Abstract

He appropriately raises some of the limitations of meta-analyses in gen-eral that we thoroughly address in the discussion, including their retrospective nature, and the possibility of heterogeneity in results, data availability bias, and publication bias.We concur that compared with the gold standard of randomized controlled trials, the results of meta-analysis need to beweighed critically. This is whywe performed careful scrutiny of articles with multiple sensitivity analyses to mini-mize the risk of these various biases influencing our results; while the inherent limitations of meta-analysis remain, we believe that the ro-bustness of our findings to multiple sensitivity analyses supports our overall conclusions. Unless large controlled trials are conducted to address these difficult questions, careful pooling of the available data will need to provide the best available answers. Our report is presently themost thoroughexistingdataanalysisonhighgradeT1 tumors, and