Title: The Prognostic Value of Indoleamine 2,3-dioxygenase in Colorectal Cancer: A
Systematic Review and Meta-analysis
Version: 0 Date: 28 Apr 2025
Reviewer's report:
Comments to Authors
This manuscript presents a systematic review and meta-analysis evaluating the prognostic
significance of IDO expression in colorectal cancer (CRC). The topic is important and the study
is generally well-structured; however, a few areas would benefit from clarification and further
elaboration to strengthen the manuscript. We respectfully suggest addressing the following
points.
1. In the Abstract, the number of included patients is reported as 2,174, while in the Results
section (3.1) it is stated as 2,334. Additionally, Table 1 presents two studies by Julia Schollbach
with identical sample sizes and characteristics, which may suggest possible overlap. It would
be helpful if the authors could clarify the total number of participants and confirm whether any
overlapping datasets were included, to ensure transparency and avoid potential bias.
2. There appears to be some inconsistency regarding the interpretation of HR values in the
manuscript. In certain sections, HR < 1 is associated with poorer prognosis, while elsewhere,
HR > 1 is interpreted as unfavorable. We recommend clearly defining the interpretation of HRs
in the Methods section and applying this consistently throughout the text, which would enhance
clarity for readers.
3. Although significant heterogeneity (I² > 80%) was observed, only subgroup analyses were
conducted to explore its sources. The authors may wish to consider discussing why meta-
regression analysis was not pursued and whether factors such as geographic region, detection
method, or sample size might account for some of the observed variability. This additional
discussion could further strengthen the robustness of the findings.
4. In the Discussion section, the manuscript suggests that elevated IDO expression may be
associated with improved prognosis via immune modulation. However, the meta-analysis
findings indicate an association between high IDO levels and worse DFS and metastasis. It
would be helpful if the authors could more clearly reconcile these points, perhaps by discussing
potential context-dependent effects of IDO in CRC progression.
Title: The Prognostic Value of Indoleamine 2,3-dioxygenase in Colorectal Cancer: A
Systematic Review and Meta-analysis
Version: 0 Date: 28 Apr 2025
Reviewer's report:
Comments to Authors
This manuscript presents a systematic review and meta-analysis evaluating the prognostic
significance of IDO expression in colorectal cancer (CRC). The topic is important and the study
is generally well-structured; however, a few areas would benefit from clarification and further
elaboration to strengthen the manuscript. We respectfully suggest addressing the following
points.
1. In the Abstract, the number of included patients is reported as 2,174, while in the Results
section (3.1) it is stated as 2,334. Additionally, Table 1 presents two studies by Julia Schollbach
with identical sample sizes and characteristics, which may suggest possible overlap. It would
be helpful if the authors could clarify the total number of participants and confirm whether any
overlapping datasets were included, to ensure transparency and avoid potential bias.
2. There appears to be some inconsistency regarding the interpretation of HR values in the
manuscript. In certain sections, HR < 1 is associated with poorer prognosis, while elsewhere,
HR > 1 is interpreted as unfavorable. We recommend clearly defining the interpretation of HRs
in the Methods section and applying this consistently throughout the text, which would enhance
clarity for readers.
3. Although significant heterogeneity (I² > 80%) was observed, only subgroup analyses were
conducted to explore its sources. The authors may wish to consider discussing why meta-
regression analysis was not pursued and whether factors such as geographic region, detection
method, or sample size might account for some of the observed variability. This additional
discussion could further strengthen the robustness of the findings.
4. In the Discussion section, the manuscript suggests that elevated IDO expression may be
associated with improved prognosis via immune modulation. However, the meta-analysis
findings indicate an association between high IDO levels and worse DFS and metastasis. It
would be helpful if the authors could more clearly reconcile these points, perhaps by discussing
potential context-dependent effects of IDO in CRC progression.
Please review this paper.
user
Title: The Prognostic Value of Indoleamine 2,3-dioxygenase in Colorectal Cancer: A
Systematic Review and Meta-analysis
Version: 0 Date: 28 Apr 2025
Reviewer's report:
Comments to Authors
This manuscript presents a systematic review and meta-analysis evaluating the prognostic
significance of IDO expression in colorectal cancer (CRC). The topic is important and the study
is generally well-structured; however, a few areas would benefit from clarification and further
elaboration to strengthen the manuscript. We respectfully suggest addressing the following
points.
1. In the Abstract, the number of included patients is reported as 2,174, while in the Results
section (3.1) it is stated as 2,334. Additionally, Table 1 presents two studies by Julia Schollbach
with identical sample sizes and characteristics, which may suggest possible overlap. It would
be helpful if the authors could clarify the total number of participants and confirm whether any
overlapping datasets were included, to ensure transparency and avoid potential bias.
2. There appears to be some inconsistency regarding the interpretation of HR values in the
manuscript. In certain sections, HR < 1 is associated with poorer prognosis, while elsewhere,
HR > 1 is interpreted as unfavorable. We recommend clearly defining the interpretation of HRs
in the Methods section and applying this consistently throughout the text, which would enhance
clarity for readers.
3. Although significant heterogeneity (I² > 80%) was observed, only subgroup analyses were
conducted to explore its sources. The authors may wish to consider discussing why meta-
regression analysis was not pursued and whether factors such as geographic region, detection
method, or sample size might account for some of the observed variability. This additional
discussion could further strengthen the robustness of the findings.
4. In the Discussion section, the manuscript suggests that elevated IDO expression may be
associated with improved prognosis via immune modulation. However, the meta-analysis
findings indicate an association between high IDO levels and worse DFS and metastasis. It
would be helpful if the authors could more clearly reconcile these points, perhaps by discussing
potential context-dependent effects of IDO in CRC progression.
assistant