Title: Impact of Pathological Complete Response on Survival in Gastric Cancer After
Neoadjuvant Chemotherapy: A Propensity Score Matching Analysis
Version: 0 Date: 14 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: dear authorsI read with interest your study about the role of NACT
in gastric cancer. I prefer to make only major comments, since the study should be extensively
revised before taken into consideration for publication.
- first of all the title is confusing and somewhat misleading. the aim of the study was to compare
interval surgery with surgery followed by ACT. With the propensity score the authors failed
to demonstrate any difference. The only finding is that prognosis is better in patients with
pCR. Therefore authors suggest to select patients for NACT only if pCR could be achieved.
How is possible to know "ex ante" the effect of NACT? it is quite weird to make a similar
recommendation!
- the study has some relevant selection bias. Since it's not a randomized study there are several
differences between the two patients cohorts. PSM could attenuate these differences but the
original bias remains (NACT patients generally have more aggressive and advanced cancer).
The PSM was calculated on several factors not influent on prognosis (laparoscopic surgery) and
did not included important variables as the NACT scheme / ACT scheme.
- since the main outcome is OS it's very important also to provide data on further treatments
(CT, RT, immunotherapy.. ) since the prognosis is highly influenced by all those treatments. It's
most important also to include year of treatment as a variable since several CT regimens were
not available (the study period is very wide, 2008-2021).
- among exclusion criteria there's remaining gastric cancer. in the study cohort there are several
patients with R1/R2 resection. How is it possible? please provide explanations.
REQUESTED REVISIONS:
please see my comments above
Title: Impact of Pathological Complete Response on Survival in Gastric Cancer After
Neoadjuvant Chemotherapy: A Propensity Score Matching Analysis
Version: 0 Date: 14 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: dear authorsI read with interest your study about the role of NACT
in gastric cancer. I prefer to make only major comments, since the study should be extensively
revised before taken into consideration for publication.
- first of all the title is confusing and somewhat misleading. the aim of the study was to compare
interval surgery with surgery followed by ACT. With the propensity score the authors failed
to demonstrate any difference. The only finding is that prognosis is better in patients with
pCR. Therefore authors suggest to select patients for NACT only if pCR could be achieved.
How is possible to know "ex ante" the effect of NACT? it is quite weird to make a similar
recommendation!
- the study has some relevant selection bias. Since it's not a randomized study there are several
differences between the two patients cohorts. PSM could attenuate these differences but the
original bias remains (NACT patients generally have more aggressive and advanced cancer).
The PSM was calculated on several factors not influent on prognosis (laparoscopic surgery) and
did not included important variables as the NACT scheme / ACT scheme.
- since the main outcome is OS it's very important also to provide data on further treatments
(CT, RT, immunotherapy.. ) since the prognosis is highly influenced by all those treatments. It's
most important also to include year of treatment as a variable since several CT regimens were
not available (the study period is very wide, 2008-2021).
- among exclusion criteria there's remaining gastric cancer. in the study cohort there are several
patients with R1/R2 resection. How is it possible? please provide explanations.
REQUESTED REVISIONS:
please see my comments above
Please review this paper.
user
Title: Impact of Pathological Complete Response on Survival in Gastric Cancer After
Neoadjuvant Chemotherapy: A Propensity Score Matching Analysis
Version: 0 Date: 14 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: dear authorsI read with interest your study about the role of NACT
in gastric cancer. I prefer to make only major comments, since the study should be extensively
revised before taken into consideration for publication.
- first of all the title is confusing and somewhat misleading. the aim of the study was to compare
interval surgery with surgery followed by ACT. With the propensity score the authors failed
to demonstrate any difference. The only finding is that prognosis is better in patients with
pCR. Therefore authors suggest to select patients for NACT only if pCR could be achieved.
How is possible to know "ex ante" the effect of NACT? it is quite weird to make a similar
recommendation!
- the study has some relevant selection bias. Since it's not a randomized study there are several
differences between the two patients cohorts. PSM could attenuate these differences but the
original bias remains (NACT patients generally have more aggressive and advanced cancer).
The PSM was calculated on several factors not influent on prognosis (laparoscopic surgery) and
did not included important variables as the NACT scheme / ACT scheme.
- since the main outcome is OS it's very important also to provide data on further treatments
(CT, RT, immunotherapy.. ) since the prognosis is highly influenced by all those treatments. It's
most important also to include year of treatment as a variable since several CT regimens were
not available (the study period is very wide, 2008-2021).
- among exclusion criteria there's remaining gastric cancer. in the study cohort there are several
patients with R1/R2 resection. How is it possible? please provide explanations.
REQUESTED REVISIONS:
please see my comments above
assistant