Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 2 Date: 01 Aug 2024
Reviewer's report:
This study elucidates the clinical utility of the lymph node ratio (LNR) in gastric cancer patients
who underwent neoadjuvant immunochemotherapy (NICT) and surgery. The novelty of this
study lies in highlighting the utility of LNR in patients who received NICT for gastric cancer.
The overall study design and conclusions are appropriately described. However, there are several
minor issues that need to be addressed:
1. PCR is known to have predictive value. However, in this study, the impact of pCR on PFS
and OS was not significant. What is the reason for this? Since PCR did not show statistical
significance, how about adding MPR to the univariate analysis for further investigation?
2. In the results section of the abstract, the LNR cut-off is described as 30%. This needs to be
corrected.
3. Page 2, line 8: CHECKMATE-649 is a study on unresectable or metastatic gastric cancer,
and RESOLVE did not involve immunotherapy. These references are incorrect and should be
revised.
4. Page 2, lines 9-16: References 7-10 do not seem to be appropriate studies to support the stated
content. It is recommended to revise or add references related to gastric cancer.
5. Page 2, lines 39-41: "Therefore, non-PCR patients may have a worse prognosis than those
who undergo surgery alone, whereas patients who achieve PCR may benefit from neoadjuvant
therapy to the greatest extent possible [29-30]." There is no evidence in the referenced studies to
support that non-PCR patients have a worse prognosis compared to those who undergo ‘surgery
alone’, and this is not a common opinion. The content needs to be revised to match the references.
6. Page 9, lines 41-43: "In this study, we used X-tile software to determine the optimal cut-off
value of 0.33 for LNR, with PCR as the dependent variable." The meaning of this sentence is
unclear. A more detailed explanation is needed.
7. Figure 3: Including the 2-year survival in the figure legend or within the figure itself would
help in understanding the content.
8. Page 9 line 6 ; polymerase chain reaction (PCR) --> PCR
9. To demonstrate that pLNR is a better prognostic factor than the pN stage, the LNR groups
need to include patients with various N stages. However, in this study, the LNR high group
consists entirely of pN3 patients, while the LNR low group includes only two pN3 patients.
Therefore, the pN3 group and the LNR high group are likely to show similar prognoses. To
convincingly show that pLNR is a better predictive marker than the pN stage, the LNR groups
should include patients with a diverse range of N stages. It is recommended to add this as a
limitation of the study.
Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 2 Date: 01 Aug 2024
Reviewer's report:
This study elucidates the clinical utility of the lymph node ratio (LNR) in gastric cancer patients
who underwent neoadjuvant immunochemotherapy (NICT) and surgery. The novelty of this
study lies in highlighting the utility of LNR in patients who received NICT for gastric cancer.
The overall study design and conclusions are appropriately described. However, there are several
minor issues that need to be addressed:
1. PCR is known to have predictive value. However, in this study, the impact of pCR on PFS
and OS was not significant. What is the reason for this? Since PCR did not show statistical
significance, how about adding MPR to the univariate analysis for further investigation?
2. In the results section of the abstract, the LNR cut-off is described as 30%. This needs to be
corrected.
3. Page 2, line 8: CHECKMATE-649 is a study on unresectable or metastatic gastric cancer,
and RESOLVE did not involve immunotherapy. These references are incorrect and should be
revised.
4. Page 2, lines 9-16: References 7-10 do not seem to be appropriate studies to support the stated
content. It is recommended to revise or add references related to gastric cancer.
5. Page 2, lines 39-41: "Therefore, non-PCR patients may have a worse prognosis than those
who undergo surgery alone, whereas patients who achieve PCR may benefit from neoadjuvant
therapy to the greatest extent possible [29-30]." There is no evidence in the referenced studies to
support that non-PCR patients have a worse prognosis compared to those who undergo ‘surgery
alone’, and this is not a common opinion. The content needs to be revised to match the references.
6. Page 9, lines 41-43: "In this study, we used X-tile software to determine the optimal cut-off
value of 0.33 for LNR, with PCR as the dependent variable." The meaning of this sentence is
unclear. A more detailed explanation is needed.
7. Figure 3: Including the 2-year survival in the figure legend or within the figure itself would
help in understanding the content.
8. Page 9 line 6 ; polymerase chain reaction (PCR) --> PCR
9. To demonstrate that pLNR is a better prognostic factor than the pN stage, the LNR groups
need to include patients with various N stages. However, in this study, the LNR high group
consists entirely of pN3 patients, while the LNR low group includes only two pN3 patients.
Therefore, the pN3 group and the LNR high group are likely to show similar prognoses. To
convincingly show that pLNR is a better predictive marker than the pN stage, the LNR groups
should include patients with a diverse range of N stages. It is recommended to add this as a
limitation of the study.
Please review this paper.
user
Title: Lymph node ratio is a prognostic indicator for locally advanced gastric cancer after
neoadjuvant immunochemotherapy
Version: 2 Date: 01 Aug 2024
Reviewer's report:
This study elucidates the clinical utility of the lymph node ratio (LNR) in gastric cancer patients
who underwent neoadjuvant immunochemotherapy (NICT) and surgery. The novelty of this
study lies in highlighting the utility of LNR in patients who received NICT for gastric cancer.
The overall study design and conclusions are appropriately described. However, there are several
minor issues that need to be addressed:
1. PCR is known to have predictive value. However, in this study, the impact of pCR on PFS
and OS was not significant. What is the reason for this? Since PCR did not show statistical
significance, how about adding MPR to the univariate analysis for further investigation?
2. In the results section of the abstract, the LNR cut-off is described as 30%. This needs to be
corrected.
3. Page 2, line 8: CHECKMATE-649 is a study on unresectable or metastatic gastric cancer,
and RESOLVE did not involve immunotherapy. These references are incorrect and should be
revised.
4. Page 2, lines 9-16: References 7-10 do not seem to be appropriate studies to support the stated
content. It is recommended to revise or add references related to gastric cancer.
5. Page 2, lines 39-41: "Therefore, non-PCR patients may have a worse prognosis than those
who undergo surgery alone, whereas patients who achieve PCR may benefit from neoadjuvant
therapy to the greatest extent possible [29-30]." There is no evidence in the referenced studies to
support that non-PCR patients have a worse prognosis compared to those who undergo ‘surgery
alone’, and this is not a common opinion. The content needs to be revised to match the references.
6. Page 9, lines 41-43: "In this study, we used X-tile software to determine the optimal cut-off
value of 0.33 for LNR, with PCR as the dependent variable." The meaning of this sentence is
unclear. A more detailed explanation is needed.
7. Figure 3: Including the 2-year survival in the figure legend or within the figure itself would
help in understanding the content.
8. Page 9 line 6 ; polymerase chain reaction (PCR) --> PCR
9. To demonstrate that pLNR is a better prognostic factor than the pN stage, the LNR groups
need to include patients with various N stages. However, in this study, the LNR high group
consists entirely of pN3 patients, while the LNR low group includes only two pN3 patients.
Therefore, the pN3 group and the LNR high group are likely to show similar prognoses. To
convincingly show that pLNR is a better predictive marker than the pN stage, the LNR groups
should include patients with a diverse range of N stages. It is recommended to add this as a
limitation of the study.
assistant