Although overall measures of goodness of fit or predictive ability are not well-established for survival models, there are alternative Palbociclib
methods to provide some useful comparative information across different comorbidity measures (eg, reporting C statistics using logistic regression models). Even the authors' finding that increasing severity of comorbidity may contribute nonlinearly to an increased risk of death must be interpreted cautiously, as this requires both validation in an independent sample as well as demonstration that the added predictive value of integrating comorbidity information in a nonlinear manner is more useful than simpler linear methods. In addition, there are practical implications for such a tool once validated; it may be far easier for a prostate cancer clinician to establish that someone has coronary artery disease or chronic obstructive pulmonary disease in a busy office setting than to attempt to determine its severity, even with guidelines or instruction manuals. Other limitations of the study, including the retrospective study design and reliance R428
on death certificates for cause of death information, are well-recognized. In conclusion, the authors should be commended for moving the field forward an important step with the use of the case-cohort design and a large, richly described dataset. Although we are some steps away from a predictive tool that can integrate comorbidity into predicting long-term survival, important insights have been provided. The next major steps are to validate the Everolimus
CIRS-Gpros in an independent, more modern, and representative cohort and then to compare it to other measures of comorbidity. The author made no disclosures. ""Margin status is a predictor of outcome for patients with liver malignancies, although what constitutes a negative margin is controversial. Traditionally, the completeness of resection is estimated by surgical histopathology of the resected specimen margin, despite the in situ margin being potentially more important. The true margin is often altered by parenchymal transection techniques. The authors propose that cytologic assessment of the in situ margin is more specific for determining the true margin. A total of 84 patients with primary or metastatic liver tumors who were undergoing surgical resection were enrolled in this prospective Institutional Review Board-approved study. Specimen and in situ (patient) margins were assessed using a ��scrape preparation�� cytologic technique and compared with traditional surgical histopathology. Patients were followed for assessment of local disease recurrence. Follow-up data were complete for 64 patients for a median of 37 months (range, 12 months-56 months). Twenty patients were excluded because of perioperative death (6 patients; 7%) or a follow-up of < 12 months. Seven patients (12.2%) had positive histopathologic specimen margins, but only 1 was found to be positive by cytology (1.8%).