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To the Editor.
—There are two questions that come to mind upon reading "Survival in Patients With Lung Cancer" by Senior and Adamson in the June issue (Arch Intern Med125:975-980, 1970).
I seriously question the validity of defining "time zero" as the day on which the tissue diagnosis of cancer was established. Although it is obviously a convenient reference point, I would suggest that by doing so one is minimizing one of the main points made in the study somewhat, namely asymptomatic neoplastic disease of the lung offers a more favorable prognosis than symptomatic disease. Time zero may indeed represent time X plux an indefinite length of time Y, time X being the asymptomatic and unrecognized time of onset of neoplastic lung disease in the patient. I am not aware of any retrospective studies done with respect to the presence of neoplastic lung disease prior to the
Wroblewski R. Survival in Patients With Lung Cancer. Arch Intern Med. 1971;127(2):319. doi:10.1001/archinte.1971.00310140147029
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