The meta-analysis by Jiang et al1 shows that, whatever the mechanism might be, VPI affects prognosis. This is quantified for various size ranges (T categories). So how do we summarize all of this information in a useful way? Jiang et al1 show that within the cohorts reported, VPI confers a prognosis similar to the next highest size range. At first glance this may seem like a way to illustrate prognosis of particular groups. However, upon thinking a little further things quickly become complex. Many factors affect prognosis besides size and VPI, such as age, comorbidities (eg, limited pulmonary reserve), what treatment was given, the type of institution where the treatment was given, geographic region, socioeconomic status, marital status, genomic characteristics, and many others.6,7 We can compare a few such as size and VPI in patients who are node-negative, but once we start to factor in the myriad of other aspects it becomes impractical. The current approach is to make an educated guess based on a composite of the nuances and our “feel” of their impact, that is, we exercise our “clinical judgment.” But the more information we have the more difficult it becomes to do this.