Title: Inflammatory and Nutritional Markers Predict Response and Prognosis of Patients with
Locally Advanced Gastric Cancer Receiving Neoadjuvant Immunochemotherapy
Version: 0 Date: 09 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the study focuses on patients who received neoadjuvant immunochemotherapy, a lack
of a control group that did not receive this treatment limits the ability to attribute the observed
outcomes to the treatment alone definitively. Including a comparison group could strengthen the
conclusions drawn from the analysis.
-The study excluded patients with certain conditions (e.g., preoperative parenteral nutrition,
distant metastasis, and other tumors), which may introduce selection bias. These exclusions are
justifiable, but it should be acknowledged that the results may not be generalizable to patients
with more complex comorbidities or advanced disease.
-The study focuses on inflammatory and nutritional markers, but it does not delve deeply into the
biological mechanisms behind how these markers affect tumor behavior or treatment response.
A more detailed exploration of the molecular or immunological processes could offer additional
insights into the potential pathways involved.
-While the use of statistical models (e.g., nomogram construction) is commendable, there is a risk
of overfitting when developing predictive models based on a relatively small cohort. The clinical
applicability of such models may be limited without further validation in external, independent
cohorts.
-Although the study was approved by an ethics committee, the study design and exclusion
criteria may limit the generalizability of the findings to other populations, especially those in
different geographical regions or with distinct clinical characteristics.
-While the study offers strong correlations between the CONUT-NRS2002 score and tumor
regression, the lack of mechanistic studies or validation experiments makes it difficult to fully
establish causality. Understanding how these markers influence the immune and nutritional
status in response to immunochemotherapy would provide deeper insight into the biological
processes behind these associations.
-The discussion mentions the optimal cut-off values for the CONUT-NRS2002 score but does
not provide further details on how these values were determined. A more detailed explanation
of the cut-off determination process (e.g., statistical methods, clinical significance) would help
readers understand the robustness and clinical relevance of the score.
-While the discussion does mention future studies, there is little information on potential follow-
up studies or how this research could evolve in the coming years. Given the potential importance
of this combined scoring system, future prospective studies are crucial for refining and validating
the model.
Title: Inflammatory and Nutritional Markers Predict Response and Prognosis of Patients with
Locally Advanced Gastric Cancer Receiving Neoadjuvant Immunochemotherapy
Version: 0 Date: 09 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the study focuses on patients who received neoadjuvant immunochemotherapy, a lack
of a control group that did not receive this treatment limits the ability to attribute the observed
outcomes to the treatment alone definitively. Including a comparison group could strengthen the
conclusions drawn from the analysis.
-The study excluded patients with certain conditions (e.g., preoperative parenteral nutrition,
distant metastasis, and other tumors), which may introduce selection bias. These exclusions are
justifiable, but it should be acknowledged that the results may not be generalizable to patients
with more complex comorbidities or advanced disease.
-The study focuses on inflammatory and nutritional markers, but it does not delve deeply into the
biological mechanisms behind how these markers affect tumor behavior or treatment response.
A more detailed exploration of the molecular or immunological processes could offer additional
insights into the potential pathways involved.
-While the use of statistical models (e.g., nomogram construction) is commendable, there is a risk
of overfitting when developing predictive models based on a relatively small cohort. The clinical
applicability of such models may be limited without further validation in external, independent
cohorts.
-Although the study was approved by an ethics committee, the study design and exclusion
criteria may limit the generalizability of the findings to other populations, especially those in
different geographical regions or with distinct clinical characteristics.
-While the study offers strong correlations between the CONUT-NRS2002 score and tumor
regression, the lack of mechanistic studies or validation experiments makes it difficult to fully
establish causality. Understanding how these markers influence the immune and nutritional
status in response to immunochemotherapy would provide deeper insight into the biological
processes behind these associations.
-The discussion mentions the optimal cut-off values for the CONUT-NRS2002 score but does
not provide further details on how these values were determined. A more detailed explanation
of the cut-off determination process (e.g., statistical methods, clinical significance) would help
readers understand the robustness and clinical relevance of the score.
-While the discussion does mention future studies, there is little information on potential follow-
up studies or how this research could evolve in the coming years. Given the potential importance
of this combined scoring system, future prospective studies are crucial for refining and validating
the model.
Please review this paper.
user
Title: Inflammatory and Nutritional Markers Predict Response and Prognosis of Patients with
Locally Advanced Gastric Cancer Receiving Neoadjuvant Immunochemotherapy
Version: 0 Date: 09 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While the study focuses on patients who received neoadjuvant immunochemotherapy, a lack
of a control group that did not receive this treatment limits the ability to attribute the observed
outcomes to the treatment alone definitively. Including a comparison group could strengthen the
conclusions drawn from the analysis.
-The study excluded patients with certain conditions (e.g., preoperative parenteral nutrition,
distant metastasis, and other tumors), which may introduce selection bias. These exclusions are
justifiable, but it should be acknowledged that the results may not be generalizable to patients
with more complex comorbidities or advanced disease.
-The study focuses on inflammatory and nutritional markers, but it does not delve deeply into the
biological mechanisms behind how these markers affect tumor behavior or treatment response.
A more detailed exploration of the molecular or immunological processes could offer additional
insights into the potential pathways involved.
-While the use of statistical models (e.g., nomogram construction) is commendable, there is a risk
of overfitting when developing predictive models based on a relatively small cohort. The clinical
applicability of such models may be limited without further validation in external, independent
cohorts.
-Although the study was approved by an ethics committee, the study design and exclusion
criteria may limit the generalizability of the findings to other populations, especially those in
different geographical regions or with distinct clinical characteristics.
-While the study offers strong correlations between the CONUT-NRS2002 score and tumor
regression, the lack of mechanistic studies or validation experiments makes it difficult to fully
establish causality. Understanding how these markers influence the immune and nutritional
status in response to immunochemotherapy would provide deeper insight into the biological
processes behind these associations.
-The discussion mentions the optimal cut-off values for the CONUT-NRS2002 score but does
not provide further details on how these values were determined. A more detailed explanation
of the cut-off determination process (e.g., statistical methods, clinical significance) would help
readers understand the robustness and clinical relevance of the score.
-While the discussion does mention future studies, there is little information on potential follow-
up studies or how this research could evolve in the coming years. Given the potential importance
of this combined scoring system, future prospective studies are crucial for refining and validating
the model.
assistant