Reviewer’s report
Title: 
Trend of geographical distribution of stomach cancer in Iran from 2004-
2014
Version: 
0 
Date: 
14 Apr 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
My overall impression of the study is that similar studies have been published
elsewhere and the authors should clearly justify the current research and focus on
their unique study results. The authors have done well in calculating all the
gastric cancer incidence of each province. 
The Introduction poorly presents the
current understanding of the epidemiology of gastric cancer in Iran. The authors
have omitted several important published papers in this field, such as this one:
Fattahi et al. The national trend of the gastric cancer burden in Iran from 1990 to
2017. Asia Pac J Clin Oncol 2021 Feb 25. DOI: 10.1111/ajco.13563.
REQUESTED REVISIONS: 
The Introduction poorly presents the current understanding of the epidemiology
of gastric cancer in Iran. The authors have omitted several important published
papers in this field. Ref.: Fattahi et al. The national trend of the gastric cancer
burden in Iran from 1990 to 2017. Asia Pac J Clin Oncol 2021 Feb 25. DOI:
10.1111/ajco.13563. 
Page 3, line 39 onward: 'The disease is …. …the second leading cause of death
due to cancer in the world.' is not correct. In 2020, it dropped to No. 3. Stomach
cancers account for the third most common cause of cancer death in 2020
(769,000 deaths). Ref.: Ferlay et al. Cancer statistics for the year 2020: an
overview. Int J Cancer 2021 Apr 5. doi: 10.1002/ijc.33588.
Also, the paper of GLOBOCAN 2020 should be cited. Ref. Sung et al. Global
cancer statistics 2020: GLOBOCAN estimates of incidence and mortality
worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021 Feb 4. doi:
10.3322/caac.21660.
Page 4, line 5: do not capitalize 'Gastric' tumors within a sentence—also Fig 4
caption.
Page 4, Sentences: 'Numerous studies are conducted to identify factors
contributing to stomach cancer in different parts of the world and the results
came out in favor of a wide range of factors including H. Pylori infection,
dietary nitrite, physical inactivity, smoking, alcohol, obesity, radiation, and
family history (6). As a result, mapping incident cases of GC is a very
informative step in better understanding the etiology of the disease.' However,
the current study did not look at all those risks as mentioned above. This should
also be mentioned in the Limitations. 
Fig 4. In-figure text: 'curvature,' not 'curvanture.'
Fig 4. There is a significant issue discovered in the allocating anatomical region
for gastric cancer. In contrast to the fact that the authors have nicely pointed out
the importance of separating gastric cancer into cardiac and non-cardiac, in Fig
4, the authors lumped the cardiac cancer and the fundus cancer together, making
the piece of information useless. I suggest the authors should truthfully present
cardiac only or mixed with ECJ (= EGJ) (probably allocated to the overlapping
site by the authors) instead of presenting the result together with fundus located
cancer. 
Limitations section: It is nice when the authors want to present the limitations of
the study. However, what were those specific limitations were not shown. The
language the authors use in this paragraph is very implicit. The authors should
mention the limitations, such as lacking information about H. pylori information,
cancer stage information, and the histopathological type (enteral or diffuse)
available for analysis. 
Page 6, line 20: a typo: 'alcho'
Page 6, line 37 onward and other paragraphs: please do not capitalize
'Esophageal cancer' within a sentence.
Publons Reviewer Recognition
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review directly to Publons (a subsidiary of Clarivate Analytics). If you would
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find the details of processing in Publons’ privacy policy
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No
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 an 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 relation 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Trend of geographical distribution of stomach cancer in Iran from 2004-
2014
Version: 
0 
Date: 
14 Apr 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
My overall impression of the study is that similar studies have been published
elsewhere and the authors should clearly justify the current research and focus on
their unique study results. The authors have done well in calculating all the
gastric cancer incidence of each province. 
The Introduction poorly presents the
current understanding of the epidemiology of gastric cancer in Iran. The authors
have omitted several important published papers in this field, such as this one:
Fattahi et al. The national trend of the gastric cancer burden in Iran from 1990 to
2017. Asia Pac J Clin Oncol 2021 Feb 25. DOI: 10.1111/ajco.13563.
REQUESTED REVISIONS: 
The Introduction poorly presents the current understanding of the epidemiology
of gastric cancer in Iran. The authors have omitted several important published
papers in this field. Ref.: Fattahi et al. The national trend of the gastric cancer
burden in Iran from 1990 to 2017. Asia Pac J Clin Oncol 2021 Feb 25. DOI:
10.1111/ajco.13563. 
Page 3, line 39 onward: 'The disease is …. …the second leading cause of death
due to cancer in the world.' is not correct. In 2020, it dropped to No. 3. Stomach
cancers account for the third most common cause of cancer death in 2020
(769,000 deaths). Ref.: Ferlay et al. Cancer statistics for the year 2020: an
overview. Int J Cancer 2021 Apr 5. doi: 10.1002/ijc.33588.
Also, the paper of GLOBOCAN 2020 should be cited. Ref. Sung et al. Global
cancer statistics 2020: GLOBOCAN estimates of incidence and mortality
worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021 Feb 4. doi:
10.3322/caac.21660.
Page 4, line 5: do not capitalize 'Gastric' tumors within a sentence—also Fig 4
caption.
Page 4, Sentences: 'Numerous studies are conducted to identify factors
contributing to stomach cancer in different parts of the world and the results
came out in favor of a wide range of factors including H. Pylori infection,
dietary nitrite, physical inactivity, smoking, alcohol, obesity, radiation, and
family history (6). As a result, mapping incident cases of GC is a very
informative step in better understanding the etiology of the disease.' However,
the current study did not look at all those risks as mentioned above. This should
also be mentioned in the Limitations. 
Fig 4. In-figure text: 'curvature,' not 'curvanture.'
Fig 4. There is a significant issue discovered in the allocating anatomical region
for gastric cancer. In contrast to the fact that the authors have nicely pointed out
the importance of separating gastric cancer into cardiac and non-cardiac, in Fig
4, the authors lumped the cardiac cancer and the fundus cancer together, making
the piece of information useless. I suggest the authors should truthfully present
cardiac only or mixed with ECJ (= EGJ) (probably allocated to the overlapping
site by the authors) instead of presenting the result together with fundus located
cancer. 
Limitations section: It is nice when the authors want to present the limitations of
the study. However, what were those specific limitations were not shown. The
language the authors use in this paragraph is very implicit. The authors should
mention the limitations, such as lacking information about H. pylori information,
cancer stage information, and the histopathological type (enteral or diffuse)
available for analysis. 
Page 6, line 20: a typo: 'alcho'
Page 6, line 37 onward and other paragraphs: please do not capitalize
'Esophageal cancer' within a sentence.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 an 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 relation 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Trend of geographical distribution of stomach cancer in Iran from 2004-
2014
Version: 
0 
Date: 
14 Apr 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are minor issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are minor issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
My overall impression of the study is that similar studies have been published
elsewhere and the authors should clearly justify the current research and focus on
their unique study results. The authors have done well in calculating all the
gastric cancer incidence of each province. 
The Introduction poorly presents the
current understanding of the epidemiology of gastric cancer in Iran. The authors
have omitted several important published papers in this field, such as this one:
Fattahi et al. The national trend of the gastric cancer burden in Iran from 1990 to
2017. Asia Pac J Clin Oncol 2021 Feb 25. DOI: 10.1111/ajco.13563.
REQUESTED REVISIONS: 
The Introduction poorly presents the current understanding of the epidemiology
of gastric cancer in Iran. The authors have omitted several important published
papers in this field. Ref.: Fattahi et al. The national trend of the gastric cancer
burden in Iran from 1990 to 2017. Asia Pac J Clin Oncol 2021 Feb 25. DOI:
10.1111/ajco.13563. 
Page 3, line 39 onward: 'The disease is …. …the second leading cause of death
due to cancer in the world.' is not correct. In 2020, it dropped to No. 3. Stomach
cancers account for the third most common cause of cancer death in 2020
(769,000 deaths). Ref.: Ferlay et al. Cancer statistics for the year 2020: an
overview. Int J Cancer 2021 Apr 5. doi: 10.1002/ijc.33588.
Also, the paper of GLOBOCAN 2020 should be cited. Ref. Sung et al. Global
cancer statistics 2020: GLOBOCAN estimates of incidence and mortality
worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021 Feb 4. doi:
10.3322/caac.21660.
Page 4, line 5: do not capitalize 'Gastric' tumors within a sentence—also Fig 4
caption.
Page 4, Sentences: 'Numerous studies are conducted to identify factors
contributing to stomach cancer in different parts of the world and the results
came out in favor of a wide range of factors including H. Pylori infection,
dietary nitrite, physical inactivity, smoking, alcohol, obesity, radiation, and
family history (6). As a result, mapping incident cases of GC is a very
informative step in better understanding the etiology of the disease.' However,
the current study did not look at all those risks as mentioned above. This should
also be mentioned in the Limitations. 
Fig 4. In-figure text: 'curvature,' not 'curvanture.'
Fig 4. There is a significant issue discovered in the allocating anatomical region
for gastric cancer. In contrast to the fact that the authors have nicely pointed out
the importance of separating gastric cancer into cardiac and non-cardiac, in Fig
4, the authors lumped the cardiac cancer and the fundus cancer together, making
the piece of information useless. I suggest the authors should truthfully present
cardiac only or mixed with ECJ (= EGJ) (probably allocated to the overlapping
site by the authors) instead of presenting the result together with fundus located
cancer. 
Limitations section: It is nice when the authors want to present the limitations of
the study. However, what were those specific limitations were not shown. The
language the authors use in this paragraph is very implicit. The authors should
mention the limitations, such as lacking information about H. pylori information,
cancer stage information, and the histopathological type (enteral or diffuse)
available for analysis. 
Page 6, line 20: a typo: 'alcho'
Page 6, line 37 onward and other paragraphs: please do not capitalize
'Esophageal cancer' within a sentence.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons after the final decision on the manuscript has been made. If you have
already registered at Publons, they will notify you of the receipt of this review
and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to
register in order for them to be able to recognize your review on your new
profile page. Publons may use the Review Data to generate derivative metadata
for the benefit of Publons and you as a reviewer, carefully considering the
sensitivity of such information. For example, Publons may verify your record as
a reviewer by updating your profile published on its webservice if you have
registered for such service or help editors to identify candidate reviewers. Please
find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
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 an 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 relation 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.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 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
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the
editorial office before completing the review.
If you wish, you can include your
name in your published report. Please note you must decide whether to include
your name at the start of the process and confirm this decision whenever
prompted. If you change your decision later, we will not be able to publish your
name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant