Title: Development and validation of a prognostic nomogram for gallbladder cancer patients
after surgery
Version: 1 Date: 02 Feb 2022
Reviewer's report:
Thank you for allowing me to review this interesting paper. Authors should be congratulated for
the effort of putting together a nomogram for this cancer.
A nomogram only is as rubust as the data where it came from. I have some issues on this:
1) All the patients of the training cohort where operated WITH curative intent, nonetheless, 78%
had a palliative surgery. This talks about the quality of the surgery/surgeons? On the other hand,
in China 18% where palliative, as in most places in the world. So the training cohort is not very
representative of gallbladder cancer surgery in general. Furthermore, in your univariate analysis
getting a palliative resection in that cohort had no effect on survival: this doesnt make any sense
as many studies show that R0 resections are far superior than R1/R2 resections. A lot of data
is missing from that "palliative" group: surgery type, margins, etc...all the problems associated
with large databases.
2) Why did you include the number of tumors and then just exclude it from the nomogram
because you just didn´t like what came out? A could argue the multiple tumors are more frequent
in papillary tumors, therefore, they have better prognosis. Once you include a variable it has to
be treated as the others.
* there is a small mistake in the percentages of tumor hystology in table.
Title: Development and validation of a prognostic nomogram for gallbladder cancer patients
after surgery
Version: 1 Date: 02 Feb 2022
Reviewer's report:
Thank you for allowing me to review this interesting paper. Authors should be congratulated for
the effort of putting together a nomogram for this cancer.
A nomogram only is as rubust as the data where it came from. I have some issues on this:
1) All the patients of the training cohort where operated WITH curative intent, nonetheless, 78%
had a palliative surgery. This talks about the quality of the surgery/surgeons? On the other hand,
in China 18% where palliative, as in most places in the world. So the training cohort is not very
representative of gallbladder cancer surgery in general. Furthermore, in your univariate analysis
getting a palliative resection in that cohort had no effect on survival: this doesnt make any sense
as many studies show that R0 resections are far superior than R1/R2 resections. A lot of data
is missing from that "palliative" group: surgery type, margins, etc...all the problems associated
with large databases.
2) Why did you include the number of tumors and then just exclude it from the nomogram
because you just didn´t like what came out? A could argue the multiple tumors are more frequent
in papillary tumors, therefore, they have better prognosis. Once you include a variable it has to
be treated as the others.
* there is a small mistake in the percentages of tumor hystology in table.
Please review this paper.
user
Title: Development and validation of a prognostic nomogram for gallbladder cancer patients
after surgery
Version: 1 Date: 02 Feb 2022
Reviewer's report:
Thank you for allowing me to review this interesting paper. Authors should be congratulated for
the effort of putting together a nomogram for this cancer.
A nomogram only is as rubust as the data where it came from. I have some issues on this:
1) All the patients of the training cohort where operated WITH curative intent, nonetheless, 78%
had a palliative surgery. This talks about the quality of the surgery/surgeons? On the other hand,
in China 18% where palliative, as in most places in the world. So the training cohort is not very
representative of gallbladder cancer surgery in general. Furthermore, in your univariate analysis
getting a palliative resection in that cohort had no effect on survival: this doesnt make any sense
as many studies show that R0 resections are far superior than R1/R2 resections. A lot of data
is missing from that "palliative" group: surgery type, margins, etc...all the problems associated
with large databases.
2) Why did you include the number of tumors and then just exclude it from the nomogram
because you just didn´t like what came out? A could argue the multiple tumors are more frequent
in papillary tumors, therefore, they have better prognosis. Once you include a variable it has to
be treated as the others.
* there is a small mistake in the percentages of tumor hystology in table.
assistant