Reviewer ’s report  
 
Title: Comparison of five tumor regression grading systems for gastric adenocarcinoma after  
neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in  
China  
 
Version: 0 Date: 10 Sep 2016  
 
Reviewer: Chikara Kunisaki  
 
Reviewer's report:  
 
Major comments  
 
The purpose of this study is interesting. However, the number of patients was small to analyze 
this kind of study. Moreover, it is difficult to understand the method of statistical analysis and 
interpretation of the results. I wonder the obtained conclusio n is appropriate.  
 
 
 
 
Minor comments  
 
1. "Comparision" should be corrected to "comparison" throughout the manuscript.  
 
 
 
2. In this study, 192 patients were included. However, in "Follow up" section, authors 
described that patients who died as a result of compli cations from surgery or whose 
follow -up time were less than 3 months after surgery were excluded from the survival 
analysis.  
 
How many patients were excluded? How many patients did authors actually analyze the 
survivals? This must be the real number of pat ients included in this study.  
 
 
 
3. What kind of neoadjuvant chemotherapy was administered in this study?  
 
 
 
4. Authors should show the rationale the definition of age division.  
 
 
 
5. In the tumor regression assessment section of Results, authors described the dis tribution 
of cases according to the Mandard -TRG system. However, there are other three systems 
and they did not mention any data about the distribution. IN this section, we need the 
results of correlation of each system about the distribution of cases.  
 
 
 
6. How did authors classify maximal diameter of tumor bed? Continuous variables?  
 
 
 
7. We need the information of adjuvant chemotherapy.  
 
 
 
8. As concerns the results of multivariate analysis section, authors described their discussion 
in addition to the results. P lease move this to the appropriate section.  
 
 
 
9. Authors performed multivariate analysis using four TRG systems and judged that the 
Mandard -TRG system was most significant. Is this method correct significantly?  
 
 
 
10. It is difficult for many readers to underst and the purpose of comparison of Mandard and 
JGCA TRG systems. Moreover, authors mentioned their interpretation about 
stratification of each system in the results section. Authors should move this mention to 
the appropriate section. We need the data of mul tivariate analysis of four TRG systems.  
 
 
 
11. Considering Figure 1 and 2, stratification of survival curves were most clear in China -
TRG system. Please discuss more clearly about this results.  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify 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 years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially 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 any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
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 that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is acce pted for 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 be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any 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: Comparison of five tumor regression grading systems for gastric adenocarcinoma after  
neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in  
China  
 
Version: 0 Date: 10 Sep 2016  
 
Reviewer: Chikara Kunisaki  
 
Reviewer's report:  
 
Major comments  
 
The purpose of this study is interesting. However, the number of patients was small to analyze 
this kind of study. Moreover, it is difficult to understand the method of statistical analysis and 
interpretation of the results. I wonder the obtained conclusio n is appropriate.  
 
 
 
 
Minor comments  
 
1. "Comparision" should be corrected to "comparison" throughout the manuscript.  
 
 
 
2. In this study, 192 patients were included. However, in "Follow up" section, authors 
described that patients who died as a result of compli cations from surgery or whose 
follow -up time were less than 3 months after surgery were excluded from the survival 
analysis.  
 
How many patients were excluded? How many patients did authors actually analyze the 
survivals? This must be the real number of pat ients included in this study.  
 
 
 
3. What kind of neoadjuvant chemotherapy was administered in this study?  
 
 
 
4. Authors should show the rationale the definition of age division.  
 
 
 
5. In the tumor regression assessment section of Results, authors described the dis tribution 
of cases according to the Mandard -TRG system. However, there are other three systems 
and they did not mention any data about the distribution. IN this section, we need the 
results of correlation of each system about the distribution of cases.  
 
 
 
6. How did authors classify maximal diameter of tumor bed? Continuous variables?  
 
 
 
7. We need the information of adjuvant chemotherapy.  
 
 
 
8. As concerns the results of multivariate analysis section, authors described their discussion 
in addition to the results. P lease move this to the appropriate section.  
 
 
 
9. Authors performed multivariate analysis using four TRG systems and judged that the 
Mandard -TRG system was most significant. Is this method correct significantly?  
 
 
 
10. It is difficult for many readers to underst and the purpose of comparison of Mandard and 
JGCA TRG systems. Moreover, authors mentioned their interpretation about 
stratification of each system in the results section. Authors should move this mention to 
the appropriate section. We need the data of mul tivariate analysis of four TRG systems.  
 
 
 
11. Considering Figure 1 and 2, stratification of survival curves were most clear in China -
TRG system. Please discuss more clearly about this results.  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify 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 years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially 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 any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
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 that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is acce pted for 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 be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any 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: Comparison of five tumor regression grading systems for gastric adenocarcinoma after  
neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in  
China  
 
Version: 0 Date: 10 Sep 2016  
 
Reviewer: Chikara Kunisaki  
 
Reviewer's report:  
 
Major comments  
 
The purpose of this study is interesting. However, the number of patients was small to analyze 
this kind of study. Moreover, it is difficult to understand the method of statistical analysis and 
interpretation of the results. I wonder the obtained conclusio n is appropriate.  
 
 
 
 
Minor comments  
 
1. "Comparision" should be corrected to "comparison" throughout the manuscript.  
 
 
 
2. In this study, 192 patients were included. However, in "Follow up" section, authors 
described that patients who died as a result of compli cations from surgery or whose 
follow -up time were less than 3 months after surgery were excluded from the survival 
analysis.  
 
How many patients were excluded? How many patients did authors actually analyze the 
survivals? This must be the real number of pat ients included in this study.  
 
 
 
3. What kind of neoadjuvant chemotherapy was administered in this study?  
 
 
 
4. Authors should show the rationale the definition of age division.  
 
 
 
5. In the tumor regression assessment section of Results, authors described the dis tribution 
of cases according to the Mandard -TRG system. However, there are other three systems 
and they did not mention any data about the distribution. IN this section, we need the 
results of correlation of each system about the distribution of cases.  
 
 
 
6. How did authors classify maximal diameter of tumor bed? Continuous variables?  
 
 
 
7. We need the information of adjuvant chemotherapy.  
 
 
 
8. As concerns the results of multivariate analysis section, authors described their discussion 
in addition to the results. P lease move this to the appropriate section.  
 
 
 
9. Authors performed multivariate analysis using four TRG systems and judged that the 
Mandard -TRG system was most significant. Is this method correct significantly?  
 
 
 
10. It is difficult for many readers to underst and the purpose of comparison of Mandard and 
JGCA TRG systems. Moreover, authors mentioned their interpretation about 
stratification of each system in the results section. Authors should move this mention to 
the appropriate section. We need the data of mul tivariate analysis of four TRG systems.  
 
 
 
11. Considering Figure 1 and 2, stratification of survival curves were most clear in China -
TRG system. Please discuss more clearly about this results.  
 
 
 
 
 
 
 
 
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify 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 years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially 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 any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
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 that I have no competing interests'  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is acce pted for 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 be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any 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