Title: An Age-group Analysis on the Efficacy of Chemotherapy in Older Adult Patients with
Metastatic Biliary Tract Cancer: A Japanese Cancer Registry Cohort Study
Version: 2 Date: 01 May 2023
Reviewer's report:
Comments to the Author
The article entitled ‘An Age-group Analysis on the Efficacy of Chemotherapy in Older Adult
Patients with Metastatic Biliary Tract Cancer: A Japanese Cancer Registry Cohort Study",
reappraised the role of systemic chemotherapy for elderly with advanced biliary tract cancer. The
authors demonstrated from this large retrospective study that chemotherapy provided a survival
benefit in patients aged over 70 years old with metastatic BTC.
This study is well conducted and the manuscript is concise and reasonably well-written. The
authors should be commended. However, these are some suggestions to improve this manuscript.
1. The authors collected the data from patients with various ICD-O-3 topographical and
morphological codes. Therefore, the authors should provide the details of the patient according
to the code in Table 1 as there are many differences in the nature of disease amongst various
types of bile duct tumors.
2. Were all patients classified as ‘advanced’ in this study initially presented as advanced disease,
or classified as advanced after disease recurrence?
3. There should be more subgroup analysis according to the location of the disease other than
just gallbladder and non-gallbladder e.g. ampulla, intrahepatic cholangiocarcinoma, perihilar
cholangiocarcinoma, distal cholangiocarcinoma, etc.
4. Was there any difference in the rate of survival between each chemotherapy regimen, and
whether it is combined or monotherapy?
5. Since there is an inevitable selection bias when analyzing the benefit of chemotherapy from a
retrospective study. Besides performing propensity score matching, the authors should provide
more information on how the authors minimized the selective bias in this case.
6. Which parameters had been adjusted in propensity score matching? More discussion should
be made regarding the essential parameters affecting patients’ survival that cannot be included
in the analysis.
7. The primary outcome mentioned overall survival. What are the data on progression-free
survival and quality of life?
8. The author should provide more details on the site of metastasis, such as distant lymph node
or distant organ metastasis, as each could affect the patient’s prognosis and should be included
in the propensity score.
9. The author should provide more details on the number of lines of chemotherapy used in this
study. If the second-line chemotherapy was given, it should be mentioned.
Title: An Age-group Analysis on the Efficacy of Chemotherapy in Older Adult Patients with
Metastatic Biliary Tract Cancer: A Japanese Cancer Registry Cohort Study
Version: 2 Date: 01 May 2023
Reviewer's report:
Comments to the Author
The article entitled ‘An Age-group Analysis on the Efficacy of Chemotherapy in Older Adult
Patients with Metastatic Biliary Tract Cancer: A Japanese Cancer Registry Cohort Study",
reappraised the role of systemic chemotherapy for elderly with advanced biliary tract cancer. The
authors demonstrated from this large retrospective study that chemotherapy provided a survival
benefit in patients aged over 70 years old with metastatic BTC.
This study is well conducted and the manuscript is concise and reasonably well-written. The
authors should be commended. However, these are some suggestions to improve this manuscript.
1. The authors collected the data from patients with various ICD-O-3 topographical and
morphological codes. Therefore, the authors should provide the details of the patient according
to the code in Table 1 as there are many differences in the nature of disease amongst various
types of bile duct tumors.
2. Were all patients classified as ‘advanced’ in this study initially presented as advanced disease,
or classified as advanced after disease recurrence?
3. There should be more subgroup analysis according to the location of the disease other than
just gallbladder and non-gallbladder e.g. ampulla, intrahepatic cholangiocarcinoma, perihilar
cholangiocarcinoma, distal cholangiocarcinoma, etc.
4. Was there any difference in the rate of survival between each chemotherapy regimen, and
whether it is combined or monotherapy?
5. Since there is an inevitable selection bias when analyzing the benefit of chemotherapy from a
retrospective study. Besides performing propensity score matching, the authors should provide
more information on how the authors minimized the selective bias in this case.
6. Which parameters had been adjusted in propensity score matching? More discussion should
be made regarding the essential parameters affecting patients’ survival that cannot be included
in the analysis.
7. The primary outcome mentioned overall survival. What are the data on progression-free
survival and quality of life?
8. The author should provide more details on the site of metastasis, such as distant lymph node
or distant organ metastasis, as each could affect the patient’s prognosis and should be included
in the propensity score.
9. The author should provide more details on the number of lines of chemotherapy used in this
study. If the second-line chemotherapy was given, it should be mentioned.
Please review this paper.
user
Title: An Age-group Analysis on the Efficacy of Chemotherapy in Older Adult Patients with
Metastatic Biliary Tract Cancer: A Japanese Cancer Registry Cohort Study
Version: 2 Date: 01 May 2023
Reviewer's report:
Comments to the Author
The article entitled ‘An Age-group Analysis on the Efficacy of Chemotherapy in Older Adult
Patients with Metastatic Biliary Tract Cancer: A Japanese Cancer Registry Cohort Study",
reappraised the role of systemic chemotherapy for elderly with advanced biliary tract cancer. The
authors demonstrated from this large retrospective study that chemotherapy provided a survival
benefit in patients aged over 70 years old with metastatic BTC.
This study is well conducted and the manuscript is concise and reasonably well-written. The
authors should be commended. However, these are some suggestions to improve this manuscript.
1. The authors collected the data from patients with various ICD-O-3 topographical and
morphological codes. Therefore, the authors should provide the details of the patient according
to the code in Table 1 as there are many differences in the nature of disease amongst various
types of bile duct tumors.
2. Were all patients classified as ‘advanced’ in this study initially presented as advanced disease,
or classified as advanced after disease recurrence?
3. There should be more subgroup analysis according to the location of the disease other than
just gallbladder and non-gallbladder e.g. ampulla, intrahepatic cholangiocarcinoma, perihilar
cholangiocarcinoma, distal cholangiocarcinoma, etc.
4. Was there any difference in the rate of survival between each chemotherapy regimen, and
whether it is combined or monotherapy?
5. Since there is an inevitable selection bias when analyzing the benefit of chemotherapy from a
retrospective study. Besides performing propensity score matching, the authors should provide
more information on how the authors minimized the selective bias in this case.
6. Which parameters had been adjusted in propensity score matching? More discussion should
be made regarding the essential parameters affecting patients’ survival that cannot be included
in the analysis.
7. The primary outcome mentioned overall survival. What are the data on progression-free
survival and quality of life?
8. The author should provide more details on the site of metastasis, such as distant lymph node
or distant organ metastasis, as each could affect the patient’s prognosis and should be included
in the propensity score.
9. The author should provide more details on the number of lines of chemotherapy used in this
study. If the second-line chemotherapy was given, it should be mentioned.
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