Article type
Abstract
Background. As with systematic reviews and meta-analyses of interventions, there is a need for guidance on determining certainty of inferences regarding prognostic factors. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach has provided guidance in determining certainty in estimates of association between prognostic factors and future outcomes. Sarcopenia, characterized by loss of muscle mass and strength, has been proposed as a prognostic factor for disease progression and survival in advanced prostate carcinoma (PCa).
Objectives. To present our experience implementing GRADE methodology to determine the certainty of the evidence regarding the impact of sarcopenia on disease progression and mortality in patients with advanced PCa.
Methods. We searched Medline, EMBASE and WOS databases for observational studies. Meta-analyses for overall, cancer-specific, and disease-free survival were performed. The quality of studies was assessed using the Quality In Prognosis Studies (QUIPS) tool. An assessment of inconsistency, indirectness, imprecision, and publication bias was performed. Evidence profile tables were prepared and the overall certainty of evidence was rated from very low to high.
Results. Nine studies (n= 1,659) were included. The available evidence suggests that the presence of sarcopenia in patients with advanced prostate carcinoma significantly reduces disease-free survival and slightly decreases overall survival. The evidence regarding the role of sarcopenia in PCa-specific survival is very uncertain, highlighting the need for further research.
Conclusions. Our single-centre experience highlights the usefulness of applying the GRADE approach when assessing evidence on prognostic factors, particularly in the case of sarcopenia's impact on disease progression and mortality in advanced PCa patients. Despite the inherent challenges associated with assessing inconsistency, indirectness, imprecision, and publication bias in prognostic studies, adherence to GRADE principles provides explicit, transparent, and rigorous standards for evaluating the strength of inferences from bodies of evidence on prognostic factors. This approach enhances the quality and reliability of prognostic assessments, ultimately facilitating informed clinical decision-making and improving patient outcomes.
Objectives. To present our experience implementing GRADE methodology to determine the certainty of the evidence regarding the impact of sarcopenia on disease progression and mortality in patients with advanced PCa.
Methods. We searched Medline, EMBASE and WOS databases for observational studies. Meta-analyses for overall, cancer-specific, and disease-free survival were performed. The quality of studies was assessed using the Quality In Prognosis Studies (QUIPS) tool. An assessment of inconsistency, indirectness, imprecision, and publication bias was performed. Evidence profile tables were prepared and the overall certainty of evidence was rated from very low to high.
Results. Nine studies (n= 1,659) were included. The available evidence suggests that the presence of sarcopenia in patients with advanced prostate carcinoma significantly reduces disease-free survival and slightly decreases overall survival. The evidence regarding the role of sarcopenia in PCa-specific survival is very uncertain, highlighting the need for further research.
Conclusions. Our single-centre experience highlights the usefulness of applying the GRADE approach when assessing evidence on prognostic factors, particularly in the case of sarcopenia's impact on disease progression and mortality in advanced PCa patients. Despite the inherent challenges associated with assessing inconsistency, indirectness, imprecision, and publication bias in prognostic studies, adherence to GRADE principles provides explicit, transparent, and rigorous standards for evaluating the strength of inferences from bodies of evidence on prognostic factors. This approach enhances the quality and reliability of prognostic assessments, ultimately facilitating informed clinical decision-making and improving patient outcomes.