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• W4214902707 abstract "We would like to comment on the recent published article entitled “Clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma.” Lu et al.1 performed an interesting study to demonstrate that segmentectomy was equivalent to lobectomy for stage I acinar predominant adenocarcinoma (ACN) while lobectomy remain the optimal procedure for stage I papillary predominant adenocarcinoma (PAP). The study highlighted the importance of decision-making on appropriate surgical procedures according to the histologic subtypes of lung adenocarcinoma. However, we have some concerns. First, several previous studies2, 3 have investigated the feasibility of identifying histologic subtypes of stage I lung adenocarcinoma on intraoperative frozen sections (FS) and found that it was difficult to predict the predominant pattern on the basis of FS, mostly because of sampling issues. Additionally, even though acceptable accuracy rate of FS for predicting ACN (76%) and PAP (85%) was observed, the interobserver agreement on the two subtypes seemed not good enough (κ = 0.481 and 0.527, respectively).3 Therefore, it might be of little significance to investigate appropriate surgical procedures for PAP and ACN given that FS-derived prediction for histologic patterns could not be precise enough to guide the extent of resection. Second, the authors included both stage IA and stage IB patients synchronously in their analysis. However, adjuvant chemotherapy might be routinely administered to patients with stage IB disease, especially to those receiving sublobar resection (segmentectomy and wedge resection).4 Therefore, it will be more reasonable to make subgroup analysis on stage IA and IB patients with ACN and PAP, respectively, since adjuvant chemotherapy is a significant prognosticator in stage IB patients.4, 5 In addition, the SEER program does not release all the data on chemotherapy due to uncertainties regarding data completeness,6 which indicates that the chemotherapy data might not be reliable enough in Table 1.1 To sum up, the authors omitted several important issues that might lead to potential bias in their studies, which should be addressed and interpreted with caution. The authors declare no potential conflict of interest. This study was supported by the National Natural Science Foundation of China (no. 82172076), the Jiangsu Key Research and Development Plan (Social Development) Project (no. BE2020653), the Key Scientific Program of Jiangsu Provincial Health Commission (no. ZD2021033), the Suzhou Key Laboratory of Thoracic Oncology (no. SZS201907), the Municipal Program of People's Livelihood Science and Technology in Suzhou (no. SS2019061), the Discipline construction project of the Second Affiliated Hospital of Soochow University (no. XKTJ-XK202004), the Scientific Program of Suzhou Municipal Health and Health Committee (no. LCZX202004). Conception and design: Donglai Chen. Manuscript drafting and reference collection: Xiaofan Wang and Xuejun Xu. Administrative support: Yongbing Chen." @default.
• W4214902707 created "2022-03-05" @default.
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• W4214902707 date "2022-03-02" @default.
• W4214902707 modified "2023-10-16" @default.
• W4214902707 title "Comment on “clinicopathological features, survival outcomes, and appropriate surgical approaches for stage I acinar and papillary predominant lung adenocarcinoma”" @default.
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• W4214902707 doi "https://doi.org/10.1002/cam4.4597" @default.
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