Peer Review #2 of "Different distant metastasis patterns based on tumor size could be found in extensive-stage small cell lung cancer patients: a large, population-based SEER study (v0.1)"

Abstract

Small-cell lung cancer (SCLC) is a malignant cancer with the ability to metastasize quickly. The relationship between tumor size and the distant metastasis patterns of Extensive-Stage Small Cell Lung Cancer (ES-SCLC) has not been reported. OBJECTIVES: The aim of this study was to determine the different distant metastasis patterns as they related to tumor size in ES-SCLC. PATIENTS AND METHODS: We used Surveillance, Epidemiology, and End Results (SEER) population-based data collected from 2010 through 2013 to identify 11058 ES-SCLC patients with definite evidence of distant metastases. Multivariate logistic regression analysis was used to demonstrate the association between tumor size and distant metastasis patterns including bone, liver, brain, and lung metastases. Age, race, sex, and N stage were also selected in the logistic regression model. RESULTS: Subtle differences in metastasis patterns were found among patients based on different tumor sizes. Patients with tumors 3-7 cm have a higher risk of bone metastasis compared with those that have tumors ≤ 3 cm (OR 1.165, 95% CI 1.055-1.287，P=0.003) and patients with tumors ≥7 cm have a higher risk of lung metastasis (OR 1.183, 95% CI 1.039-1.347，P=0.011). In addition, patients with tumors ≥7 cm had a lower risk of brain metastasis and liver metastasis than patients with tumors ≤ 3 cm(OR 0.799, 95% CI 0.709-0.901，P＜0.001;OR 0.747, 95% CI 0.672-0.830，P＜0.001). Interestingly, there was no correlation between a larger tumor and a higher risk of metastasis. However, the tumor metastasis pattern did have some correlation with age, gender, race and N-status. CONCLUSION: The pattern of distant metastasis of ES-SCLC is related to the tumor size and the tumor size is indicative of the metastatic site. Larger tumor sizes did not correlate with a higher risk of distant metastasis but the size is related