This disagreement is partially caused by different assessment systems.
The reported range of EGFR expression varies between 4-70% and is caused by different assessment methods and study cohorts [ 3].
The variability among the studies is most likely caused by different assessment methods and antibodies, scoring systems, standardization approaches, and different study cohorts.
Underestimation is widespread for all birth modes, 35 partly caused by visual assessment 23, 36 although one study reports overestimation following caesarean section.
There are subjective inter-reader effects and effects caused by changing assessment criteria within the same reader over a period of years due to increasing experience or changing criteria, but not due to the method used.
As in other studies with similar negative results [ 12, 40], we expect that the non-significant result is caused by incorrect assessment of surgical radicality, which in this study was estimated based on surgeons' impression of tumor remaining in the resection area.
Stress and harship caused by benefit assessments perceived to be unfairly punitive also appears regularly in these grim accounts.
Because we were so concerned about a patient's mental health – which worsened as a result of the stress caused by these assessments – we have had to involve a psychiatric crisis team.
As the focus of our study was not in absolute figures but on trends and variations between population groups, the bias caused by self-assessment barely disturbs our main conclusions.
The balance between benefits and overall risk to a patient in a trial and in standard clinical care are usually not much different, as both the clinical outcomes and the additional risks and inconveniences caused by additional assessments are not great.
Ishida R, Okada M. Effects of a firm purpose in life on anxiety and sympathetic nervous activity caused by emotional stress: assessment by psycho‐physiological method.
