Title: Deep muscularis propria tumor invasion without lymph node metastasis as a unique
subclassification of stage IB gastric cancer: a retrospective study
Version: 3 Date: 12 Nov 2021
Reviewer's report:
TO THE AUTHORS:
Authors classified T2 patients into two groups and conducting a detailed prognostic analysis, and
found that the prognosis of dMPN0 (stage IB) gastric cancer contributed to be a poor prognosis
and considered to be new indication criteria for adjuvant chemotherapy. However, there are
several points that remain unclear and to be revised.
Major Comments;
1. The differences of clinicopathological factors between in the sMP group and dMP group
appear to have a significant impact on the survival analysis. Is there a similar difference in
survival when propensity score matching is performed?
2. In this study, many of the mortality events occurred after 5 years. It should be shown the
cancer-specific survival curve and/or recurrence-free survival curve. Especially, in the subgroup
analysis with and without adjuvant chemotherapy (Figure 4B), there does not appear to be a
significant difference in the survival analysis at 5 years after surgery, at which there are no
censored cases at this point.
3. The dMPN0 group tends to have a better prognosis than the sMPN1-2 group although there is
no statistical difference. On this basis, there seems to be little significance in comparing survival
rate of the dMPN0/adjuvant chemotherapy+ group and sMPN1-2 groups.
4. In the multivariate analysis, there are a number of variables whose values are not written. Are
these factors not included in the variables for multivariate analysis? It should be clearly stated.
5. What are the clinical implications of including maximal LDH during follow-up in the
analysis? It seems that LDH levels is elevated in all case of cachexia in the terminal stage of
cancer.
6. sMP and dMP are not commonly assessed. Why not present pathological images of sMP and
dMP to visually demonstrate the diagnostic criteria?
Minor Comments;
1. On 26th line in page 6, the 5-year overall survival rate of dMP / N0 was described to be 91%
while it is described to be 92 % on 32th line in page 6. Similarly, on 32th line in page 6, the 5-
year OS of sMP/N1-2 was described to be 82% while it is described to be 81 % on 38th line in
page 6. Authors should revise to correct values.
2. Authors should add the number at risk table to each Kaplan-Meier curve to clarify the
population in the subgroup analysis.
3. The main purpose of this article is to investigate the prognostic impact of sMP and dMP, and
the correlation analysis with clinical factors shows no difference between EGFR, VEGF, and
HER2. So, description about HER2 should be more concise in Discussion section.
Title: Deep muscularis propria tumor invasion without lymph node metastasis as a unique
subclassification of stage IB gastric cancer: a retrospective study
Version: 3 Date: 12 Nov 2021
Reviewer's report:
TO THE AUTHORS:
Authors classified T2 patients into two groups and conducting a detailed prognostic analysis, and
found that the prognosis of dMPN0 (stage IB) gastric cancer contributed to be a poor prognosis
and considered to be new indication criteria for adjuvant chemotherapy. However, there are
several points that remain unclear and to be revised.
Major Comments;
1. The differences of clinicopathological factors between in the sMP group and dMP group
appear to have a significant impact on the survival analysis. Is there a similar difference in
survival when propensity score matching is performed?
2. In this study, many of the mortality events occurred after 5 years. It should be shown the
cancer-specific survival curve and/or recurrence-free survival curve. Especially, in the subgroup
analysis with and without adjuvant chemotherapy (Figure 4B), there does not appear to be a
significant difference in the survival analysis at 5 years after surgery, at which there are no
censored cases at this point.
3. The dMPN0 group tends to have a better prognosis than the sMPN1-2 group although there is
no statistical difference. On this basis, there seems to be little significance in comparing survival
rate of the dMPN0/adjuvant chemotherapy+ group and sMPN1-2 groups.
4. In the multivariate analysis, there are a number of variables whose values are not written. Are
these factors not included in the variables for multivariate analysis? It should be clearly stated.
5. What are the clinical implications of including maximal LDH during follow-up in the
analysis? It seems that LDH levels is elevated in all case of cachexia in the terminal stage of
cancer.
6. sMP and dMP are not commonly assessed. Why not present pathological images of sMP and
dMP to visually demonstrate the diagnostic criteria?
Minor Comments;
1. On 26th line in page 6, the 5-year overall survival rate of dMP / N0 was described to be 91%
while it is described to be 92 % on 32th line in page 6. Similarly, on 32th line in page 6, the 5-
year OS of sMP/N1-2 was described to be 82% while it is described to be 81 % on 38th line in
page 6. Authors should revise to correct values.
2. Authors should add the number at risk table to each Kaplan-Meier curve to clarify the
population in the subgroup analysis.
3. The main purpose of this article is to investigate the prognostic impact of sMP and dMP, and
the correlation analysis with clinical factors shows no difference between EGFR, VEGF, and
HER2. So, description about HER2 should be more concise in Discussion section.
Please review this paper.
user
Title: Deep muscularis propria tumor invasion without lymph node metastasis as a unique
subclassification of stage IB gastric cancer: a retrospective study
Version: 3 Date: 12 Nov 2021
Reviewer's report:
TO THE AUTHORS:
Authors classified T2 patients into two groups and conducting a detailed prognostic analysis, and
found that the prognosis of dMPN0 (stage IB) gastric cancer contributed to be a poor prognosis
and considered to be new indication criteria for adjuvant chemotherapy. However, there are
several points that remain unclear and to be revised.
Major Comments;
1. The differences of clinicopathological factors between in the sMP group and dMP group
appear to have a significant impact on the survival analysis. Is there a similar difference in
survival when propensity score matching is performed?
2. In this study, many of the mortality events occurred after 5 years. It should be shown the
cancer-specific survival curve and/or recurrence-free survival curve. Especially, in the subgroup
analysis with and without adjuvant chemotherapy (Figure 4B), there does not appear to be a
significant difference in the survival analysis at 5 years after surgery, at which there are no
censored cases at this point.
3. The dMPN0 group tends to have a better prognosis than the sMPN1-2 group although there is
no statistical difference. On this basis, there seems to be little significance in comparing survival
rate of the dMPN0/adjuvant chemotherapy+ group and sMPN1-2 groups.
4. In the multivariate analysis, there are a number of variables whose values are not written. Are
these factors not included in the variables for multivariate analysis? It should be clearly stated.
5. What are the clinical implications of including maximal LDH during follow-up in the
analysis? It seems that LDH levels is elevated in all case of cachexia in the terminal stage of
cancer.
6. sMP and dMP are not commonly assessed. Why not present pathological images of sMP and
dMP to visually demonstrate the diagnostic criteria?
Minor Comments;
1. On 26th line in page 6, the 5-year overall survival rate of dMP / N0 was described to be 91%
while it is described to be 92 % on 32th line in page 6. Similarly, on 32th line in page 6, the 5-
year OS of sMP/N1-2 was described to be 82% while it is described to be 81 % on 38th line in
page 6. Authors should revise to correct values.
2. Authors should add the number at risk table to each Kaplan-Meier curve to clarify the
population in the subgroup analysis.
3. The main purpose of this article is to investigate the prognostic impact of sMP and dMP, and
the correlation analysis with clinical factors shows no difference between EGFR, VEGF, and
HER2. So, description about HER2 should be more concise in Discussion section.
assistant