今天早上打开电脑，网易客户端弹出一封新邮件提醒，点开一看，标题是：“SCS Decision“。  内容为”Dear Dr. Wang, I am pleased to inform you that your work has now been accepted for publication in Journal of Craniofacial Surgery. All manuscript materials will be forwarded immediately to the production staff for placement in an upcoming issue.“

看完这段话，不禁感慨万千，小弟硕博五年以来，虽然高分文章没有，但是 3 分左右的也发了几篇，但是以这篇 SCS 接受的文章发表最为困难。跟各位战友分享一下这篇烂文章的发表流程，可以以我为鉴啊！

最早是研二的时候，硕导让总结一下我院下咽癌放疗后手术对于喉功能保留的经验，我花了大约 1 年多时间检阅、随访了我院建院以来 1000 多例初治下咽癌患者，建成数据库，并于 2012 年上半年完成论文写作，但随后文章就一直在老板手里修改没让投。

2013-6-19 号，老板同意投出去，于是一投 EJSO，IF 为 2.708。当时觉得自己文章入组患者数据量非常大，而且总结的是比较少见的放疗后手术来保留喉功能，可以冲刺一下稍微高分点的。科研型博士可能觉得两分多点的杂志不值一提哈，不过头颈外科是个小专业，排名第一的杂志也就 3 分多点，所以我们当时都觉得能发 EJSO 已经很不错啦。

话说 EJSO 效率就是快，2013-6-24 就回信拒稿了：

”Dear Dr. Wang,

Thank you for submitting your above named manuscript to the EJSO. We regret to inform you that we are unable to accept your submission for publication in the journal.

Decisions which are taken on manuscripts submitted to the EJSO are based on a review of the manuscript and the accompanying information by the Editor-in-Chief or Editors. The EJSO receives many more manuscripts than it can publish each year and only those papers which meet stringent requirements of high scientific quality and significance, originality, and priority can be accepted for publication. Based on a preliminary review, it is the opinion of the Editors that your manuscript does not meet all of these criteria and is not, therefore, acceptable for publication.

The Editors sincerely thank you for the opportunity to review your manuscript.

With best wishes,

Thomas Lehnert

Editor-in-Chief

EJSO

Reviewers' comments:“

Reviewers' comments: 后面不是我忘了复制了，本来就没有内容，也就是这篇文章压根没机会送审稿人看，直接被枪毙。

好在小弟虽然投中经验不多，但是被拒稿经验还是很丰富的，立马改投了 MED ONCOL，IF 2.147。因为 EJSO 并没有给出任何修改意见，所以只修改了一下格式。投稿时间是 2013-6-25 号，拒稿第二天就投出去了，我真是太迅速了:D。不过 MED ONCOL 的编辑也不甘示弱，2013-6-27 日就立马拒稿了，拒稿信内容如下：

”Dear Xiaolei Wang,

We have received the screening reports from our advisors on your manuscript, Laryngeal function preservation in multidisciplinary therapy for locally advanced pyriform sinus carcinoma: 30-year experience at a single institution..

With regret, I must inform you that, based on the advice received and a very competitive situation in the Journal (rejection rate currently exceeds 80%), your manuscript did not score high enough for detailed processing and thus cannot be accepted for publication in Medical Oncology.

I would like to thank you very much for forwarding your manuscript to us for consideration and wish you every success in finding an alternative place of publication.

Sincerely yours,

Anders Osterborg

Medical Oncology“

痛定思痛啊，两次投稿连个修回意见都没有。我想了一下原因，头颈本来就是小专业，而下咽癌更是头颈部的罕见肿瘤，估计综合类医刊对这个病兴趣不大，还是改投头颈类的专业期刊吧。我真是太机智了~~

好在我有特别的投稿技巧，长期被拒的经验锻炼了我改投杂志的能力，不到一天我就改好格式，2013-6-27（第二次拒稿当天）把文章投到了 Oral Oncology，IF 为 2.695。影响因子上升表明我这时候对自己文章还是很有信心的，前几次拒稿只是目标期刊有误，专业类期刊还是有慧眼识珠的编辑的：D。

果然，这次 Oral Oncology 没两三天就把我的文章拒了，而是让我等了一个多月后，2013-7-5 才把我的文章拒了。内容如下：

”Dear Dr. Wang,

Thank you for submitting your manuscript to Oral Oncology. We regret to inform you that we are unable to accept it for publication in the journal.

Oral Oncology receives many more manuscripts that it can accept for publication each year and only those manuscripts which meet stringent requirements of high scientific quality and significance, originality, and priority can be accepted for publication. Based on a preliminary review, it is the opinion of the Editors that your manuscript does not meet all of these criteria and, therefore, is unlikely to be acceptable for publication.

We hope that this decision will ultimately hasten publication of your work in another excellent journal. We are grateful to you for your interest, and hope you will continue to consider Oral Oncology for future submissions in our field.

Thank you.

Yours sincerely

Dr. Ezra Cohen

Editor-in-Chief

Oral Oncology

Editors' comments:

This is a large series but the conclusions are not novel. Few centers in the world would treat advanced pyriform sinus cancers with a single modality in current times. Moreover, the functional data are minimal and only reflect whether surgery was performed rather than true function.“

大家可以看出这个拒稿信的不一样的地方了吧，没错，有了编辑审稿意见了，虽然一个月这个杂志都没把我论文送给审稿人瞄一眼。但是这个意见过于含糊，看了我也不知道怎么修改这篇文章，但还是前进了一小步了。

于是，又在拒稿当天（2013-7-5），我立马修改完格式改投了 Acta Oto-Laryngologica，IF 为 1.106。可见我这时候对文章已经没啥自信了，觉得能发一个一分多点的就不错了。因为这篇文章不是用来毕业的，投完之后就去忙其他更有希望的文章去了，所以也没特别关注。大约又是一个月以后（2013-8-15），如愿盼来 Acta Oto-Laryngologica 的拒稿信：

”Dear Dr. Wang:

I write you in regards to manuscript # SOTO-2013-0240 entitled "Laryngeal function preservation in multidisciplinary therapy for locally advanced pyriform sinus carcinoma: 30-year experience at a single institution." which you submitted to the Acta Oto-Laryngologica.

In view of the criticisms of the reviewer(s) found at the bottom of this letter, your manuscript has been denied publication in the Acta Oto-Laryngologica.

Thank you for considering the Acta Oto-Laryngologica for the publication of your research. I hope the outcome of this specific submission will not discourage you from the submission of future manuscripts.

Sincerely,

Prof. Matti Anniko

Editor-in-Chief, Acta Oto-Laryngologica

actaoto@informa.com

Reviewer(s)' Comments to Author:

Referee: 1

Comments to the Author

This paper reported the oncological results of the patients with hypopharyngeal cancers. Although the number of patients is large, the survival results are relatively worse even in the best group. Besides there is no additional information. I think this paper is not suitable for publication in Acta.

Referee: 2

Comments to the Author

1.The chemotherapy is indispensable as one of the multidisciplinary treatment, now.

However, the multidisciplinary treatment for the hypopharyngeal cancer excluding the chemotherapy was investigated in this article. Therefore, this article lacks in clinical value.

2.The difference between patients who underwent radiotherapy followed by salvage surgery in group Ra and patients of R+S group is unclear.

3.There is much bias in selection of treatment method. Therefore, a comparison of treatment results among 4 groups has not important meaning.

4.English is primitive.”

感激涕零哈，终于有了详细的审稿人意见了。不过看完之后还是觉得修改起来太过麻烦，所以我改完格式后，2013-8-17 随手扔给了 APJCP，IF 1.271。因为听说这个杂志收了好多水平一般般的文章，希望编辑或者审稿人看走眼接受得了。APJCP 有个挺奇葩的投稿流程，先后让我交了各种文件（版权转让、基金证明）之后，终于在 2013-9-18（国耻日啊！！）号果断把我拒稿了：

”Dear Dr. Xiao-Lei Wang 18.09.2013

Thank you for your submission titled “Laryngeal function preservation in multidisciplinary therapy for locally advanced pyriform sinus carcinoma: 30-year experience at a single institution” to the APJCP. It has now undergone initial processing and review but unfortunately was not given sufficient priority for further consideration of publication.

Once again, thank you for your interest in publishing in the APJCP.

Carol

Managing Editor

On behalf of the Chief Editor and the Editorial Team“

这时候我已经对这篇文章完全失望了，我之前听过中华医学会的一个讲座，有个人讲到说一般坚持投五次文章就可以被接受，但到现在我的文章已经五投不中了。这篇文章从我研二一直投到博一，实在是奇葩。这时候我硕导跟我说科里有个人刚在 archives of otolaryngology-head & neck surgery 发了一篇文章，让我投这个杂志试试。我检索之后发现这个杂志已经成为 JAMA 的子刊，改名叫做 JAMA Otolaryngology–Head & Neck Surgery，IF 为 1.779，在头颈专业算比较高的了。感觉完全没戏，但为了满足老板的心愿，于是我在 2013-9-23 再次投稿（第六次）。话说 JAMA 期刊对杂志要求就是繁琐，其间因为格式不对被退回两次，直到 2013-10-4 才给了文章编号并送审，不过没等多久就如愿等来拒稿信（2013-11-1）：

”Dear Prof. Wang:

We have now completed our review of your manuscript, and I regret to tell you that we are not able to undertake further consideration of your submission for publication in JAMA Otolaryngology-Head & Neck Surgery. Publication priorities and page allocations place a limitation on the number of manuscripts we can work with toward possible acceptance.

I am enclosing the reviewers' comments, which I hope you will find helpful.

Thank you for the privilege of reviewing your work.

Sincerely,

Paul A. Levine, M.D.

Editor

JAMA Otolaryngology - Head & Neck Surgery

183 Tuckahoe Farm Lane

Charlottesville, VA 22901

Phone: (434)960-9202

eFax: (866) 541-1826

International fax: 011-1-312-277-6436

Email: jamaoto@jamanetwork.org

Confidentiality Note: This communication, including any attachments, is solely for the use of the addressee, may contain privileged, confidential or proprietary information, and may not be redistributed in any way without the sender's consent. Thank you.

Reviewer Comments:

Reviewer #1 (Remarks to the Author):

This manuscript suffers from what impacts many retrospective reviews based on the heterogeneity of the population. The four groups have different sizes and the analysis is unclear. I could not find any type of analysis comparing those who had conservation surgery vs. total laryngectomy. That may have been a clinically relevant analysis. But, I suspect the heterogeneity of the study population would probably compromise that analysis. Their conclusions are what is well-documented in the literature relative to the value of combined vs. single modality therapy. In summary, I do not feel that this manuscript contains any new clinically relevant information.

Reviewer #2 (Remarks to the Author):

This study concludes that partial radiation followed by planned surgical resection for T3 and T4 pyriform sinus cancer and surgical excision followed by x-ray therapy both result in a better 2 and 5 year survival then single modality therapy. Cases are reviewed which did not get combined chemotherapy. This study thus relates to historical treatment in the twentieth century with non-surgical vs surgical protocols. Most current protocols do not include single modality therapy for T3 and T4 pyriform sinus cancer and the non-surgical protocols almost always include chemotherapy. This author suggests that they will report their results for combined chemoradiation in a separate paper.

The report of laryngeal function preservation is not defined but only categorized. Do these patients swallow without aspiration, do they have PEG tubes and do they voice spontaneously or with a plugged tracheostomy in place? To consider laryngeal function preservation, these must be better defined.

The study acknowledges the younger and healthier enrollees were offered and accepted surgical choices of surgery and XRT which biased results since older patients always received XRT alone.

This study with major revision can be published. It still reflects XRT and surgery and thus does not highlight current best management. As a prospective study, it could serve better as benchmark to measure against surgery and chemotherapy or chemoradiation.“

这时候我还是没有对文章进行改动，再次投稿的时候跟硕导商量一下，觉得能发在有分的杂志上面就行了，也不追求大于 1 分了。所以找了个冷门的期刊”Journal of Craniofacial Surgery“，IF 为 0.686，2013-11-2 号投稿成功。2013-12-25 号等到了审稿意见，大修。不知道老外是不是快过节心情好，放了我一马，也算送我一个圣诞礼物：

”Dear Dr. Wang,

I have received the comments of the reviewers on your manuscript, a copy is included below. The reviewers believe that your studies are of potential interest to our readers but feel that substantial revision would be necessary before the paper could be considered again for publication in the Journal of Craniofacial Surgery.

If you are willing to revise the manuscript taking into consideration the suggestions of the reviewers, I will send the revised paper to the original reviewers for their appraisal. Please include with your revised submission an itemized, point-by-point response to the comments of the reviewers. The revisions should be completed by Jan 24, 2014 to avoid being considered as a new submission.

To submit a revision, go to http://scs.edmgr.com/ and log in as an Author. You will see a menu item called "Submission Needing Revision." Please click on this item to obtain your submission record and begin the revision process.

With Kind Regards,

Mutaz B. Habal, M.D.

Editor-in-Chief

Journal of Craniofacial Surgery

Reviewer Comments:

The authors present their experience with four main treatment modalities for T3 and T4 pyriform sinus carcinoma. By comparing their results over 30 years, they found that

combination therapy (XRT then surgery OR surgery then XRT) offered improved survival over XRT or surgery alone. In addition, within the combination therapy groups, patients

who undergo XRT followed by surgery have improved laryngeal function preservation. Given comparable survival and improved functional results, the authors advocate for XRT

followed by surgery for T3 and T4 pyriform sinus carcinoma.

Below are several additional points:

The authors mention it briefly, but selection bias needs to be better addressed in the discussion. For instance, the authors mention that patients undergoing combination therapy are overwhelmingly younger than patients undergoing either surgery or XRT alone while gender, T and N classification did not differ across groups. If available, it would be

beneficial to compare functional status and comorbidities across the four groups. The patients undergoing combination therapy also had lower grade tumors than patients

undergoing single modality therapy. This represents another potential confounder to explain the significantly increased survival from combination therapy.

The authors publish Kaplan-Meier survival curves across all 4 modalities. Given that the XRT alone or surgery alone patients are significantly older at baseline, it is not clear

whether they succumb to their disease or to an unrelated event. It would be beneficial to either specify what proportion of deaths across groups is cancer-related or add graphs and statistics comparing disease-free survival. While the study statistics demonstrating improved survival from combination therapy are very strong, it is not clear if improved

survival is due to the treatment modality or patient selection.

As the authors make a distinction between XRT followed by surgery versus XRT alone and salvage surgery, it is worth mentioning that the improved survival from XRT followed by

surgery may be due to down staging of the cancer.

Complete Revision Instructions:

PRELIMINARY STEPS:

1. Click on the "Submissions Needing Revision" link.

2. To view the previous decision letter and reviewer comments, please click the blue decision term listed under the View Decision menu.

2. If you would like to download the previous manuscript in order to make revisions, click on "Download Files" under the Action menu.

RESUBMISSION STEPS:

3. To BEGIN the RESUBMISSION: Click "Submit Revision" under the Action menu.

4. Proof each screen to ensure the information is still correct (the Title, Authors, etc), then click Next at the bottom of each page.

5. On the Attach Files screen, be sure to click beside each previous submission item that you would like included in the following submission. BE SURE TO CHOOSE TO CARRY OVER YOUR COPYRIGHT FORM.

6. Now, as you did previously, simply upload the parts of your manuscript. When you are finished, please click Next.

7. Click "Build PDF for My Approval."

8. Click "Go to Submissions Waiting for Authors Approval."

9. Wait for the PDF to Build. When it has been built, you will see the link "View Submission" in the Action menu. Click "View Submission," and open the manuscript in order to proof your work.

10. If you find problems with the manuscript, please click "Edit Submission" from the Action menu. Make the appropriate changes, beginning again at step 3.

11. If you find no problems with the manuscript, please click "Approve Submission" from the Action menu. Your re-submission is now complete!“

可以看出这个杂志的审稿人还是认真看了我的稿件的，而且很多意见与 JAMA OTO 以及 Acta Oto-Laryngologica 是一致的。这时候我觉得我为这篇文章付出这么多，还能希望它能够发表。但是要发表，还是得对文章进行较大改动。我总结了七次投稿的审稿意见（其实只有三次给了具体的修改意见），对文章进行了较大的改动，加入术前化疗的病例、重新定义的喉功能保留的概念、找公司对论文进行了润色、突出本文重点是介绍放疗后手术这一综合治疗模式，几乎把文章重新写了一遍。大约十天以后，2014-1-6 号才向杂志社修回稿件，然后就一直没有消息。好在这篇文章不是我主要关注对象，所以也不心焦。过了大约两个月，直到今天（2014-3-17），杂志终于发来了接收函。

总结经验教训：

1、选题错误：首先选择这种泛泛的病例回顾研究本来就很难发高分文章，感觉老外对中国人的文章一向抱有怀疑态度，除非有图片之类的东西支持。而资料详细的少见病研究好像更容易发文章，我之前在 head neck 发表的一篇文章就是因为有术中照片；

2、重视审稿人意见：有三个期刊都回复了详细审稿意见，很多地方都是一致的。比如要求加入术前化疗的病例，但我由于思维受到科室传统治疗模式的限制，总觉得化疗效果有限，不太愿意做太多研究，但事实上国外能发高分的临床研究基本都跟化疗有关。而且如果早点按照审稿意见对文章进行大修的话，说不定还有机会发在更高分的杂志上面，不过这个算是事后诸葛亮哈；

3、最后，坚持就是胜利，与各位战友共勉。