Title: Clinicopathological features of early-onset colorectal cancer in Japanese patients: A
single-center retrospective study
Version: 2 Date: 05 Jan 2025
Reviewer's report:
This study investigates the clinicopathological characteristics of early-onset colorectal cancer
(EoCRC) in Japanese patients, defined as CRC diagnosed before the age of 50. By
retrospectively analyzing 731 patients diagnosed between 2015 and 2021, the authors found
that EoCRC accounted for 6.3% of cases, with a higher prevalence of rectal cancer compared
to late-onset CRC (45.7% vs. 26.4%, p < 0.001). Additionally, 41.3% of EoCRC patients were
diagnosed through fecal immunochemical test (FIT) screening, which was significantly higher
than in late-onset cases (p = 0.032) and associated with earlier stage detection. The study
highlights the potential role of FIT screening in facilitating early diagnosis of EoCRC and
suggests that symptomatic presentation often corresponds with advanced disease stages.
Questions:
1.The age cutoff used to define early-onset and late-onset CRC lacks support from relevant
literature; it is recommended to provide references to justify this choice. Additionally, the large
disparity between the two groups makes it challenging to draw robust conclusions for readers.
2.The statistical analysis of median age differences appears redundant, as the result is predictably
significant.
3.The statistical models employed in this study seem to be univariate. It is suggested to use
multivariate analyses to account for potential confounding factors.
4.Regarding the survival analysis comparison between the two groups, a challenge often faced in
similar studies is the inherent difference in life expectancy between older and younger patients
(though Japan’s high average life expectancy may mitigate this). The comparison of survival
outcomes thus becomes less reliable. Presenting data on deaths due to non-cancer causes could
help address the bias introduced by the older age group.
5.In presenting survival analysis, as all results are negative (albeit approaching significance),
it is still recommended to report specific survival rates at fixed time points (e.g., 3 years or 5
years) for both groups.
6.The study’s conclusions do not provide clinically significant results regarding the treatment of
the two patient groups, likely due to the severe distribution bias in the population. The primary
positive findings relate to the early detection and treatment of CRC. It is recommended to
expand the discussion to include topics such as public health screening, screening compliance,
or health awareness to emphasize the study’s strengths. For example, the higher prevalence of
rectal cancer in younger patients suggests the importance of digital rectal examinations for at-
risk populations.
6.The aesthetic quality of the figures is suboptimal and affects the overall visual appeal. It is
recommended to use programming software or specialized tools to enhance the graphics.
In summary, the study holds potential clinical application value, and its conclusions offer
guidance for public health policy and screening strategies.
Title: Clinicopathological features of early-onset colorectal cancer in Japanese patients: A
single-center retrospective study
Version: 2 Date: 05 Jan 2025
Reviewer's report:
This study investigates the clinicopathological characteristics of early-onset colorectal cancer
(EoCRC) in Japanese patients, defined as CRC diagnosed before the age of 50. By
retrospectively analyzing 731 patients diagnosed between 2015 and 2021, the authors found
that EoCRC accounted for 6.3% of cases, with a higher prevalence of rectal cancer compared
to late-onset CRC (45.7% vs. 26.4%, p < 0.001). Additionally, 41.3% of EoCRC patients were
diagnosed through fecal immunochemical test (FIT) screening, which was significantly higher
than in late-onset cases (p = 0.032) and associated with earlier stage detection. The study
highlights the potential role of FIT screening in facilitating early diagnosis of EoCRC and
suggests that symptomatic presentation often corresponds with advanced disease stages.
Questions:
1.The age cutoff used to define early-onset and late-onset CRC lacks support from relevant
literature; it is recommended to provide references to justify this choice. Additionally, the large
disparity between the two groups makes it challenging to draw robust conclusions for readers.
2.The statistical analysis of median age differences appears redundant, as the result is predictably
significant.
3.The statistical models employed in this study seem to be univariate. It is suggested to use
multivariate analyses to account for potential confounding factors.
4.Regarding the survival analysis comparison between the two groups, a challenge often faced in
similar studies is the inherent difference in life expectancy between older and younger patients
(though Japan’s high average life expectancy may mitigate this). The comparison of survival
outcomes thus becomes less reliable. Presenting data on deaths due to non-cancer causes could
help address the bias introduced by the older age group.
5.In presenting survival analysis, as all results are negative (albeit approaching significance),
it is still recommended to report specific survival rates at fixed time points (e.g., 3 years or 5
years) for both groups.
6.The study’s conclusions do not provide clinically significant results regarding the treatment of
the two patient groups, likely due to the severe distribution bias in the population. The primary
positive findings relate to the early detection and treatment of CRC. It is recommended to
expand the discussion to include topics such as public health screening, screening compliance,
or health awareness to emphasize the study’s strengths. For example, the higher prevalence of
rectal cancer in younger patients suggests the importance of digital rectal examinations for at-
risk populations.
6.The aesthetic quality of the figures is suboptimal and affects the overall visual appeal. It is
recommended to use programming software or specialized tools to enhance the graphics.
In summary, the study holds potential clinical application value, and its conclusions offer
guidance for public health policy and screening strategies.
Please review this paper.
user
Title: Clinicopathological features of early-onset colorectal cancer in Japanese patients: A
single-center retrospective study
Version: 2 Date: 05 Jan 2025
Reviewer's report:
This study investigates the clinicopathological characteristics of early-onset colorectal cancer
(EoCRC) in Japanese patients, defined as CRC diagnosed before the age of 50. By
retrospectively analyzing 731 patients diagnosed between 2015 and 2021, the authors found
that EoCRC accounted for 6.3% of cases, with a higher prevalence of rectal cancer compared
to late-onset CRC (45.7% vs. 26.4%, p < 0.001). Additionally, 41.3% of EoCRC patients were
diagnosed through fecal immunochemical test (FIT) screening, which was significantly higher
than in late-onset cases (p = 0.032) and associated with earlier stage detection. The study
highlights the potential role of FIT screening in facilitating early diagnosis of EoCRC and
suggests that symptomatic presentation often corresponds with advanced disease stages.
Questions:
1.The age cutoff used to define early-onset and late-onset CRC lacks support from relevant
literature; it is recommended to provide references to justify this choice. Additionally, the large
disparity between the two groups makes it challenging to draw robust conclusions for readers.
2.The statistical analysis of median age differences appears redundant, as the result is predictably
significant.
3.The statistical models employed in this study seem to be univariate. It is suggested to use
multivariate analyses to account for potential confounding factors.
4.Regarding the survival analysis comparison between the two groups, a challenge often faced in
similar studies is the inherent difference in life expectancy between older and younger patients
(though Japan’s high average life expectancy may mitigate this). The comparison of survival
outcomes thus becomes less reliable. Presenting data on deaths due to non-cancer causes could
help address the bias introduced by the older age group.
5.In presenting survival analysis, as all results are negative (albeit approaching significance),
it is still recommended to report specific survival rates at fixed time points (e.g., 3 years or 5
years) for both groups.
6.The study’s conclusions do not provide clinically significant results regarding the treatment of
the two patient groups, likely due to the severe distribution bias in the population. The primary
positive findings relate to the early detection and treatment of CRC. It is recommended to
expand the discussion to include topics such as public health screening, screening compliance,
or health awareness to emphasize the study’s strengths. For example, the higher prevalence of
rectal cancer in younger patients suggests the importance of digital rectal examinations for at-
risk populations.
6.The aesthetic quality of the figures is suboptimal and affects the overall visual appeal. It is
recommended to use programming software or specialized tools to enhance the graphics.
In summary, the study holds potential clinical application value, and its conclusions offer
guidance for public health policy and screening strategies.
assistant