Reviewer ’s report  
 
Title:  Two staging systems for gastrointestinal stromal tumors in the stomach: Which is better?  
 
Version: 0 Date: 10 Oct 2016 
 
Reviewer:  Francesca  Galuppini  
 
Reviewer’s report:  
 
GENERAL COMMENTS  
 
This retrospective study is aimed to evaluate long -term prognoses of patients who underwent 
surgical resection for gastric GISTs and to compare the clinical efficacy of two stag ing systems: 
the National Institutes of Health (NIH) consensus criteria and the 7th Union for International 
Cancer Control/American Joint Committee on Cancer (UICC/AJCC) tumor -node metastasis 
(TNM) staging system.  
 
The Authors realized an observational retr ospective study including 145 patients who underwent 
curative resection for gastric GISTs. The total follow up time was 44 months on average.  
 
11 recurrent lesions occurred in 9 patients (6.4%). Via multivariate analysis, tumor size (>5 cm), 
mitotic count (>5/50high power field), and epithelioid and mixed pathological type were 
significantly associated with recurrence. Overall 5 -year RFS was 93.4%. Although no 
statistically significant differences were detected (C -statistic difference p = 0.886), all metric s 
showed lower values for the UICC/AJCC TNM staging system than for the NIH consensus 
criteria, indicating that the UICC/AJCC TNM staging system may be a better model.  
 
The manuscript is potentially attractive but there are some concerns.  
 
The major concern s are represented by the selection of patients.  
 
SPECIFIC COMMENTS  
 
TITLE  
 
Adequate  
 
ABSTRACT  
 
The Authors wrote: " Via multivariate analysis, tumor size (>5 cm), mitotic count (>5/high 
power field), and epithelioid and mixed pathological type were significan tly associated with 
recurrence". Please, replace ">5/high power field" with "<5/50 high power field" accordingly 
with the main text.  
 
BACKGROUND  
 
The Authors could explain better the differences between the two staging system.  
 
Please, write the genes' name i n italic.  
 
MATERIAL AND METHODS  
 
The Authors could include molecular informations about the considered samples, if available.  
The Authors should explain their choice to exclude patients with distant metastasis at the time of 
diagnosis.  
 
RESULTS  
 
Please, control the percentages at line 60 pg 6 and line 1 page 7: "According to the 7th 
UICC/AJCC TNM staging system, 89 patients (61.4%) were stage IA, 7 (4.8%) were IB, 34 
(23.4%) were II, 10 (6.9%) were IIIA, and 5 (3.4%) were IIIB.  
 
DISCUSSION  
 
The 5 -year disease free survival rate of patients resulted 93.4%. As the Authors wrote in 
Discussion line 50, page 8, in Literature was reported a percentage of 67,5%. How the Authors 
could explain this discordance?  
 
The difference between the two staging systems i n risk stratification of gastric GISTs resulted no 
statistically significant. The main feature of  UICC/AJCC TNM staging system, compared to 
NIH consensus criteria, is that it considers the primary location of the tumors. It's possible that in 
a series wit h only gastric primitive tumors the differrences between the two systems are not 
assessable? The Authors culd discuss this point.  
 
REFERENCES  
 
Adequate  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relat ion to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review  policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wis h to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title:  Two staging systems for gastrointestinal stromal tumors in the stomach: Which is better?  
 
Version: 0 Date: 10 Oct 2016 
 
Reviewer:  Francesca  Galuppini  
 
Reviewer’s report:  
 
GENERAL COMMENTS  
 
This retrospective study is aimed to evaluate long -term prognoses of patients who underwent 
surgical resection for gastric GISTs and to compare the clinical efficacy of two stag ing systems: 
the National Institutes of Health (NIH) consensus criteria and the 7th Union for International 
Cancer Control/American Joint Committee on Cancer (UICC/AJCC) tumor -node metastasis 
(TNM) staging system.  
 
The Authors realized an observational retr ospective study including 145 patients who underwent 
curative resection for gastric GISTs. The total follow up time was 44 months on average.  
 
11 recurrent lesions occurred in 9 patients (6.4%). Via multivariate analysis, tumor size (>5 cm), 
mitotic count (>5/50high power field), and epithelioid and mixed pathological type were 
significantly associated with recurrence. Overall 5 -year RFS was 93.4%. Although no 
statistically significant differences were detected (C -statistic difference p = 0.886), all metric s 
showed lower values for the UICC/AJCC TNM staging system than for the NIH consensus 
criteria, indicating that the UICC/AJCC TNM staging system may be a better model.  
 
The manuscript is potentially attractive but there are some concerns.  
 
The major concern s are represented by the selection of patients.  
 
SPECIFIC COMMENTS  
 
TITLE  
 
Adequate  
 
ABSTRACT  
 
The Authors wrote: " Via multivariate analysis, tumor size (>5 cm), mitotic count (>5/high 
power field), and epithelioid and mixed pathological type were significan tly associated with 
recurrence". Please, replace ">5/high power field" with "<5/50 high power field" accordingly 
with the main text.  
 
BACKGROUND  
 
The Authors could explain better the differences between the two staging system.  
 
Please, write the genes' name i n italic.  
 
MATERIAL AND METHODS  
 
The Authors could include molecular informations about the considered samples, if available.  
The Authors should explain their choice to exclude patients with distant metastasis at the time of 
diagnosis.  
 
RESULTS  
 
Please, control the percentages at line 60 pg 6 and line 1 page 7: "According to the 7th 
UICC/AJCC TNM staging system, 89 patients (61.4%) were stage IA, 7 (4.8%) were IB, 34 
(23.4%) were II, 10 (6.9%) were IIIA, and 5 (3.4%) were IIIB.  
 
DISCUSSION  
 
The 5 -year disease free survival rate of patients resulted 93.4%. As the Authors wrote in 
Discussion line 50, page 8, in Literature was reported a percentage of 67,5%. How the Authors 
could explain this discordance?  
 
The difference between the two staging systems i n risk stratification of gastric GISTs resulted no 
statistically significant. The main feature of  UICC/AJCC TNM staging system, compared to 
NIH consensus criteria, is that it considers the primary location of the tumors. It's possible that in 
a series wit h only gastric primitive tumors the differrences between the two systems are not 
assessable? The Authors culd discuss this point.  
 
REFERENCES  
 
Adequate  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relat ion to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review  policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wis h to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title:  Two staging systems for gastrointestinal stromal tumors in the stomach: Which is better?  
 
Version: 0 Date: 10 Oct 2016 
 
Reviewer:  Francesca  Galuppini  
 
Reviewer’s report:  
 
GENERAL COMMENTS  
 
This retrospective study is aimed to evaluate long -term prognoses of patients who underwent 
surgical resection for gastric GISTs and to compare the clinical efficacy of two stag ing systems: 
the National Institutes of Health (NIH) consensus criteria and the 7th Union for International 
Cancer Control/American Joint Committee on Cancer (UICC/AJCC) tumor -node metastasis 
(TNM) staging system.  
 
The Authors realized an observational retr ospective study including 145 patients who underwent 
curative resection for gastric GISTs. The total follow up time was 44 months on average.  
 
11 recurrent lesions occurred in 9 patients (6.4%). Via multivariate analysis, tumor size (>5 cm), 
mitotic count (>5/50high power field), and epithelioid and mixed pathological type were 
significantly associated with recurrence. Overall 5 -year RFS was 93.4%. Although no 
statistically significant differences were detected (C -statistic difference p = 0.886), all metric s 
showed lower values for the UICC/AJCC TNM staging system than for the NIH consensus 
criteria, indicating that the UICC/AJCC TNM staging system may be a better model.  
 
The manuscript is potentially attractive but there are some concerns.  
 
The major concern s are represented by the selection of patients.  
 
SPECIFIC COMMENTS  
 
TITLE  
 
Adequate  
 
ABSTRACT  
 
The Authors wrote: " Via multivariate analysis, tumor size (>5 cm), mitotic count (>5/high 
power field), and epithelioid and mixed pathological type were significan tly associated with 
recurrence". Please, replace ">5/high power field" with "<5/50 high power field" accordingly 
with the main text.  
 
BACKGROUND  
 
The Authors could explain better the differences between the two staging system.  
 
Please, write the genes' name i n italic.  
 
MATERIAL AND METHODS  
 
The Authors could include molecular informations about the considered samples, if available.  
The Authors should explain their choice to exclude patients with distant metastasis at the time of 
diagnosis.  
 
RESULTS  
 
Please, control the percentages at line 60 pg 6 and line 1 page 7: "According to the 7th 
UICC/AJCC TNM staging system, 89 patients (61.4%) were stage IA, 7 (4.8%) were IB, 34 
(23.4%) were II, 10 (6.9%) were IIIA, and 5 (3.4%) were IIIB.  
 
DISCUSSION  
 
The 5 -year disease free survival rate of patients resulted 93.4%. As the Authors wrote in 
Discussion line 50, page 8, in Literature was reported a percentage of 67,5%. How the Authors 
could explain this discordance?  
 
The difference between the two staging systems i n risk stratification of gastric GISTs resulted no 
statistically significant. The main feature of  UICC/AJCC TNM staging system, compared to 
NIH consensus criteria, is that it considers the primary location of the tumors. It's possible that in 
a series wit h only gastric primitive tumors the differrences between the two systems are not 
assessable? The Authors culd discuss this point.  
 
REFERENCES  
 
Adequate  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript  or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in a n organisation that may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you currently applying for any patents relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relat ion to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests  
 
I agree to the open peer review  policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wis h to be included in my named report can be included as confidential comments 
to the editors, which will not be published . 
 
I agree to the open peer review policy of the journal  
assistant