Title: Comparison of Outcomes Between Surgery and Non-Surgery After Conversion Therapy
for Advanced Gastric Cancer with Unresectable Factors: A Systematic Review and Meta-
Analysis
Version: 1 Date: 23 Feb 2025
Reviewer's report:
I have the following concerns about this manuscript and hope that the author to clarify.
1. The author needs to make adjustments to the format of this manuscript. When inserting a
(Figure), there should be a space. The same issue applies to, for example, the PRISMA flow
diagram. Could you please leave a blank line before each title?
2. It is not mentioned in the manuscript whether the clinical trial registration repositories
(ClinicalTrials.gov) or the grey literature have been searched. This may potentially lead to the
publication bias.
3. All the included studies are NRCTs, and no RCTs are included. Did the author attempt to
search for RCTs? If no RCTs were found, the author should discuss the impact of potential
biases of NRCTs on the results.
4. The NOS#7 points was used as the inclusion criterion, but the specific scoring details of each
study were not specified. The author is required to provide the detailed scoring results of each
study.
5. High heterogeneity was observed in some of the analyses. The author reduced the
heterogeneity by excluding some studies through sensitivity analysis. Are there any
methodological differences in these excluded studies? Can the potential sources of heterogeneity
be further explored?
6. For some analyses with relatively low heterogeneity (such as 1-year OS, the I² value was
not clearly reported), the author needs to clearly report all the heterogeneity in the results and
explicitly explain the applicability of the fixed-effect model.
7. The RR of 1-year OS is 0.38 (95% CI: 0.31–0.47), indicating a significant reduction in the
risk of death in the surgical group. However, is the HR more suitable for survival analysis? Has
the possibility of using HR instead of RR been considered to improve the clinical interpretability
of the results?
8. In the analysis of 3-year OS, the heterogeneity decreased after excluding the studies by Li
(2021) and Liang (2023). Could you provide a more detailed explanation of the reasons?
9. There was no significant difference in the CR rate, while the PR rate was significantly
increased. The author needs to explore the potential reasons for this contradictory result.
10. The author did not provide supplementary materials for the specific search strategy or
screening process. Will the complete search formula or the original screening records be
provided?
Title: Comparison of Outcomes Between Surgery and Non-Surgery After Conversion Therapy
for Advanced Gastric Cancer with Unresectable Factors: A Systematic Review and Meta-
Analysis
Version: 1 Date: 23 Feb 2025
Reviewer's report:
I have the following concerns about this manuscript and hope that the author to clarify.
1. The author needs to make adjustments to the format of this manuscript. When inserting a
(Figure), there should be a space. The same issue applies to, for example, the PRISMA flow
diagram. Could you please leave a blank line before each title?
2. It is not mentioned in the manuscript whether the clinical trial registration repositories
(ClinicalTrials.gov) or the grey literature have been searched. This may potentially lead to the
publication bias.
3. All the included studies are NRCTs, and no RCTs are included. Did the author attempt to
search for RCTs? If no RCTs were found, the author should discuss the impact of potential
biases of NRCTs on the results.
4. The NOS#7 points was used as the inclusion criterion, but the specific scoring details of each
study were not specified. The author is required to provide the detailed scoring results of each
study.
5. High heterogeneity was observed in some of the analyses. The author reduced the
heterogeneity by excluding some studies through sensitivity analysis. Are there any
methodological differences in these excluded studies? Can the potential sources of heterogeneity
be further explored?
6. For some analyses with relatively low heterogeneity (such as 1-year OS, the I² value was
not clearly reported), the author needs to clearly report all the heterogeneity in the results and
explicitly explain the applicability of the fixed-effect model.
7. The RR of 1-year OS is 0.38 (95% CI: 0.31–0.47), indicating a significant reduction in the
risk of death in the surgical group. However, is the HR more suitable for survival analysis? Has
the possibility of using HR instead of RR been considered to improve the clinical interpretability
of the results?
8. In the analysis of 3-year OS, the heterogeneity decreased after excluding the studies by Li
(2021) and Liang (2023). Could you provide a more detailed explanation of the reasons?
9. There was no significant difference in the CR rate, while the PR rate was significantly
increased. The author needs to explore the potential reasons for this contradictory result.
10. The author did not provide supplementary materials for the specific search strategy or
screening process. Will the complete search formula or the original screening records be
provided?
Please review this paper.
user
Title: Comparison of Outcomes Between Surgery and Non-Surgery After Conversion Therapy
for Advanced Gastric Cancer with Unresectable Factors: A Systematic Review and Meta-
Analysis
Version: 1 Date: 23 Feb 2025
Reviewer's report:
I have the following concerns about this manuscript and hope that the author to clarify.
1. The author needs to make adjustments to the format of this manuscript. When inserting a
(Figure), there should be a space. The same issue applies to, for example, the PRISMA flow
diagram. Could you please leave a blank line before each title?
2. It is not mentioned in the manuscript whether the clinical trial registration repositories
(ClinicalTrials.gov) or the grey literature have been searched. This may potentially lead to the
publication bias.
3. All the included studies are NRCTs, and no RCTs are included. Did the author attempt to
search for RCTs? If no RCTs were found, the author should discuss the impact of potential
biases of NRCTs on the results.
4. The NOS#7 points was used as the inclusion criterion, but the specific scoring details of each
study were not specified. The author is required to provide the detailed scoring results of each
study.
5. High heterogeneity was observed in some of the analyses. The author reduced the
heterogeneity by excluding some studies through sensitivity analysis. Are there any
methodological differences in these excluded studies? Can the potential sources of heterogeneity
be further explored?
6. For some analyses with relatively low heterogeneity (such as 1-year OS, the I² value was
not clearly reported), the author needs to clearly report all the heterogeneity in the results and
explicitly explain the applicability of the fixed-effect model.
7. The RR of 1-year OS is 0.38 (95% CI: 0.31–0.47), indicating a significant reduction in the
risk of death in the surgical group. However, is the HR more suitable for survival analysis? Has
the possibility of using HR instead of RR been considered to improve the clinical interpretability
of the results?
8. In the analysis of 3-year OS, the heterogeneity decreased after excluding the studies by Li
(2021) and Liang (2023). Could you provide a more detailed explanation of the reasons?
9. There was no significant difference in the CR rate, while the PR rate was significantly
increased. The author needs to explore the potential reasons for this contradictory result.
10. The author did not provide supplementary materials for the specific search strategy or
screening process. Will the complete search formula or the original screening records be
provided?
assistant