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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