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July 1992

Will Rogers Phenomenon

Author Affiliations

Louisville, Ky

Arch Surg. 1992;127(7):868. doi:10.1001/archsurg.1992.01420070136027

To the Editor.—I write to raise the flag of a "Will Rogers Phenomenon"1 in the article by Heller et al.2 Any time a supersensitive test not in prior use is introduced that changes the designated stage of a cancerous lesion, a staging shift has occurred. Removing severe cases from a lower stage makes it appear as though, on average, the remaining patients with this lower stage of cancer live longer. By moving the early bad cases to the group with higher-stage cancer, the patients representing the early bad cases also appear to live longer because the remaining patients with higher-stage cancer have more favorable prognoses. Survival data on cases with and without positive cell cultures for melanoma cells should be studied as to the prognostic significance of the cell culture results treated as an independent variable. This would allow the quantification of the relevance of the new