“…Surprisingly, chemotherapy was associated with worse mortality for patients younger than 50 years who had pT1a tumors. Reasons for this observation are unclear, although it may be in part because of worse chemotherapy toxic effects outweighing its benefits for pT1a tumors 4 and younger cohorts receiving chemotherapy with more aggressive tumor biology. 5 Pertinent variables, such as performance status, tumor recurrence, and toxicity, were unavailable in the National Cancer Database, resulting in unmeasured confounding despite matching.…”