Letter to the Editor: Re: “Comparison of Treatment Strategies for Patients With Clinical Stage T1–3/N2 Lung Cancer”

Authors: Junmiao Wen MD1 and Donglai Chen MD2
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  • 1 Fudan University Shanghai Cancer Center, Shanghai, China; and
  • | 2 Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

Re: Cheng YF, Hung WH, Chen HC, et al. Comparison of Treatment Strategies for Patients With Clinical Stage T1–3/N2 Lung Cancer. J Natl Compr Canc Netw 2020;18(2):143–150.

We would like to comment on a recent article by Cheng et al1 titled “Comparison of Treatment Strategies for Patients With Clinical Stage T1–3/N2 Lung Cancer.” In this SEER-based work, the authors included patient diagnosed clinical stage T1–3/N2 lung cancer and compared the survival outcomes between patients receiving different treatment strategies. They found that in cT1–3N2 lung cancer, multimodal treatments tended to provide better 5-year overall survival than surgery alone or concurrent chemoradiotherapy.1 However, the methodology they used in this study needs to be carefully evaluated.

First, in this study, the authors selected patients diagnosed with clinical stage T1–3N2M0 lung cancer between 2010 and 2015 as the training cohort. However, according to the SEER Program,2 the “clinical stage” variable was not provided in the dataset until 2016. Therefore, for patients diagnosed before 2016, it was impossible for researchers to identify the clinical stage. Moreover, given that defining the clinical stage of patients is one of the focuses of this study, how the clinical stages of patients diagnosed between 2010 and 2015 were obtained requires detailed explanation.

Second, the definition of treatment strategies was questioned. In this study, regarding with the treatment groups, the authors classified the patients into 5 subgroups: surgery alone, surgery plus adjuvant chemotherapy with or without radiotherapy, neoadjuvant chemotherapy with or without radiotherapy plus surgery and adjuvant chemotherapy with or without radiotherapy, concurrent chemoradiotherapy, and chemotherapy and others. This seems very comprehensive, but it needs to be questioned in essence. In the SEER database, the sequence of radiotherapy and surgery could be obtained, but the record of the sequence of chemotherapy and the details of chemotherapy regimens was not provided.3 How the authors get the order of chemotherapy and radiotherapy and surgery is worth considering. Our views are derived from our practice in using the SEER database and are consistent with those of other SEER-based studies.46 Moreover, one recent publication reported that the SEER chemotherapy data had relatively low sensitivity. Therefore, the distinction between treatment models in this study is open to question.

In summary, although the research's intentions and results are good, the perspective of selecting patients and classification of the treatment methods needs further explanation.

References

  • 1.

    Cheng YF, Hung W, Chen H, et al. Comparison of treatment strategies for patients with clinical stage T1–3/N2 lung cancer. J Natl Compr Canc Netw 2020;18:143150.

  • 2.

    Ruhl J, Adamo M, Dickie L. (February 2016). SEER Program Coding and Staging Manual 2016: Section V. National Cancer Institute, Bethesda, MD 208509765.

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  • 3.

    National Cancer Institute. Surveillance, Epidemiology, and End Results. Radiation/Chemotherapy Databases (1975–2016). Accessed July 6, 2020. Available at: https://seer.cancer.gov/data/treatment.html

    • Search Google Scholar
    • Export Citation
  • 4.

    Lim YJ, Song C, Kim JS. Improved survival with postoperative radiotherapy in thymic carcinoma: a propensity-matched analysis of Surveillance, Epidemiology, and End Results (SEER) database. Lung Cancer 2017;108:161167.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Sullivan J, Weksler B. Neuroendocrine tumors of the thymus: analysis of factors affecting survival in 254 patients. Ann Thorac Surg 2017;103:935939.

  • 6.

    Noone AM, Lund JL, Mariotto A, et al. Comparison of SEER treatment data with Medicare claims. Med Care 2016;54:e5564.

  • 1.

    Cheng YF, Hung W, Chen H, et al. Comparison of treatment strategies for patients with clinical stage T1–3/N2 lung cancer. J Natl Compr Canc Netw 2020;18:143150.

  • 2.

    Ruhl J, Adamo M, Dickie L. (February 2016). SEER Program Coding and Staging Manual 2016: Section V. National Cancer Institute, Bethesda, MD 208509765.

    • Search Google Scholar
    • Export Citation
  • 3.

    National Cancer Institute. Surveillance, Epidemiology, and End Results. Radiation/Chemotherapy Databases (1975–2016). Accessed July 6, 2020. Available at: https://seer.cancer.gov/data/treatment.html

    • Search Google Scholar
    • Export Citation
  • 4.

    Lim YJ, Song C, Kim JS. Improved survival with postoperative radiotherapy in thymic carcinoma: a propensity-matched analysis of Surveillance, Epidemiology, and End Results (SEER) database. Lung Cancer 2017;108:161167.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Sullivan J, Weksler B. Neuroendocrine tumors of the thymus: analysis of factors affecting survival in 254 patients. Ann Thorac Surg 2017;103:935939.

  • 6.

    Noone AM, Lund JL, Mariotto A, et al. Comparison of SEER treatment data with Medicare claims. Med Care 2016;54:e5564.

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