Reviewer ’s report  
 
Title: Elevated preoperative platelet -to-lymphocyte ratio predicts poor prognosis of patients with  
primary gastrointestinal stromal tumor  
 
Version: 0 Date: 13 Apr 2019  
 
Reviewer: Marco Puzzoni  
 
Reviewer's report:  
 
Wei-Long Chang et al. conducted a r etrospective study in patients with GIST who underwent 
surgery from 2005 to 2008. The study aims to evaluate the putative prognostic role of NLR and 
PLR in this setting.  Given the statistical design, the study qualifies as hypothesis -generating 
study. As for methods, the stud y has a good internal validity.  
 
The authors reported that elevations in the NLR (≥2.34) and PLR (≥185.04) were associated with 
shorter RFS and OS (P &lt;0.01) at univariate analysis. Moreover, multivariate analysis revealed 
that elevat ed PLR was an independent factor for poor RFS (hazard ratio [HR]: 3.041; 95% 
confidence interval [CI]: 2.001 -4.622; P &lt;0.001) and OS (HR: 1.899; 95% CI: 1.136 -3.173; 
P=0.014). The study has a good internal consistency in correlating PLR to outcome in the se 
terms.  
 
The study has an undiscussed biological plausibility and a good external validity in correlating 
PLR to outcome. In particular several studies correlated PLR to RFS.  
As for originality, the shorter OS correlated to high PLR in patients with GIST represents the 
new data. The retrospective design of the study prevent us to draw definitive conclusions.  
 
 
In conclusion this is a well -conducted retrospective study, however there is some concerns about 
this manuscript.  
 
1) Outcome data reported  are incom plete. The author should report median OS and median RFS 
values with interval confidence obtained  both in the global population and in the patients with 
high vs low PLR.  
 
2) Given the statistical design, the hypothesis -generating observation derived from t he study 
warrants further prospective investigation to be included in clinical practice. The author should 
emphasize that the retrospective nature of the study prevent us to derive definitive conclusions.  
 
 
 
 
 
 
 
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.  
 
Not relevant to this manuscript  
 
Quality of w ritten English  
Please indicate the quality of language in the manuscript:  
 
Needs some lan guage corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received r eimbursements, 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.  
 
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 wish 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: Elevated preoperative platelet -to-lymphocyte ratio predicts poor prognosis of patients with  
primary gastrointestinal stromal tumor  
 
Version: 0 Date: 13 Apr 2019  
 
Reviewer: Marco Puzzoni  
 
Reviewer's report:  
 
Wei-Long Chang et al. conducted a r etrospective study in patients with GIST who underwent 
surgery from 2005 to 2008. The study aims to evaluate the putative prognostic role of NLR and 
PLR in this setting.  Given the statistical design, the study qualifies as hypothesis -generating 
study. As for methods, the stud y has a good internal validity.  
 
The authors reported that elevations in the NLR (≥2.34) and PLR (≥185.04) were associated with 
shorter RFS and OS (P &lt;0.01) at univariate analysis. Moreover, multivariate analysis revealed 
that elevat ed PLR was an independent factor for poor RFS (hazard ratio [HR]: 3.041; 95% 
confidence interval [CI]: 2.001 -4.622; P &lt;0.001) and OS (HR: 1.899; 95% CI: 1.136 -3.173; 
P=0.014). The study has a good internal consistency in correlating PLR to outcome in the se 
terms.  
 
The study has an undiscussed biological plausibility and a good external validity in correlating 
PLR to outcome. In particular several studies correlated PLR to RFS.  
As for originality, the shorter OS correlated to high PLR in patients with GIST represents the 
new data. The retrospective design of the study prevent us to draw definitive conclusions.  
 
 
In conclusion this is a well -conducted retrospective study, however there is some concerns about 
this manuscript.  
 
1) Outcome data reported  are incom plete. The author should report median OS and median RFS 
values with interval confidence obtained  both in the global population and in the patients with 
high vs low PLR.  
 
2) Given the statistical design, the hypothesis -generating observation derived from t he study 
warrants further prospective investigation to be included in clinical practice. The author should 
emphasize that the retrospective nature of the study prevent us to derive definitive conclusions.  
 
 
 
 
 
 
 
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.  
 
Not relevant to this manuscript  
 
Quality of w ritten English  
Please indicate the quality of language in the manuscript:  
 
Needs some lan guage corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received r eimbursements, 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.  
 
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 wish 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: Elevated preoperative platelet -to-lymphocyte ratio predicts poor prognosis of patients with  
primary gastrointestinal stromal tumor  
 
Version: 0 Date: 13 Apr 2019  
 
Reviewer: Marco Puzzoni  
 
Reviewer's report:  
 
Wei-Long Chang et al. conducted a r etrospective study in patients with GIST who underwent 
surgery from 2005 to 2008. The study aims to evaluate the putative prognostic role of NLR and 
PLR in this setting.  Given the statistical design, the study qualifies as hypothesis -generating 
study. As for methods, the stud y has a good internal validity.  
 
The authors reported that elevations in the NLR (≥2.34) and PLR (≥185.04) were associated with 
shorter RFS and OS (P &lt;0.01) at univariate analysis. Moreover, multivariate analysis revealed 
that elevat ed PLR was an independent factor for poor RFS (hazard ratio [HR]: 3.041; 95% 
confidence interval [CI]: 2.001 -4.622; P &lt;0.001) and OS (HR: 1.899; 95% CI: 1.136 -3.173; 
P=0.014). The study has a good internal consistency in correlating PLR to outcome in the se 
terms.  
 
The study has an undiscussed biological plausibility and a good external validity in correlating 
PLR to outcome. In particular several studies correlated PLR to RFS.  
As for originality, the shorter OS correlated to high PLR in patients with GIST represents the 
new data. The retrospective design of the study prevent us to draw definitive conclusions.  
 
 
In conclusion this is a well -conducted retrospective study, however there is some concerns about 
this manuscript.  
 
1) Outcome data reported  are incom plete. The author should report median OS and median RFS 
values with interval confidence obtained  both in the global population and in the patients with 
high vs low PLR.  
 
2) Given the statistical design, the hypothesis -generating observation derived from t he study 
warrants further prospective investigation to be included in clinical practice. The author should 
emphasize that the retrospective nature of the study prevent us to derive definitive conclusions.  
 
 
 
 
 
 
 
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.  
 
Not relevant to this manuscript  
 
Quality of w ritten English  
Please indicate the quality of language in the manuscript:  
 
Needs some lan guage corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received r eimbursements, 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.  
 
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 wish 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