These results indicate that life in the real world has, in fact, gotten better for patients with advanced, incurable NSCLC. One-year and 2-year survivals of 40% and 23% are markedly better than the historical 1-year survival of 10%. The benefit does not seem to be related to better patient selection because it involves a consecutive unselected series of patients, and because there is no difference in patient and disease characteristics between those seen later and earlier in the study (before and after 1997). Although this is a retrospective study, data regarding such prognostic factors were obtained in a prospective standardized fashion. The better outcomes also do not seem to be related to stage migration, as the authors state that there has been no change in staging procedures throughout the course of the study. Specifically, positron emission tomography scanning was not generally used and did not result in a change of stage in these patients when it was used. However, details of staging procedures are not provided, and it remains possible that there were differences that were not apparent, even to the authors. Finally, it is possible that the improvement in outcomes represents a change in the type of patient referred to this center over time. The authors have stated that no change in referral practice in the region has occurred during the course of the study (Waechter, MD; personal communication; August 2004).