What Are the Levels of Evidence on Which We Base Decisions for Surgical Management of Lower Extremity Bone Tumors?

Evaniew, Nathan; Nuttall, James; Farrokhyar, Forough; Bhandari, Mohit; Ghert, Michelle

doi:10.1007/s11999-013-3311-1

Cited by 24 publications

(22 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is a retrospective study and its findings must be interpreted in consideration of this. As is the challenge for the sarcoma community in general, the level of evidence is low [30] and there are to our knowledge no prospective studies of CS epidemiology. There are also large discrepancies in the quality of retrospective studies.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Chondrosarcoma in Norway 1990–2013; an epidemiological and prognostic observational study of a complete national cohort

et al. 2019

View full text Add to dashboard Cite

Background: Knowledge of chondrosarcoma (CS) of bone to date is based on institutional reports and registry publications with limits in reporting, detail and quality of data. Method: We have performed a retrospective search of CS of bone in the National Cancer Registry in Norway from 1990-2013, cross checked against local tumor databases with further quality control and supplementation of all data from clinical files. The time period is defined by the routine use of axial imaging in clinical practice. A total of 311 cases are included. We performed 108 pathological reviews and 223 radiological reviews. The manuscript was prepared according to the STROBE checklist for strengthening of observational studies. We performed uni-/multivariate cox analyses to define independent prognostic variables from the main cohort of central CS of bone. Results: The incidence of CS of bone in Norway is 2.85/million/yr. for both sexes overall, rising to 3.45/million/yr. in the last 5-year period. There is an increase in the most common central CS subtype, stronger for women than for men. Central CS had, in general 10-15% local recurrence rates, all evident by 5 years while metastasis rate increases with location and grade. Exceptions are extremity grade 1 CS which displayed no metastatic events and axial grade-3 disease with high rates (50%) of both local and metastatic relapse. Peripheral CS had limited metastatic potential (2%), but rates of local relapse (13%) continue to appear towards 10 years of follow up. Malignancy grade 3 independently predicts rate of metastasis and presence of soft tissue component predicts local recurrence, metastasis and survival. Conclusion: Rates of local recurrence, metastasis and disease specific survival follow clear patterns depending on subtype, location and grade allowing better tailoring of follow-up regimes. Malignancy grade 3 and the presence of a soft tissue component independently predict behavior for central CS of bone. ARTICLE HISTORY

show abstract

Section: Discussionmentioning

confidence: 99%

“…Concurrently, there is increasing focus on the low level of evidence used in decision making regarding primary bone tumors [30]. This challenge is being met by consensus guidelines for the strengthening of reporting of observational studies [31].…”

Section: Introductionmentioning

confidence: 99%

Chondrosarcoma in Norway 1990–2013; an epidemiological and prognostic observational study of a complete national cohort

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The OTA was selected as a control group in this study as a result of the trauma community's ability to generate multiple high-quality clinical trials that have had an immediate influence on clinical management and patient outcomes [7,9,25,36,41,44]. Conversely, the inability to produce high-level orthopaedic oncology studies may be stunting progress in clinical care [15]. There are multiple plausible explanations for the dearth of high-level orthopaedic oncology research.…”

Section: Discussionmentioning

confidence: 99%

Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time?

Lerman

Cable

Thornley

et al. 2017

Clinical Orthopaedics &Amp; Related Research

Self Cite

View full text Add to dashboard Cite

Background Level of evidence (LOE) framework is a tool with which to categorize clinical studies based on their likelihood to be influenced by bias. Improvements in LOE have been demonstrated throughout orthopaedics, prompting our evaluation of orthopaedic oncology research LOE to determine if it has changed in kind. Questions/purposes (1) Has the LOE presented at the Musculoskeletal Tumor Society (MSTS) annual meeting improved over time? (2) Over the past decade, how do the MSTS and Orthopaedic Trauma Association (OTA) annual meetings compare regarding LOE overall and for the subset of therapeutic studies? Methods We reviewed abstracts from MSTS and OTA annual meeting podium presentations from 2005 to 2014. Three independent reviewers evaluated a total of 1222 abstracts for study type and LOE; there were 577 abstracts from MSTS and 645 from OTA. Changes in the distributions of study type and LOE over time were evaluated by Pearson chi-square test. Results There was no change over time in MSTS LOE for all study types (p = 0.13) and therapeutic (p = 0.36) study types during the reviewed decade. In contrast, OTA LOE increased over this time for all study types (p \ 0.01). The proportion of Level I therapeutic studies was higher at the OTA than the MSTS (3% [14 of 413] versus 0.5% [two of 387], respectively), whereas the proportion of Level IV studies was lower at the OTA than the MSTS (32% [134 of 413] versus 75% [292 of 387], respectively) during the reviewed decade. The proportion of controlled therapeutic studies (LOE I through III) versus uncontrolled studies (LOE IV) increased over time at OTA (p \ 0.021), but not at MSTS (p = 0.10). Conclusions Uncontrolled case series continue to dominate the MSTS scientific program, limiting progress in

show abstract

“…Within the surgical subspecialty of orthopaedic oncology, there is very little high level evidence to inform clinical decision making -including a lack of international multicenter surgical RCTs [17,18].…”

Section: Introductionmentioning

confidence: 99%

Recruitment patterns in a large international randomized controlled trial of perioperative care in cancer patients

Gazendam

Bozzo

Schneider

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Introduction: The Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) randomized controlled trial (RCT) was the first study to prospectively enroll and randomize orthopaedic oncology patients in multiple centers internationally. The objective of this study was to describe recruitment patterns, examine the differences in enrollment across different PARITY sites, and to identify variables associated with differing levels of recruitment.Methods: Data from this study was obtained from the PARITY trial Methods Center and records of correspondence between the Methods Center and recruiting sites. We performed descriptive statistics to report the recruitment patterns over time. We compared recruitment, time to set up, and time to enroll the first patient between North American and international sites, private and public health care models, and the presence or absence of research personnel. Two-tailed non-paired t-tests were performed to test average monthly recruitment rates between groups. Results: A total of 602 patients from 36 North American and 12 international sites were recruited from 2013 to 2019. Average monthly enrollment increased each year of the study. North American sites were able to start up significantly faster than international sites (19.5 vs. 27.0 months p=0.04). However, international sites had a significantly higher recruitment rate once active (0.2 participants/month vs. 0.59 participants/month, p=0.023). Sites with research personnel were able to reach ‘enrolment ready’ status significantly faster than sites without research personnel (19.3 vs. 30.3 months, p=0.032), but there was no difference in recruitment once active (0.28 participants/month vs. 0.2 participants/month). Publicly funded sites were to recruit significantly more patients compared to private institutions (0.4/month vs. 0.17/month, p=0.03).Conclusions: As a collaborative group, the PARITY investigators increased the pace of recruitment throughout the trial, likely by increasing the number of active sites. The longer time to start-up at international sites may be due to the complex governing regulations of pharmaceutical trials. Nevertheless, international sites should be considered essential as they recruited significantly more patients per month once active. The absence of research support personnel may lead to delays in time to start up. The results of the current study will provide guidance for choosing which sites to recruit for participation in future collaborative clinical trials in orthopaedic oncology and other surgical specialties.

show abstract

What Are the Levels of Evidence on Which We Base Decisions for Surgical Management of Lower Extremity Bone Tumors?

Cited by 24 publications

References 33 publications

Chondrosarcoma in Norway 1990–2013; an epidemiological and prognostic observational study of a complete national cohort

Chondrosarcoma in Norway 1990–2013; an epidemiological and prognostic observational study of a complete national cohort

Has the Level of Evidence of Podium Presentations at the Musculoskeletal Tumor Society Annual Meeting Changed Over Time?

Recruitment patterns in a large international randomized controlled trial of perioperative care in cancer patients

Contact Info

Product

Resources

About