Title: Prognostic nutritional index is an independent prognostic factor for older patients aged
#85 years treated by gastric endoscopic submucosal dissection
Version: 2 Date: 19 May 2021
Reviewer's report:
In this article, the authors analyzed an aged population cohort who underwent gastric ESD for
early gastric cancer. The authors attempted to explore independent prognostic factors for these
patients, and they concluded PNI was the only factor after multivariate analysis.
I have several concerns for this study:
1. While the study is methodologically acceptable, it has no remarkable novelty compared to
other previous studies (Iwai et al, digestive endoscopy 2017, DOI: doi:10.1111/den.13051 and
Sekiguchi et al, GIE 2017, DOI: doi:10.1016/j.gie.2016.10.013). The authors have to think about
more adding value for future clinical practice.
2. Since PNI is determined by albumin and lymphocyte level, I am curious that albumin level
has not been considered as one of the clinical factor in this study (and previous studies!). On
the one hand, PNI may have confounding by albumin level; on the other hand, if albumin level
is predictive for OS, it is much more simpler to use. I strongly recommend the authors should
add this analysis.
3. The authors may have more discussion for the rationale about the predictive value from PNI.
Title: Prognostic nutritional index is an independent prognostic factor for older patients aged
#85 years treated by gastric endoscopic submucosal dissection
Version: 2 Date: 19 May 2021
Reviewer's report:
In this article, the authors analyzed an aged population cohort who underwent gastric ESD for
early gastric cancer. The authors attempted to explore independent prognostic factors for these
patients, and they concluded PNI was the only factor after multivariate analysis.
I have several concerns for this study:
1. While the study is methodologically acceptable, it has no remarkable novelty compared to
other previous studies (Iwai et al, digestive endoscopy 2017, DOI: doi:10.1111/den.13051 and
Sekiguchi et al, GIE 2017, DOI: doi:10.1016/j.gie.2016.10.013). The authors have to think about
more adding value for future clinical practice.
2. Since PNI is determined by albumin and lymphocyte level, I am curious that albumin level
has not been considered as one of the clinical factor in this study (and previous studies!). On
the one hand, PNI may have confounding by albumin level; on the other hand, if albumin level
is predictive for OS, it is much more simpler to use. I strongly recommend the authors should
add this analysis.
3. The authors may have more discussion for the rationale about the predictive value from PNI.
Please review this paper.
user
Title: Prognostic nutritional index is an independent prognostic factor for older patients aged
#85 years treated by gastric endoscopic submucosal dissection
Version: 2 Date: 19 May 2021
Reviewer's report:
In this article, the authors analyzed an aged population cohort who underwent gastric ESD for
early gastric cancer. The authors attempted to explore independent prognostic factors for these
patients, and they concluded PNI was the only factor after multivariate analysis.
I have several concerns for this study:
1. While the study is methodologically acceptable, it has no remarkable novelty compared to
other previous studies (Iwai et al, digestive endoscopy 2017, DOI: doi:10.1111/den.13051 and
Sekiguchi et al, GIE 2017, DOI: doi:10.1016/j.gie.2016.10.013). The authors have to think about
more adding value for future clinical practice.
2. Since PNI is determined by albumin and lymphocyte level, I am curious that albumin level
has not been considered as one of the clinical factor in this study (and previous studies!). On
the one hand, PNI may have confounding by albumin level; on the other hand, if albumin level
is predictive for OS, it is much more simpler to use. I strongly recommend the authors should
add this analysis.
3. The authors may have more discussion for the rationale about the predictive value from PNI.
assistant