Reviewer ’s report  
 
Title: Improvement of Asia -Pacific Colorectal Screening score and evaluation of its use 
combined with fecal immunochemical test  
 
Version: 1 Date: 25 Nov 2019  
 
Reviewer: Michel Scotte  
 
Reviewer's report:  
 
The authors report an interesting and large study aiming at better identifying patients with high -
risk of colorectal neoplasia using non invasive methods. They ad d to the precedent score 
different parameters including physical data and life habits.  
 
This constitutes the main problem of this study since this data are very subjective and of poor 
value, especially with self reporting questionnaires! Could the autors pr ecise some points :  
 
Why did they choose a BMI of 23 and talk about obesity since obesity is defined by a BMI >30? 
 
What was the definition of diabetes mellitus? Type 1 or 2? HBA1c? patients with medical 
treatment?  
 
How was defined smoking, Active or past smoking? What quantification ?  
 
The second problem of this paper is a high rate of false negatives. In the HR group with negative 
FOBT, colonoscopy found about 40% of patients with neoplasia  In the AR group with negative 
FOBT colonoscopy found about 40% of  patients with neoplasia. Could the authors explain and 
discuss this result?  
 
Finally, did they find a difference in all these parameters according to the location of the 
neoplasia?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the man uscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five year s received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in a ny way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding , or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you  can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I underst and that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to b e made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that a ny comments 
which I do not wish to be included in my named report can be included as confidential comments  
to the editors , which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Improvement of Asia -Pacific Colorectal Screening score and evaluation of its use 
combined with fecal immunochemical test  
 
Version: 1 Date: 25 Nov 2019  
 
Reviewer: Michel Scotte  
 
Reviewer's report:  
 
The authors report an interesting and large study aiming at better identifying patients with high -
risk of colorectal neoplasia using non invasive methods. They ad d to the precedent score 
different parameters including physical data and life habits.  
 
This constitutes the main problem of this study since this data are very subjective and of poor 
value, especially with self reporting questionnaires! Could the autors pr ecise some points :  
 
Why did they choose a BMI of 23 and talk about obesity since obesity is defined by a BMI >30? 
 
What was the definition of diabetes mellitus? Type 1 or 2? HBA1c? patients with medical 
treatment?  
 
How was defined smoking, Active or past smoking? What quantification ?  
 
The second problem of this paper is a high rate of false negatives. In the HR group with negative 
FOBT, colonoscopy found about 40% of patients with neoplasia  In the AR group with negative 
FOBT colonoscopy found about 40% of  patients with neoplasia. Could the authors explain and 
discuss this result?  
 
Finally, did they find a difference in all these parameters according to the location of the 
neoplasia?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the man uscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five year s received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in a ny way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding , or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you  can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I underst and that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to b e made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that a ny comments 
which I do not wish to be included in my named report can be included as confidential comments  
to the editors , which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Improvement of Asia -Pacific Colorectal Screening score and evaluation of its use 
combined with fecal immunochemical test  
 
Version: 1 Date: 25 Nov 2019  
 
Reviewer: Michel Scotte  
 
Reviewer's report:  
 
The authors report an interesting and large study aiming at better identifying patients with high -
risk of colorectal neoplasia using non invasive methods. They ad d to the precedent score 
different parameters including physical data and life habits.  
 
This constitutes the main problem of this study since this data are very subjective and of poor 
value, especially with self reporting questionnaires! Could the autors pr ecise some points :  
 
Why did they choose a BMI of 23 and talk about obesity since obesity is defined by a BMI >30? 
 
What was the definition of diabetes mellitus? Type 1 or 2? HBA1c? patients with medical 
treatment?  
 
How was defined smoking, Active or past smoking? What quantification ?  
 
The second problem of this paper is a high rate of false negatives. In the HR group with negative 
FOBT, colonoscopy found about 40% of patients with neoplasia  In the AR group with negative 
FOBT colonoscopy found about 40% of  patients with neoplasia. Could the authors explain and 
discuss this result?  
 
Finally, did they find a difference in all these parameters according to the location of the 
neoplasia?  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, p lease specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the man uscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1.  Have you in the past five year s received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation that may in a ny way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents  relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding , or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any non -financial competing interests in relation to this paper?  
 
If you  can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
I declare I have no competing interests  
 
I agree to the open peer review policy of the journal. I underst and that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to b e made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that a ny comments 
which I do not wish to be included in my named report can be included as confidential comments  
to the editors , which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant