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Response to Comment on "Prognostic Impact of Postoperative Lymph Node Metastases After Neoadjuvant Chemoradiotherapy for Locally Advanced Squamous Cell Carcinoma of Esophagus".

Reply: We want to thank Dr. Chen and their colleagues for spending time writing the article, focusing on our recently online published study from the results of NEOCRTEC5010. Our research is a randomized multicenter study regarding the significant prognostic impact of postoperative lymph node metastases after neoadjuvant chemoradiotherapy (NCRT) for locally advanced squamous cell carcinoma of the esophagus (ESCC). They carefully considered our article and thoughtfully proposed the advantages and limitations of our research. In their article, Chen et al put forward 4 valuable comments and suggestions. The first question is regarding the evaluation approach on the cN status in patients with clinical stage T1-4N1M0/ T4N0M0 (stage IIB or III) based on the sixth edition of the American Joint Committee on Cancer Staging Manual in our study. The question pointed out whether the useful tool of positron emission tomography-computed tomography (PET-CT) or enhanced CT scanning or any other approach implemented for evaluation of the cN status. Our study started in 2007. The PET-CT was not mandatory in the study at that time. Besides, the cost of PET-CT is expensive, around 10,000 RMB. Furthermore, it was not covered in medical insurance in China. In our study, 37 patients received PET-CT. Ninety-seven of 451 patients did not receive ultrasound endoscopy (EUS) in this study, due to refusal in 41 patients and esophageal stricture impeding the scope to pass through in 56 patients. During the time of our research, we do not