Oncology Frontier: Might this difference cause problems for physicians in attempting to manage patients?

　　《肿瘤瞭望》：NCCN指南与ASCO指南的差异会造成医生决策困难吗？

　　Dr Carlson: I don’t think the way the two guidelines are developed impact much on their ability to be used at the point of patient care. The ASCO Guidelines generally use a formal systematic review process where a specific protocol is developed and a panel of experts is appointed to review extensive amounts of literature and data to make determinations based upon a very specific set of questions that are typically fairly limited within a clinical context. Using the ASCO formal systematic review process， if there is not much high-quality data that exists for a patient decision， the ASCO system cannot make a recommendation. Within the NCCN， we utilize high-level evidence in making recommendations when there is high-level evidence available (as does ASCO). However， in those places where there is not high-level evidence， the NCCN process can still make recommendations. In that context， recommendations are based on a consensus of experts for that specific disease. An analysis of our own guidelines has shown that only 6% of the places where choices need to be made within the spectrum of oncology care are based on high-level evidence. If you focus only on those places where there is high-level evidence available， you end up not being very helpful in the vast majority of circumstances that patients find themselves in.

　　Carlson博士：NCCN指南与ASCO指南的制定方法差异不会影响医生决策。ASCO指南的制定有其正规、系统的程序，在制定指南之前，其需要设计方案，任命专家组审查大量文献和数据，基于特定的临床问题推荐治疗决策，如果高质量证据不充分，ASCO指南则不做推荐。而NCCN也根据高水平证据做出推荐（同ASCO），但没有高水平证据时，NCCN指南则基于“专家共识”提出推荐。通过分析NCCN指南发现，只有6%的肿瘤治疗推荐是基于高水平证据，若仅基于高水平证据才做推荐，则在绝大多数情况下该指南没有很大帮助。