Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 3 Date: 16 Apr 2025
Reviewer's report:
Comments to the author,
While the authors have responded to the reviewers’ queries point by point, the revisions and
explanations remain inadequate. At this stage, the manuscript does not meet the acceptance
criteria.
Major comments
1. Although the authors believed the portal vein tumor thrombus was a synchronous
hematogenous metastasis, this interpretation cannot be accepted, as it does not align with current
staging definitions. The portal vein tumor thrombus from a pancreatic tumor should not be
classified as distant metastasis, but rather as direct vascular invasion. The AJCC Cancer Staging
Manual, 8th Edition, and the UICC TNM Classification of Malignant Tumors, 8th Edition
support this interpretation. T4 includes tumor invasion into major vessels, such as the celiac
axis, superior mesenteric artery, superior mesenteric vein, and portal vein. In other words, portal
vein tumor thrombus arises from a direct invasion of the primary tumor into the vessel lumen,
rather than dissemination through the bloodstream. This mechanism differs from hematogenous
metastasis to distant organs such as the liver or lungs. The authors have to revise the terminology,
manuscript, and tables. Otherwise, the term “synchronous metastasis” appears to be a source
of misunderstanding throughout the manuscript. The reviewer recommends removing this term
from all tables and relevant sections to avoid misinterpretation.
2. The authors seem to have misunderstood the previous comment #3. In the legend of Figure
3, they claim that significant differences were observed in age and tumor size between the
recurrence and non-recurrence groups. However, the p-value of age in Figure 3 is 0.193, which
is insignificant. The authors have to revise the figure legend.
Minor comment,
In the authors’ response to the previous minor comment #1, the authors have inserted a space
accompanied by an underline rather than a standard space. This formatting choice is not
appropriate and introduces unnecessary visual elements. The reviewer recommends removing
the underline entirely.
Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 3 Date: 16 Apr 2025
Reviewer's report:
Comments to the author,
While the authors have responded to the reviewers’ queries point by point, the revisions and
explanations remain inadequate. At this stage, the manuscript does not meet the acceptance
criteria.
Major comments
1. Although the authors believed the portal vein tumor thrombus was a synchronous
hematogenous metastasis, this interpretation cannot be accepted, as it does not align with current
staging definitions. The portal vein tumor thrombus from a pancreatic tumor should not be
classified as distant metastasis, but rather as direct vascular invasion. The AJCC Cancer Staging
Manual, 8th Edition, and the UICC TNM Classification of Malignant Tumors, 8th Edition
support this interpretation. T4 includes tumor invasion into major vessels, such as the celiac
axis, superior mesenteric artery, superior mesenteric vein, and portal vein. In other words, portal
vein tumor thrombus arises from a direct invasion of the primary tumor into the vessel lumen,
rather than dissemination through the bloodstream. This mechanism differs from hematogenous
metastasis to distant organs such as the liver or lungs. The authors have to revise the terminology,
manuscript, and tables. Otherwise, the term “synchronous metastasis” appears to be a source
of misunderstanding throughout the manuscript. The reviewer recommends removing this term
from all tables and relevant sections to avoid misinterpretation.
2. The authors seem to have misunderstood the previous comment #3. In the legend of Figure
3, they claim that significant differences were observed in age and tumor size between the
recurrence and non-recurrence groups. However, the p-value of age in Figure 3 is 0.193, which
is insignificant. The authors have to revise the figure legend.
Minor comment,
In the authors’ response to the previous minor comment #1, the authors have inserted a space
accompanied by an underline rather than a standard space. This formatting choice is not
appropriate and introduces unnecessary visual elements. The reviewer recommends removing
the underline entirely.
Please review this paper.
user
Title: The nomograph predicting the recurrence of Solid Pseudopapillary Neoplasm of the
Pancreas: a study of the SEER database and a Chinese cohort
Version: 3 Date: 16 Apr 2025
Reviewer's report:
Comments to the author,
While the authors have responded to the reviewers’ queries point by point, the revisions and
explanations remain inadequate. At this stage, the manuscript does not meet the acceptance
criteria.
Major comments
1. Although the authors believed the portal vein tumor thrombus was a synchronous
hematogenous metastasis, this interpretation cannot be accepted, as it does not align with current
staging definitions. The portal vein tumor thrombus from a pancreatic tumor should not be
classified as distant metastasis, but rather as direct vascular invasion. The AJCC Cancer Staging
Manual, 8th Edition, and the UICC TNM Classification of Malignant Tumors, 8th Edition
support this interpretation. T4 includes tumor invasion into major vessels, such as the celiac
axis, superior mesenteric artery, superior mesenteric vein, and portal vein. In other words, portal
vein tumor thrombus arises from a direct invasion of the primary tumor into the vessel lumen,
rather than dissemination through the bloodstream. This mechanism differs from hematogenous
metastasis to distant organs such as the liver or lungs. The authors have to revise the terminology,
manuscript, and tables. Otherwise, the term “synchronous metastasis” appears to be a source
of misunderstanding throughout the manuscript. The reviewer recommends removing this term
from all tables and relevant sections to avoid misinterpretation.
2. The authors seem to have misunderstood the previous comment #3. In the legend of Figure
3, they claim that significant differences were observed in age and tumor size between the
recurrence and non-recurrence groups. However, the p-value of age in Figure 3 is 0.193, which
is insignificant. The authors have to revise the figure legend.
Minor comment,
In the authors’ response to the previous minor comment #1, the authors have inserted a space
accompanied by an underline rather than a standard space. This formatting choice is not
appropriate and introduces unnecessary visual elements. The reviewer recommends removing
the underline entirely.
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