Objectives To assess the quality of the currently available clinical practice
Objectives To assess the quality of the currently available clinical practice guidelines (CPGs) for hepatocellular carcinoma, and provide a reference for clinicians in selecting the best available clinical protocols. Bax inhibitor peptide V5 were: scope and purpose 83% (95% confidence interval (CI), 81% to 86%), clarity of presentation 79% (95% CI, 73% to 86%), stakeholder involvement 39% (95% CI, 30% to 49%), editorial independence 58% (95% CI, 52% to 64%), rigor of development 39% (95% CI, 31% to 46%), and applicability 16% (95% CI, 10% to 23%). Evidence-based guidelines were superior to Bax inhibitor peptide V5 those established by consensus for the domains of rigor of development (p<0.001), clarity of presentation (p?=?0.01) and applicability (p?=?0.021). Conclusions The overall methodological quality of CPGs for hepatocellular carcinoma and metastatic liver cancer is usually moderate, with poor applicability and potential discord of interest issues. The evidence-based guidelines has become mainstream for high quality CPGs development; however, there is still need to further increase the transparency and quality of evidence rating, as well as the recommendation process, and to address potential discord of interest. Introduction Hepatocellular carcinoma (HCC) is the seventh most common malignancy worldwide , and the third most common cause of death from malignancy with an overall mortality-to-incidence ratio of 0.93. Most of the burden is in developing countries, where almost 85% of cases occur , . The annual cost of HCC in the United States is usually $454.9 million, with an average cost per patient of $32,907. Healthcare costs and lost productivity account for 89.2% and 10.8% of the total, respectively . A survey showed that the cost for patients with HCC is usually approximately 6 to 8 8 fold higher than for those without this malignancy, with the imply per-patient-per-month (PPPM) cost of $7,863 for cases and $1,243 for controls . It is estimated that the number of disability-adjusted life years (DALYs) lost and medical costs due to HCC will gradually increase as the incidence of HCC rises in more youthful people. The Institute of Medicine (IOM) has established the definition of clinical practice guidelines (CPGs) as systematically developed statements to assist practitioner and individual decisions about appropriate health care for specific clinical circumstances . This will provide doctors with detailed and authoritative recommendations and alter their customary or outdated clinical methods, which will improve healthcare consistency, promote health support equity and reduce healthcare costs for the government . Currently, although the quantity and quality of CPGs have been improved, the differences among guidelines formulated by numerous institutes or experts still differ widely. Therefore, a demanding evaluation of the quality of CPGs is usually urgently needed. Appraisal of Guidelines for Research & Evaluation (AGREE II) is recognized as a preferred tool for the quality appraisal of guidelines , . This can provide a methodological strategy for the development of guidelines, and inform authors on the type of information and the manner in which the information should be reported in the guidelines, thereby ultimately improving the level of healthcare . Schmidt et al  evaluated the quality of 32 guidelines on the diagnosis and treatment of HCC in 2011. They concluded that most guidelines lacked appropriate methodological quality. However, all guidelines they included were published before 2010 and were assessed using the original four-point scale of the AGREE instrument published in 2003, which is not in compliance with current methodological requirements of health measurement design. In particular, this noncompliance might threaten the overall performance and reliability of the instrument . The aim of the present study is usually to systematically assess the quality of current available CPGs for HCC or metastatic liver malignancy using the AGREE II instrument, and provide a reference for clinicians in selecting the best clinical protocols. Materials and Methods Inclusion criteria The available guidelines on the treatment of main or metastatic RCBTB1 liver cancer published in English or Chinese were included. Exclusion criteria a) HCC guidelines for diagnosis (i.e., ultrasound, enhanced Bax inhibitor peptide V5 computerized tomography (CT)); b) The Chinese version or other versions of oversea CPGs; c) Quality improvement guidelines, position statements or guideline summaries; d) National Institute for Health and Excellence interventional process guidance (Good IPG) or overview; e) Conference abstracts, overviews, main studies, systematic reviews or letters. Guideline sources and search strategy The electronic databases of PubMed, MEDLINE, Web of Science, Chinese Biomedical Literature database (CBM), China National Knowledge Infrastructure (CNKI), and WanFang were systematically.