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. 2012 Oct 9;2(5):e001736. doi: 10.1136/bmjopen-2012-001736

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Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions

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A conservative estimate of natural 5-year survivors is set at 5% (15/300 in this depiction) and they are in green. Ranking patients on the Y and X axes from least to most favourable based on fewer metastases and longer interval since diagnosis might have the effect of clustering these natural survivors as shown. If selection for surgery is also based on these factors, it might be the selection rather than the surgery which is associated with a higher than anticipated survival rate shown here as 10/25 or 40%.