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How to use Adjuvant! Online:
discussion
Controversies and questions:
Prognostic estimates are absolutely precise? No, and they will never be ...
1. Number of events needed to measure with great precision
estimates.
2. Precision of staging changes with time: sentinel node biopsy; CT scanning and
other staging techniques.
3. Improvements in local therapy: chest wall irradiation post mastectomy node
positive patients may improve survival
cause of drift in the survival statistics for
patients with a given pathological stage.
4. Improvement of salvage therapy
10 year mortality rates will fall even if adjuvant
therapy becomes no more effective.
… but:
•
Numerical estimates are better then using terms like low, moderate, and high risk that are vague.
•
The data is robust enough to give some meaning to the terms low, moderate and high risk.
•
Staging, local therapy, and salvage therapy are changing, but not yet in so revolutionary way that makes
outcome estimates based on cases from the late 1980's and 1990's irrelevant.
19-9-2017