Title: Preoperative CT Lymph Node Size as a Predictor of Nodal Metastasis in Resectable Colon
Cancer: A Retrospective Study of 694 Patients
Version: 2 Date: 18 Dec 2024
Reviewer's report:
This manuscript by T. Kawazoe et al. explores the predictive value of lymph node size on
preoperative CT for identifying nodal metastasis in resectable colon cancer. The study highlights
region-specific differences in cutoff values and demonstrates clinical relevance for treatment
planning. The authors provide valuable insights into preoperative diagnostics and their role in
colon cancer management. However, several aspects require clarification and further discussion:
1. In Materials and Methods (page 2, lines 16–28), excluding patients who received preoperative
therapies or non-curative surgeries may introduce selection bias. Does this exclusion limit the
cohort’s representativeness, especially for advanced or atypical disease cases that could affect
lymph node size or metastasis rates?
2. The Results section (page 5, lines 1–6) shows diagnostic performance differences based on
CT slice thickness (#2 mm vs. >2 mm). Can the authors recommend optimal imaging protocols
for institutions with varying capabilities or provide further analysis to guide practice?
3. In Results (page 6, lines 1–15), cutoff values differ between right-sided and left-sided colon
cancers (e.g., 7.7 mm vs. 5.8 mm for maximum long diameter). What anatomical or biological
factors might explain this difference? How could these findings guide preoperative assessments
or surgical strategies tailored to tumor location?
4. In Discussion (page 8, lines 5–10), the manuscript proposes new cutoff values for lymph
node size by tumor location. How do these compare with guidelines like NCCN or JSCCR? A
discussion on integrating these findings into clinical workflows would enhance applicability.
5. In Conclusion (page 11, lines 1–5), combining long and short diameters is suggested to
be clinically useful. Could the authors provide specific examples of its impact on staging or
treatment planning? What barriers might clinicians encounter when adopting these methods?
Title: Preoperative CT Lymph Node Size as a Predictor of Nodal Metastasis in Resectable Colon
Cancer: A Retrospective Study of 694 Patients
Version: 2 Date: 18 Dec 2024
Reviewer's report:
This manuscript by T. Kawazoe et al. explores the predictive value of lymph node size on
preoperative CT for identifying nodal metastasis in resectable colon cancer. The study highlights
region-specific differences in cutoff values and demonstrates clinical relevance for treatment
planning. The authors provide valuable insights into preoperative diagnostics and their role in
colon cancer management. However, several aspects require clarification and further discussion:
1. In Materials and Methods (page 2, lines 16–28), excluding patients who received preoperative
therapies or non-curative surgeries may introduce selection bias. Does this exclusion limit the
cohort’s representativeness, especially for advanced or atypical disease cases that could affect
lymph node size or metastasis rates?
2. The Results section (page 5, lines 1–6) shows diagnostic performance differences based on
CT slice thickness (#2 mm vs. >2 mm). Can the authors recommend optimal imaging protocols
for institutions with varying capabilities or provide further analysis to guide practice?
3. In Results (page 6, lines 1–15), cutoff values differ between right-sided and left-sided colon
cancers (e.g., 7.7 mm vs. 5.8 mm for maximum long diameter). What anatomical or biological
factors might explain this difference? How could these findings guide preoperative assessments
or surgical strategies tailored to tumor location?
4. In Discussion (page 8, lines 5–10), the manuscript proposes new cutoff values for lymph
node size by tumor location. How do these compare with guidelines like NCCN or JSCCR? A
discussion on integrating these findings into clinical workflows would enhance applicability.
5. In Conclusion (page 11, lines 1–5), combining long and short diameters is suggested to
be clinically useful. Could the authors provide specific examples of its impact on staging or
treatment planning? What barriers might clinicians encounter when adopting these methods?
Please review this paper.
user
Title: Preoperative CT Lymph Node Size as a Predictor of Nodal Metastasis in Resectable Colon
Cancer: A Retrospective Study of 694 Patients
Version: 2 Date: 18 Dec 2024
Reviewer's report:
This manuscript by T. Kawazoe et al. explores the predictive value of lymph node size on
preoperative CT for identifying nodal metastasis in resectable colon cancer. The study highlights
region-specific differences in cutoff values and demonstrates clinical relevance for treatment
planning. The authors provide valuable insights into preoperative diagnostics and their role in
colon cancer management. However, several aspects require clarification and further discussion:
1. In Materials and Methods (page 2, lines 16–28), excluding patients who received preoperative
therapies or non-curative surgeries may introduce selection bias. Does this exclusion limit the
cohort’s representativeness, especially for advanced or atypical disease cases that could affect
lymph node size or metastasis rates?
2. The Results section (page 5, lines 1–6) shows diagnostic performance differences based on
CT slice thickness (#2 mm vs. >2 mm). Can the authors recommend optimal imaging protocols
for institutions with varying capabilities or provide further analysis to guide practice?
3. In Results (page 6, lines 1–15), cutoff values differ between right-sided and left-sided colon
cancers (e.g., 7.7 mm vs. 5.8 mm for maximum long diameter). What anatomical or biological
factors might explain this difference? How could these findings guide preoperative assessments
or surgical strategies tailored to tumor location?
4. In Discussion (page 8, lines 5–10), the manuscript proposes new cutoff values for lymph
node size by tumor location. How do these compare with guidelines like NCCN or JSCCR? A
discussion on integrating these findings into clinical workflows would enhance applicability.
5. In Conclusion (page 11, lines 1–5), combining long and short diameters is suggested to
be clinically useful. Could the authors provide specific examples of its impact on staging or
treatment planning? What barriers might clinicians encounter when adopting these methods?
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