Therapeutic Strategies and Oncological Outcome of Peritoneal Metastases from Lung Cancer: A Systematic Review and Pooled Analysis

Round 1

Reviewer 1 Report

1.The introduction part should be well written. It seems that this part is too short. The aim of a meta-analysis should be an inconclusive finding was existed in the current research area. I found that there are only a few studies investigated this topic after searching in the PubMed. How about their findings? What is the issue or discrepancy in this filed? The author should introduce these in this part. The following references could be cited to introduce the background of lung cancer (https://doi.org/10.3389/fgene.2022.833797, doi:10.7150/ijms.71267, and doi: 10.21037/jtd-20-2803).

2. The methods part should be well written especially in the meta-analysis. The search strategy in each database should be provided as supplementary material so as to guarantee its reproductivity. Besides, did the author included meeting abstract? Furthermore, why did not search in the Embase database? Did the author used Mesh terms or only used the free word? The author searched these keywords in the full text or abstract? All these should be clearly described.

3. Is there any difference of peritoneal metastasis between different pathological subtypes of lung cancer? It seemed that currently included studies are mainly low-quality studies. Meta-analysis and subgroup analysis could not be performed in the current study. There will be valuable finding if the above analyses could be conducted. So, this is also should be discussed in the limitation parts.

4. In all the tables, the country should be replaced as Country/ region.

Author Response

1.The introduction part should be well written. It seems that this part is too short. The aim of a meta-analysis should be an inconclusive finding was existed in the current research area. I found that there are only a few studies investigated this topic after searching in the PubMed. How about their findings? What is the issue or discrepancy in this filed? The author should introduce these in this part. The following references could be cited to introduce the background of lung cancer (https://doi.org/10.3389/fgene.2022.833797, doi:10.7150/ijms.71267, and doi: 10.21037/jtd-20-2803)

Many thanks for providing these useful comments, after which we have better introduced the topic of lung cancer peritoneal carcinosis, explained the absence of a systematic review on the topic and integrated the section with the references provided as requested.

2. The methods part should be well written especially in the meta-analysis. The search strategy in each database should be provided as supplementary material so as to guarantee its reproductivity. Besides, did the author included meeting abstract? Furthermore, why did not search in the Embase database? Did the author used Mesh terms or only used the free word? The author searched these keywords in the full text or abstract? All these should be clearly described. 

Many thanks for your valuable comments on our methodology. The following is not a meta-analysis a systematic review with pooled analysis that has been strictly PRISMA guideline compliant and condicted by Authors with experience in this area.

Search strategy and term combination used has been better explained in Method section to guarantee reproducibility. Meeting abstracts where not included in order to include only peer-reviewed published data, this has been added in exclusion criteria.

We are sorry if Embase haven’t been searched but four database sources (Pubmed, Medline, Cochrane Library and Web of Science) have been used to conduct our search. In addition, references of included article have been evaluated to highlight other possible includable articles; usually >/= three database are enough for systematic reviews.

 The term combination utilised the most pertinent free word combination. MeSH terms were not used since could have mislead the search since there are not specific term for secondary neoplasm of peritoneum.

Keywords have searched the title and the abstract, this has been explained in search strategy method section

3. Is there any difference of peritoneal metastasis between different pathological subtypes of lung cancer? It seemed that currently included studies are mainly low-quality studies. Meta-analysis and subgroup analysis could not be performed in the current study. There will be valuable finding if the above analyses could be conducted. So, this is also should be discussed in the limitation parts.

We agree scarcity of data could not allow a proper metanalytic study, this has been added in our limitation section as asked

4. In all the tables, the country should be replaced as Country/ region.

Many thanks for pointing out that, this has been changed in-text as requested

Author Response File: Author Response.docx

Reviewer 2 Report

Interesting article reviewing an unusual metastatic location. In this sense, the article offers information with a low percentage (1.5%). 

The description of the characteristics of the patients is adequate but could be improved. The same is true of the description of the results in terms of survival and treatments used.

 

Suggestions:

1º Review section 2.1: remove extra parentheses and extrascript: The following term combination was used: (((peritoneal carcinomatosis) OR (perito-neal metastases) OR (gastrointestinal metastases)) AND ((lung cancer) OR (lung neo-plasia))).

2º Review section 3.3: the same stage II is repeated (Regarding pTNM staging, at diagnosis 0.1% of patients were stage II, 0.3%% were stage II and the vast majority (99.6%) were stage). review the entire article to rule out other errors

3º I recommend using the word before the Arabic sign for numbers after a comma or point  (PCLC occurs mainly in males (57%) and at a median age between 52-66 (range: 24–82). 64% of patient )

4º clarify the meaning of NSCLC

5º I recommend improving the quality of the tables

6º I recommend separate tables indicating the characteristics of the patients with synchronous vs metachronous, in relation to histology, molecular data, and another table with the treatments grouped by chemotherapy alone and or target therapy.

 

7º. Since it is a descriptive study, my opinion is that the discussion should not elucidate the therapeutic strategy. Emphasis should be placed on whether there is any specific characteristic for this rare metastatic location once the bibliographic review has been done and how to improve the survival results with current therapeutic tools, including surgery or local treatment.

 

Author Response

Interesting article reviewing an unusual metastatic location. In this sense, the article offers information with a low percentage (1.5%). The description of the characteristics of the patients is adequate but could be improved. The same is true of the description of the results in terms of survival and treatments used.

Thanks for reviewing our article with your valuable comments thanks to we feel the quality of the manuscript has greatly improved

 

Suggestions:

1º Review section 2.1: remove extra parentheses and extrascript: The following term combination was used: (((peritoneal carcinomatosis) OR (perito-neal metastases) OR (gastrointestinal metastases)) AND ((lung cancer) OR (lung neo-plasia))).

Many thanks for your comment, based on your suggestion, term combination has now been written in a clearer way

 

2º Review section 3.3: the same stage II is repeated (Regarding pTNM staging, at diagnosis 0.1% of patients were stage II, 0.3%% were stage II and the vast majority (99.6%) were stage). review the entire article to rule out other errors

Many thanks for highlighting our typo, 0.3% were stage III cancer, this has been amended in the revised manuscript

 

3º I recommend using the word before the Arabic sign for numbers after a comma or point  (PCLC occurs mainly in males (57%) and at a median age between 52-66 (range: 24–82). 64% of patient )

Many thanks for your comments, changes on Arabic numbers have been made accordingly.

 

4º clarify the meaning of NSCLC

Abbreviation has now been explained as requested

 

5º I recommend improving the quality of the tables

Thanks for pointing out this aspect, quality of table has been improved, Table 2 is now at the end of the article with orizontal layout to improve readers readability. We will further discuss this aspect with Production Office in case the manuscript will be accepted

 

6º I recommend separate tables indicating the characteristics of the patients with synchronous vs metachronous, in relation to histology, molecular data, and another table with the treatments grouped by chemotherapy alone and or target therapy.

 We are very glad you made such comment that helped us introduce another aspect in our analysis: we have added as suggested a new table (Table 4) in which results of synchronous versus metachronous patient were analysed. Not in every case data were extractable and that is why we have not made the comparison at first, but we are satisfied with the final results of the table. Methods, results, and discussion section have been changed accordingly.  Unfortunately, same comparison was not possible for chemotherapy vs target due to the paucity of patients includable (45) that would have been less excluding article where data were not extractable.

 

7º. Since it is a descriptive study, my opinion is that the discussion should not elucidate the therapeutic strategy. Emphasis should be placed on whether there is any specific characteristic for this rare metastatic location once the bibliographic review has been done and how to improve the survival results with current therapeutic tools, including surgery or local treatment.

Many thanks for raising this concern, any personal consideration on therapeutic strategy not supported by literature or presented data has been eliminated by Discussion and Conclusions. Similarly, we have emphasised where to address future studies.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

This manuscript could be accepted.