Kevin S. Hughes, MD, Burlington, Mass: This is an excellent paper looking at a very important question: how do we better select patients for hepatic resection? The test of time, as Dr Blake Cady has often suggested, works very well and has been shown to work well with no detrimental effects. In the synchronous group, the mean survival resected at once is 28 months but if delayed is 37 months. They have obviously teased out a better group and avoided resection in a group that would otherwise have died from occult disease, thus avoiding resection and identifying a better group for resection. In the metachronous population, though, that has not been the case. The 3- to 6-month test of time that they used has not shown improvement in survival for the metachronous group. I would suggest that may be because this group, the metachronous group, has slower-growing tumors, a longer doubling time, and their test of time may not be long enough. That's supported by their own data. All the patients in the synchronous group have hematogenous spread that's identified at the time of surgery, and the local regional spread is greater in that group: 61% node positive, 39% T3 or T4, and nobody in the T1-T2 range. The metachronous group has occult disease at most hematogenously, and locally, has less nodal disease, less T3, T4, and does have some T1, T2. In the short test of time in the synchronous group, 64% of the patients become unresectable in the synchronous group, but in the metachronous group only 29% become unresectable. These are probably slower-growing tumors selected out by the metachronous population. First, do you have the ability now with your radiologic reviews of both of these groups to actually measure doubling time and have you found a difference in doubling time between the synchronous and the metachronous groups, and, second, in looking at the grade of the tumors and other biologic markers, is there a difference in the grade or the aggressiveness of the tumors in the synchronous group vs the metachronous group.