Comment on “What is the effect of tumor diameter, lymph node metastases, and maximum standardized uptake value on prognosis in limited-stage small cell lung cancer?”

Dear Editor,

I read with great interest the article entitled “What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer?” by Çimen et al.¹. While the study sheds light on important factors that may affect prognosis in patients with limited-stage small cell lung cancer, I would like to raise some concerns.

First, it is unclear how many patients in the study¹ died versus how many survived. This information is critical in understanding the impact of tumor diameter, lymph node metastases, and the maximum standardized uptake value (SUVmax) value on prognosis. A potential hypothesis is that only 5 patients experienced fatal events while 72 patients survived. This significant disparity in death and survival rates could result in inaccurate conclusions. Therefore, it is necessary to clearly describe how many patients died and how many patients survived. Additionally, it would be helpful to know the duration of follow-up in the study, as this information is crucial for accurately interpreting the study findings and drawing conclusions regarding the prognostic factors in limited-stage small cell lung cancer.

Second, another concern that needs to be addressed is the lack of information on the surgical treatment strategy adopted for the patients. Limited-stage small cell lung cancer² is a highly aggressive malignancy, and the prognosis of patients is heavily influenced by the choice of treatment. Surgery is a key component of the multimodal approach for limited-stage small cell lung cancer and can significantly impact survival rates. According to a study³ conducted on a cohort of 14,179 patients with limited-stage small cell lung cancer, it was found that surgical intervention, particularly the use of lobectomy, was associated with better survival outcomes for a specific subset of patients with limited-stage small cell lung cancer. This study³ suggests that careful patient selection may be key in determining the effectiveness of surgery as a treatment option for limited-stage small cell lung cancer. Therefore, the absence of information on the surgical treatment strategy employed for the patients in this study is a significant limitation that needs to be acknowledged, since this information is crucial for an accurate interpretation of the study results and for drawing appropriate conclusions. Without this critical information, the reliability and generalizability of the study results are likely to be affected.

Third, this study lacks information on the clinicopathological features of the patients. These factors can significantly affect the prognosis of limited-stage small cell lung cancer, and therefore their omission limits the interpretability of the study results. To better understand the clinicopathological features of small cell lung cancer and their impact on prognosis, a previous study⁴ conducted a comprehensive analysis on 247 patients who had undergone surgery. The study revealed that certain features, such as spindle cell type and tumor-infiltrating lymphocytes >30%, were independent prognostic factors in patients with small cell lung cancer. Therefore, it may be helpful to consider exploring the clinicopathological features of the patients in more detail to better understand their impact on prognosis. Therefore, it is necessary and interesting to further explore the relationship between clinicopathological features and the prognosis of NSCLC patients.

• Funding: none.

REFERENCES

• ¹
  Çimen F, Aloglu M, Düzgün S, Şentürk A, Atikcan Ş, Özmen Ö. What is the effect of tumor diameter, lymph node metastases, and SUVmax value on prognosis in limited-stage small cell lung cancer? Rev Assoc Med Bras (1992). 2022;68(9):1252-8. https://doi.org/10.1590/1806-9282.20220325
  » https://doi.org/10.1590/1806-9282.20220325
• ²
  Fu X, Liu Z, Xiang L, Liu M, Zheng X, Wang J, et al. PD-L1 predicts poor prognosis in surgically resected limited stage small-cell lung cancer. Cancer Manag Res. 2020;12:10939-48. https://doi.org/10.2147/CMAR.S260599
  » https://doi.org/10.2147/CMAR.S260599
• ³
  Schreiber D, Rineer J, Weedon J, Vongtama D, Wortham A, Kim A, et al. Survival outcomes with the use of surgery in limited-stage small cell lung cancer: should its role be re-evaluated? Cancer. 2010;116(5):1350-7. https://doi.org/10.1002/cncr.24853
  » https://doi.org/10.1002/cncr.24853
• ⁴
  Liu L, Wei J, Teng F, Zhu Y, Xing P, Zhang J, et al. Clinicopathological features and prognostic analysis of 247 small cell lung cancer with limited-stage after surgery. Hum Pathol. 2021;108:84-92. https://doi.org/10.1016/j.humpath.2020.11.007
  » https://doi.org/10.1016/j.humpath.2020.11.007

Publication Dates

• Publication in this collection
  26 June 2023
• Date of issue
  2023

History

• Received
  17 Jan 2023
• Accepted
  20 Feb 2023