We thank Chen et al for their thoughtful comments on our article, “Effects of Postoperative Radiotherapy on Survival of Patients With Stage IIIA Resected Non–Small Cell Lung Cancer: Analysis of the SEER Database.”1 We appreciate their interesting points.
According to the inclusion criteria in our study, we selected patients pathologically diagnosed with stage IIIA non–small cell lung cancer (NSCLC) in 2010 through 2015. According to the NCCN Guidelines, adjuvant chemotherapy is strongly recommended for patients with resected stage IIIA disease, including those with resected stage IIIA-N2 disease who can tolerate chemotherapy.2 It is undeniable that preoperative neoadjuvant chemotherapy is applied to patients with IIIA-N2 disease, but in the real world, the number of people who received neoadjuvant chemotherapy is smaller than the number who received adjuvant chemotherapy for all patients with IIIA NSCLC. However, in light of Chen et al’s comments, use of the word chemotherapy would be more accurate.
At present, there is no clear standard for postoperative radiotherapy (PORT) use in accordance with the total number of harvested nodes. As previously reported,3,4 the number of positive lymph node metastases is an independent prognostic factor for survival and prognosis in NSCLC. Additionally, in our study, the numbers of lymph nodes dissected in a sizable portion of patients with IIIA disease were unknown. Therefore, in order to reduce the selection bias of retrospective study, we did not analyze the impact of PORT on prognosis from dissected nodes. Thus, our study focused on the effect of PORT on the prognosis of patients with different numbers of positive lymph nodes.
It is notable that the SEER database, as an important large-scale retrospective database, collected information from a large number of patients, including chemoradiotherapy and prognosis data, which provides valuable reference for clinical decision-making. However, data on radiotherapy, such as radiation dose, R1/R2 resection, and location and size of positive metastatic lymph nodes, which may affect the application of PORT, are not available. These data from different hospitals can be included and homogenized in future prospective studies. As we mentioned, more prospective studies are needed to verify the value of PORT in stage IIIA NSCLC.
In conclusion, our view is that analyzing the radiotherapy information from patients with stage IIIA NSCLC recorded in the SEER database can provide a useful reference for clinicians. Future studies should integrate records from different databases and include prospective clinical trials to explore the role of PORT in patients with stage IIIA NSCLC. Again, we are grateful for Chen et al's attention and comments. They raise useful suggestions for future research.
Gao F, Li N, Xu Y, Effects of postoperative radiotherapy on survival of patients with stage IIIA resected non–small cell lung cancer: analysis of the SEER database. J Natl Compr Canc Netw 2020;18:718–727.
Fukui T, Mori S, Yokoi K, Significance of the number of positive lymph nodes in resected non-small cell lung cancer. J Thorac Oncol 2006;1:120–125.
Wei S, Asamura H, Kawachi R, Which is the better prognostic factor for resected non-small cell lung cancer: the number of metastatic lymph nodes or the currently used nodal stage classification? J Thorac Oncol 2011;6:310–318.
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)| false , Wei S , Asamura H , Kawachi R Which is the better prognostic factor for resected non-small cell lung cancer: the number of metastatic lymph nodes or the currently used nodal stage classification?J Thorac Oncol 2011; 6: 310– 318. 21206387 10.1097/JTO.0b013e3181ff9b45