Peer Review History

Original SubmissionNovember 3, 2022
Decision Letter - Kartikeya Rajdev, Editor

PONE-D-22-30040Lobar emphysema ratio of more than 1% in the lobe with lung cancer as poor predictor for recurrence and overall survival in patients with stage I non-small cell lung cancerPLOS ONE

Dear Dr. Park,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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We look forward to receiving your revised manuscript.

Kind regards,

Kartikeya Rajdev, MD

Academic Editor

PLOS ONE

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https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/ https://blogs.plos.org/plos/2019/06/looking-good-tips-for-creating-your-plos-figures-graphics/

4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Very well written. Very few studies have been published focusing on the correlation between lobar emphysema and stage I non-small cell lung cancer. There are a few studies on a similar topic, and this study is consistent with published literature.

Reviewer #2: Well done study. Conclusion was expected as patients with more severe emphysema will have poor outcome in general. Given the higher rates of active smoker and worse Fev1 in the HER group, they could potentially be a confounding factor when looking at DFS and OS. Since we are discussing emphysema in this study it would have been better if diffusion capacity (DLCO) was also reported for each category to look for another potential confounding factor.

Reviewer #3: Very nicely done study.

Manuscript is well written and easy to follow.

I had one comment

1)Did the authors look at degree of airflow obstruction(FEV1%) as a predictor of decreased DFS or OS? It will add to the findings of references 21,23,24 in the text.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Revision 1

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.

Title Page (Page 1, Line 9, 12)

I added the information about affiliation “Gyeongsang National University Hospital”

Title Page (Page 1, Line 14)

I changed the word ‘pichola’ to ‘MJP’.

2. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

; We uploaded our minimal data set as supporting information file.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

3. Please upload a new copy of Figure 1b as the detail is not clear. Please follow the link for more information:

; Figure 1b is a multipanel image. So I changed figure 1b into figure 1b,c,d for better understanding. And I added some information in the figure legend about figure 1b,c,d.

I added the word “in axial and coronal images” in Line 131, Page 6.

I added the following sentence in Line 134-135, Page 6

“The lung densities in whole lung and each pulmonary lobe were presented using the density histogram analysis. The lobar emphysema ratio in the left lower lobe was 16.591, and he was confirmed to have adenocarcinoma after lobectomy.”

4. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Reviewer #1: Very well written. Very few studies have been published focusing on the correlation between lobar emphysema and stage I non-small cell lung cancer. There are a few studies on a similar topic, and this study is consistent with published literature.

; Thank you for your nice comments.

Reviewer #2: Well done study. Conclusion was expected as patients with more severe emphysema will have poor outcome in general. Given the higher rates of active smoker and worse Fev1 in the HER group, they could potentially be a confounding factor when looking at DFS and OS. Since we are discussing emphysema in this study it would have been better if diffusion capacity (DLCO) was also reported for each category to look for another potential confounding factor.

; I agree with your opinion. I reviewed some related articles, added the following paragraph in the discussion section. (Line 260-271 Page 14)

“Although airflow obstruction has been known as an independent risk factor for lung cancer [23,24], its prognostic significance is still controversial in patients with early-stage lung cancer. Lopez et al. reported that airflow obstruction is a poor prognostic factor for 2-year survival in stage I lung cancer [28]. However, Ueda et al. reported that airflow obstruction is not a significant poor prognostic factor for 5-year OS and DFS in patients with lung cancer, mostly early-stage lung cancer [13], these findings are consistent with our results. Further research are required to verify the prognostic value of airflow obstruction in patients with lung cancer.

Smoking status is a well-known poor prognostic factor for survival in patients with lung cancer [29,30], furthermore smoking cessation after diagnosis lowers the mortality in patients with early-stage lung cancer [31]. In contrast, our results indicated that smoking status is not a significant prognostic factor for OS and DFS. Compared to previous large-scale investigations, the number of study population and mortality rate were low in our study. These factors might affect our study's results.

I also mentioned the diffusion capacity in the limitation section. (line 277-279, Page 14, 15)

“Fourth, although we did not gather information on diffusion capacity in all patients, it may be a complicating factor for survival in patients with lung cancer. Patients with normal PFT in our institution are optional to undergo the diffusion capacity test.”

Reviewer #3: Very nicely done study.

Manuscript is well written and easy to follow.

I had one comment

1) Did the authors look at degree of airflow obstruction(FEV1%) as a predictor of decreased DFS or OS? It will add to the findings of references 21,23,24 in the text.

;

Thank you for your comments. Previous studies indicated that the prognostic role of airflow obstruction (FEV1%) is controversial in patients with lung cancer.

The prognostic impact of airflow obstruction is uncertain in reference 21. The reference of 23, 24 revealed the association between airflow obstruction and risk of lung cancer.

I reviewed the other related articles and added this paragraph in the discussion section (Line 260-266, Page 14).

“Although airflow obstruction has been known as an independent risk factor for lung cancer [23,24], its prognostic significance is still controversial in patients with early-stage lung cancer. Lopez et al. reported that airflow obstruction is a poor prognostic factor for 2-year survival in stage I lung cancer [28]. However, Ueda et al. reported that airflow obstruction is not a significant poor prognostic factor for 5-year OS and DFS in patients with lung cancer, mostly early-stage lung cancer [13], these findings are consistent with our results. Further research are required to verify the prognostic value of airflow obstruction in patients with lung cancer.”

---------------------------

Finally I corrected some minor error.

1. I changed the word from “nonesmall” to “non-small” in the reference 21, Line 339

Bishawi M, Moore W, Bilfinger T. Severity of emphysema predicts location of lung cancer and 5-y survival of patients with stage I nonesmall cell lung cancer. J Surg Res. 2013;184: 1–5. doi:10.1016/j.jss.2013.05.081

Bishawi M, Moore W, Bilfinger T. Severity of emphysema predicts location of lung cancer and 5-y survival of patients with stage I non-small cell lung cancer. J Surg Res. 2013;184: 1–5. doi:10.1016/j.jss.2013.05.081

2. I changed the word “emphysema quantification” to “density histogram analysis” in Line 226, Page 12.

Attachments
Attachment
Submitted filename: response to reviewers.docx
Decision Letter - Kartikeya Rajdev, Editor

Lobar emphysema ratio of more than 1% in the lobe with lung cancer as poor predictor for recurrence and overall survival in patients with stage I non-small cell lung cancer

PONE-D-22-30040R1

Dear Dr. Park,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Kartikeya Rajdev, MD

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #3: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

Reviewer #3: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: Thank you for addressing my questions and clarifying/updating the paper. I understand that Diffusion capacity may not be readily available on all patients.

Reviewer #3: Authors have done a great job in answering the reviewer comments. Well written.Manuscript can be accepted in its current form.No further corrections/questions.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

**********

Formally Accepted
Acceptance Letter - Kartikeya Rajdev, Editor

PONE-D-22-30040R1

Lobar emphysema ratio of more than 1% in the lobe with lung cancer as poor predictor for recurrence and overall survival in patients with stage I non-small cell lung cancer

Dear Dr. Park:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Kartikeya Rajdev

Academic Editor

PLOS ONE

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