Impact of Persistent N2 Disease and Lymph Node Ratio on Oncological Outcomes after Multimodal Treatment in Pre-Operative Histologically Proven N2 Disease Non-Small-Cell Lung Cancer

Review Data

Q: Is the topic relevant to the journal area of interest? Is it contemporary and interesting for

researchers?

A: Very good

Abstract & Keywords

Q: Are all required components included in the abstract? Are the keywords appropriately chosen?

A: Very good

Goal

Q: Is the goal explicitly stated in the Introduction? Is its formulation clear and unambiguous?

A: Good

Structure

Q: Is the paper's structure coherent? Is it in coherence with the goal of the paper?

A: Good

Comments:

The subheading "Conclusion" must be introduced after "Discussion".

Tools and Methods

Q: Are methods the author uses adequate and well used?

A: Very good

Discussion & Conclusion

Q: Is it related to the results presented before? Do you consider them as coherent?

A: Very good

Comments:

The Discussion explains the challenges in treating the patients in the present study clearly. It also offers useful suggestions with respect to the treatment regimen. The results are well supported with figures and tables. The study concludes that ypN2 (persistent N2 disease) patients had acceptable prognosis after neoadjuvant chemotherapy and surgery and this finding is particularly true for patients with low burden of nodal disease assessed by the lymph node ratio. Future studies are required to verify the prognostic role of LNR and to assess the right cut-off of this potentially useful tool to address patients to tailored adjuvant treatment.

Literature

Q: Does the author utilize relevant literature?

A: Good

Author's knowledge

Q: What is the level of the author’s knowledge? Does the author utilize all recent contributions relevant to the topic?

A: Very good

Length

Q: Is the length of the paper adequate to the significance of the topic? Do you suggest shortening the paper without losing its value?

A: Good

Figures & Tables

Q: Does the author use them suitably? Are legend and notations clear?

A: Very good

Writing style

Q: Is it clear and understandable?

A: Very good

Further comments on the paper

Comments: This retrospective cohort study evaluates the long-term oncological outcomes of patients affected by persistent N2 disease (stage IIIA-IIIB) who underwent a multimodal treatment including neoadjuvant chemotherapy and surgery from June 2014 to March 2020. A lot of literature has demonstrated that in this setting the strongest prognostic factors are the mediastinal lymph node involvement, and in particular patients with persistent N2 involvement (ypN2) had a poor prognosis. Certain limitations of the study are its retrospective nature with inherent potential selection bias, cohort study without control group. Also, the lymph node ratio is affected by the type of lymph node dissection and could differ between surgeons and institutions.

Q: Would you recommend this manuscript for further publication?

A: Yes - Suitable to be published

If you have any questions and clarifications you can write to the journal.

Thanks,
Science Repository Team