Abstract
distant metastasectomy and that this approach should be undertaken whenever feasible. Strong points of the study are its size and the conscientious follow-up of the patients. However, the study lacks the scientific soundness of a randomized design; this study thus may have had a selection bias. The authors attempt to control for this hazard by comparing surgical and nonsurgical cohorts, based on M stage, number of distant metastases, number of metastatic sites, and short or long disease-free interval. This approach confirmed the better survival for the surgery-containing regimen, especially for the stage M1a cohort and for the cohort of patients with one metastatic lesion. Power to confirm the survival benefit of the surgery-containing regimens can also be derived from the multivariate analysis, which revealed treatment modality and M stage as
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