Abstract
We agree with the authors that statistical and practical contextualization of our findings comparing cancer-specific and overall survival of patients undergoing partial nephrectomy, radical nephrectomy, or nonsurgical management (NSM) is essential.1 The limitations of observational data for comparative effectiveness research are important to note and have led to significant efforts to adjust for selection biases and confounders. Cohort studies can provide high-quality pragmatic evidence and greatly influence policy decisions but they will never reproduce the “truth” we strive for in a properly designed randomized control trial.
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