Title: Prognostic factors of pancreatic tumors in children and adolescents: A population study
based on the Surveillance, Epidemiology, and End Results Database
Version: 3 Date: 18 Dec 2023
Reviewer's report:
This is an interesting population-based study examining prognostic factors for pancreatic tumors
in children using the SEER database. There are a few major issues that need to be addressed:
1) Selection bias - The study includes only patients from the SEER database, which does not
have national coverage. This may limit the generalizability of findings. I would suggest the
authors acknowledge this limitation in the discussion.
2) Information bias - The SEER database lacks detailed information on tumor characteristics,
treatments, and outcomes. Important prognostic information may be missing. Please discuss
how this could impact your results.
3) Confounding - There may be factors that influence both the exposures/treatments and
outcomes in this observational study. For example, patients selected for surgery may have
less advanced tumors. The use of multivariable models helps account for this, but residual
confounding is likely.
4) Small sample size - Given the rarity of these tumors, the study is underpowered to detect
smaller differences in survival between groups. This should be noted as a major limitation,
especially for the subgroup and multivariable analyses.
5) Clarity of objectives - The purpose statement focuses on examining clinicopathological
features and prognosis. However, the results and discussion emphasize prognostic factors. Please
clarify the main objective(s) of your study.
6) Analysis issues - Were assumptions of proportional hazards met for Cox models? This should
be assessed.
Minor issues:
- Standardize terminology for pancreatic tumors throughout the manuscript
- Carefully proofread manuscript to fix typos, grammatical issues
- Improve flow between sections
- Provide descriptive statistics for continuous variables (mean/median, range etc)
Title: Prognostic factors of pancreatic tumors in children and adolescents: A population study
based on the Surveillance, Epidemiology, and End Results Database
Version: 3 Date: 18 Dec 2023
Reviewer's report:
This is an interesting population-based study examining prognostic factors for pancreatic tumors
in children using the SEER database. There are a few major issues that need to be addressed:
1) Selection bias - The study includes only patients from the SEER database, which does not
have national coverage. This may limit the generalizability of findings. I would suggest the
authors acknowledge this limitation in the discussion.
2) Information bias - The SEER database lacks detailed information on tumor characteristics,
treatments, and outcomes. Important prognostic information may be missing. Please discuss
how this could impact your results.
3) Confounding - There may be factors that influence both the exposures/treatments and
outcomes in this observational study. For example, patients selected for surgery may have
less advanced tumors. The use of multivariable models helps account for this, but residual
confounding is likely.
4) Small sample size - Given the rarity of these tumors, the study is underpowered to detect
smaller differences in survival between groups. This should be noted as a major limitation,
especially for the subgroup and multivariable analyses.
5) Clarity of objectives - The purpose statement focuses on examining clinicopathological
features and prognosis. However, the results and discussion emphasize prognostic factors. Please
clarify the main objective(s) of your study.
6) Analysis issues - Were assumptions of proportional hazards met for Cox models? This should
be assessed.
Minor issues:
- Standardize terminology for pancreatic tumors throughout the manuscript
- Carefully proofread manuscript to fix typos, grammatical issues
- Improve flow between sections
- Provide descriptive statistics for continuous variables (mean/median, range etc)
Please review this paper.
user
Title: Prognostic factors of pancreatic tumors in children and adolescents: A population study
based on the Surveillance, Epidemiology, and End Results Database
Version: 3 Date: 18 Dec 2023
Reviewer's report:
This is an interesting population-based study examining prognostic factors for pancreatic tumors
in children using the SEER database. There are a few major issues that need to be addressed:
1) Selection bias - The study includes only patients from the SEER database, which does not
have national coverage. This may limit the generalizability of findings. I would suggest the
authors acknowledge this limitation in the discussion.
2) Information bias - The SEER database lacks detailed information on tumor characteristics,
treatments, and outcomes. Important prognostic information may be missing. Please discuss
how this could impact your results.
3) Confounding - There may be factors that influence both the exposures/treatments and
outcomes in this observational study. For example, patients selected for surgery may have
less advanced tumors. The use of multivariable models helps account for this, but residual
confounding is likely.
4) Small sample size - Given the rarity of these tumors, the study is underpowered to detect
smaller differences in survival between groups. This should be noted as a major limitation,
especially for the subgroup and multivariable analyses.
5) Clarity of objectives - The purpose statement focuses on examining clinicopathological
features and prognosis. However, the results and discussion emphasize prognostic factors. Please
clarify the main objective(s) of your study.
6) Analysis issues - Were assumptions of proportional hazards met for Cox models? This should
be assessed.
Minor issues:
- Standardize terminology for pancreatic tumors throughout the manuscript
- Carefully proofread manuscript to fix typos, grammatical issues
- Improve flow between sections
- Provide descriptive statistics for continuous variables (mean/median, range etc)
assistant