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In Reply: Mr Maisonneuve and Dr Lowenfels call attention to the possibility that histological misclassification could, at least in part, account for the long-term survival observed in a considerable proportion of patients in our study. Actuarial 5-year survival was 22.5% in the group receiving adjuvant treatment with gemcitabine compared with 11.5% in the observation group. According to the original pathology reports, only 11 patients (4 in the gemcitabine group and 7 in the observation group) had tumors with histology other than adenocarcinoma, suggesting that the probability of a significant bias in favor of the adjuvant group was low. This assumption was confirmed by a modified analysis of our survival data that excluded all nonadenocarcinoma patients; this resulted in only minor changes in the qualified overall survival curves in either group (log-rank P = .01 compared with P = .02 in the original analysis). However, I agree about the potential problem of misclassification, . . . [Full Text of this Article]

Helmut Oettle, MD, PhD
helmut.oettle@charite.de
Department of Medical Oncology and Hematology
Charité School of Medicine
Campus Virchow-Klinikum
Berlin, Germany

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