a shorter survival and lower quality of life. Malignant pleural effusion (MPE) refers to pleural effusion caused by the metastasis of malignant * Correspondence: [email protected]; [email protected]; [email protected] † Yan-Mei Shi and Li-Ya An contributed equally to this work. 1 Department of Gastrointestinal Surgery, Second Affiliated Hospital of Kunming Medical University/Second Faculty of Clinical Medicine, Kunming Medical University, Kunming 650101, China Full list of author information is available at the end of the article
tumors from the pleura or other location to the pleura. The median survival is approximately 3 to 12 months. Most commonly, cases of MPE originate from lung cancer (37.5%), followed by breast cancer (16.8%) and lymphoma (11.5%) [1]. Malignant ascites refers to peritoneal effusion caused by primary peritoneal or other malignant tumors that metastasize to the peritoneum. Malignant ascites is most common in ovarian cancer (37%), followed by liver-biliary and pancreatic tumors (21%) and gastric cancer (18%). Excluding ovarian cancer, the median survival is approximately 5.7 months [1]. Patients with malignant pleural effusion an
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