Lung Resections for Elderly Patients with Lung Metastases: A Comparative Study of the Postoperative Complications and Overall Survival
Round 1
Reviewer 1 Report
1.There is a certain selection bias in the choice of PM for the elderly, so it may affect your conclusions.
2.Differences in primary cancer types may lead to very different results, so is it possible to stratify each primary cancer type?
3.The format of the table needs to be modified and should be unified into a three-line table.
Author Response
Dear editor and reviewers,
thank you for your comments of our manuscript. We respectively would like to re-submit our original manuscript titled “Lung resections for elderly patients with lung metastases: A comparative study of the postoperative complications and overall survival” as an Original Article to the “Current Oncology".
In the following text we have attempted to answer and address the comments and questions raised by the reviewers.
We hope our manuscript meets the criteria for review and we are looking forward to receiving your decision.
Yours sincerely,
Dr. Mohamed Hassan
Reviewer 1
1.There is a certain selection bias in the choice of PM for the elderly, so it may affect your conclusions.
Reply 1: Thank you for your comment. We agree with you, a selection bias could exist as elderly patients in reduced general condition or with higher number of lung metastases would not be referred to surgery. The strength of this study is due to the large sample of targeted population which offer a chance to understand the outcome of pulmonary metastasectomy in this high-risk population. We add this as a limitation to this study (line: 328).
2.Differences in primary cancer types may lead to very different results, so is it possible to stratify each primary cancer type?
Reply 2: We have the survival of the 4 main primary tumor types in elderly patients further analyzed and the additional information was added in the results and in discussion. (line: 192 and 288). The results should be interpreted with caution due to the relatively small size of the subgroups.
3.The format of the table needs to be modified and should be unified into a three-line table.
Reply 3: Tables were modified as suggested.
Reviewer 2 Report
It's an original article about using lung resection for lung metastases and comparing the postoperative complications and overall survival. The Authors did an excellent job collecting the patients' data over 20 years with many lung resections.
My concerns in this manuscript about the following aspects:
1) The authors didN't compare the overall survival between the different tumor entities. It will be more interesting for the readers to find if there is a significant difference under the other tumors and if the lung metastases will be resected
2) The authors didn't mention whether the overall survival was related only to the operations or whether the patients received chemotherapy or radiotherapy after the operation since most of their patients had colorectal tumors.
Author Response
Dear editor and reviewers,
thank you for your comments of our manuscript. We respectively would like to re-submit our original manuscript titled “Lung resections for elderly patients with lung metastases: A comparative study of the postoperative complications and overall survival” as an Original Article to the “Current Oncology".
In the following text we have attempted to answer and address the comments and questions raised by the reviewers.
We hope our manuscript meets the criteria for review and we are looking forward to receiving your decision.
Yours sincerely,
Dr. Mohamed Hassan
1) The authors didN't compare the overall survival between the different tumor entities. It will be more interesting for the readers to find if there is a significant difference under the other tumors and if the lung metastases will be resected
Reply 1: Tank you for your comment. We have the survival of the main 4 primary tumor types in elderly patients further analyzed and the additional information was added in the results and in discussion. The results should be interpreted with caution due to the relatively small size of the subgroups. (line: 192 and 288).
2) The authors didn't mention whether the overall survival was related only to the operations or whether the patients received chemotherapy or radiotherapy after the operation since most of their patients had colorectal tumors.
Reply 2: Due to the retrospective nature of the study this valuable information about additive chemotherapy was not captured. The local treatment of lung metastases was only in form of surgical resection. We agree with you and future studies should consider effect of additive chemotherapy. We added this to the limitations of the study (line: 334).
Reviewer 3 Report
In this study, the authors shared their personal experiences of pulmonary metastasectomy in patients with pulmonary. The authors divided patients into two groups elderly aged>70 and control/younger aged <70. The author’s observations are:
No difference in postoperative complications between the two groups
COPD is associated with poor outcomes in the elderly group.
My recommendations are:
1: The authors divided patients into two groups i.e elderly > 70 years and non-elderly <70 years of age, but in the abstract in some places, it is called, non-elderly, control group, and other groups, etc, the language for the group should be uniform. “The 5-year survival rate was 67% in the elderly group and 78% months in the other group” this sentence does not make sense.
2: For the original article the abstract should be structured.
3: In the introduction, the authors said “selected patients” please elaborate. The background information in the introduction does not provide enough information. I would recommend expanding the introduction.
4: Line 39 “variety of primary tumors” it’s better to explain the tumor types.
5: Explain inclusion and exclusion criteria based on your observation of “selected patients”.
6: Line 45. Here you called patients are divided into elderly and younger. Use uniform language.
7: Line 82, GOLD IV COPD patients were excluded from the study, it should be described in the method section of inclusion and exclusion criteria. Why do you exclude GOLD IV patients? Add a reference if there is a guideline.
8: Line 103, Cardiac comorbidities were more common in the elderly group but the author did not provide information if there were cases related to chemotherapy-induced cardiac comorbidities.
9: The authors did not provide information on chemotherapy for primary tumors as well as postoperative chemotherapy and radiotherapy. The chemotherapy regimens and cycles can be added to table 2.
10: In discussion, the results of the study are repeated in every single paragraph. Expand the results of your study in the first paragraph of the discussion. The rest of the discussion should be based on the literature review of PM. Also, I would recommend adding a paragraph on future personalized therapy approaches based on genomic profiling because it’s a common practice now.
Author Response
Dear editor and reviewers,
thank you for your comments of our manuscript. We respectively would like to re-submit our original manuscript titled “Lung resections for elderly patients with lung metastases: A comparative study of the postoperative complications and overall survival” as an Original Article to the “Current Oncology".
In the following text we have attempted to answer and address the comments and questions raised by the reviewers.
We hope our manuscript meets the criteria for review and we are looking forward to receiving your decision.
Yours sincerely,
Dr. Mohamed Hassan
1: The authors divided patients into two groups i.e elderly > 70 years and non-elderly <70 years of age, but in the abstract in some places, it is called, non-elderly, control group, and other groups, etc, the language for the group should be uniform. “The 5-year survival rate was 67% in the elderly group and 78% months in the other group” this sentence does not make sense.
Reply 1: Thanks for your comment. We modified our text as suggested. Through the text the term non-elderly is used. The sentence was corrected. “The 5-year survival rate was 67% in the elderly group and 78% in the non-elderly group”
2: For the original article the abstract should be structured.
Reply 2: the abstract was structured as suggested.
3: In the introduction, the authors said “selected patients” please elaborate. The background information in the introduction does not provide enough information. I would recommend expanding the introduction.
Reply 3: Modifications in the introduction section were done. Additional information was added as suggested. Criteria of patient selection for pulmonary metastasectomy were added. (line 31-33 and line 53-57)
4: Line 39 “variety of primary tumors” it’s better to explain the tumor types.
Reply 4: The tumor types are explained as suggested (line 48 and table 2).
5: Explain inclusion and exclusion criteria based on your observation of “selected patients”.
Reply 5: inclusion and exclusion criteria were explained (line 53-57).
6: Line 45. Here you called patients are divided into elderly and younger. Use uniform language.
Reply 6: we modified our text as suggested
7: Line 82, GOLD IV COPD patients were excluded from the study, it should be described in the method section of inclusion and exclusion criteria. Why do you exclude GOLD IV patients? Add a reference if there is a guideline.
Reply 7: Patients with end stage COPD in GOLD stage IV have FEV < 30%. These patients have advanced lung damage and a reduced general condition. According to our internal guidelines, we exclude these patients from pulmonary metastasectomy. Unfortunately, there is no universal guidelines available. We included GOLD IV COPD as exclusion criteria in our study.
8: Line 103, Cardiac comorbidities were more common in the elderly group but the author did not provide information if there were cases related to chemotherapy-induced cardiac comorbidities.
Reply 8: Unfortunately, because our data are based on an institutional data bank, information concerning chemotherapy is lacking. For this reason, cases with chemotherapy-induced cardiac comorbidities could not be identified. We added this consideration to the discussion (line: 237).
9: The authors did not provide information on chemotherapy for primary tumors as well as postoperative chemotherapy and radiotherapy. The chemotherapy regimens and cycles can be added to table 2.
Reply 9: Due to the retrospective nature of the study this valuable information about chemotherapy was not captured. We agree with you and future studies should consider effect of additive chemotherapy. We added this to the limitations of the study (line: 334).
10: In discussion, the results of the study are repeated in every single paragraph. Expand the results of your study in the first paragraph of the discussion. The rest of the discussion should be based on the literature review of PM. Also, I would recommend adding a paragraph on future personalized therapy approaches based on genomic profiling because it’s a common practice now.
Reply 10: Concerning unnecessary text in the discussion, this was removed, and a short mention was made in the first paragraph as suggested. Thanks for your recommendation. Concerning the personalized therapy approaches based on genomic profiling, we added a small paragraph (line: 320-325)
Round 2
Reviewer 2 Report
the authors correct their manuscript and take the recommendations of the reviewers in their manuscript
Reviewer 3 Report
Thank you for working on our comments. The manuscript is significantly improved. I have no further edits.
