Title: Association of clinicopathological factor with Lymph Node Metastasis in Rectal Cancer
Patients: a retrospective cohort study
Version: 1 Date: 18 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While retrospective cohort studies are valuable, they are inherently subject to biases such as
selection bias and missing data. The retrospective nature of this study means that causality cannot
be established, and the results may not be generalizable to other settings or patient populations.
-The study does not mention if the findings were validated externally or if the findings are
applicable beyond the study cohort. External validation using an independent cohort would help
confirm the robustness and generalizability of the results.
-Although the exclusion criteria are robust, the study may still have unaccounted confounding
factors. For instance, factors like body mass index (BMI), comorbidities, or other inflammatory
conditions may influence NLR and PLR, but these are not mentioned as variables considered
in the analysis.
-The study includes only patients who underwent laparoscopic radical resection. However,
variations in surgical techniques could influence postoperative inflammatory responses and thus
the biomarkers, though this potential confounding factor isn't addressed.
-The study focuses primarily on preoperative inflammatory markers but does not provide in-
depth information on postoperative treatments, such as chemotherapy, which could influence
NLR and PLR. Follow-up data would also be helpful to assess how these biomarkers predict
long-term outcomes, including recurrence or survival.
-While NLR and PLR are the focus, the study does not discuss the role of other potential
inflammatory biomarkers, such as C-reactive protein (CRP) or interleukins, which may provide
additional insights or reinforce the findings of NLR and PLR.
-Although NLR and PLR were assessed independently, the study does not explore the potential
interactions of these markers with other known risk factors, such as PNI and LVI. A multivariate
analysis could provide more insight into the role of these markers when adjusted for other
important variables.
-The study could have mentioned other inflammatory markers, such as C-reactive protein (CRP),
interleukins, or tumor markers (e.g., CEA), which may play a role in predicting LNM. Including
a broader set of biomarkers would have provided more context and possibly enhanced the
predictive value of the study.
-The study does not provide a clear pathway for clinical application of NLR and PLR in rectal
cancer management. It would have been helpful to discuss how clinicians might use these
biomarkers, especially since other factors (e.g., PNI and LVI) were shown to be more significant.
Title: Association of clinicopathological factor with Lymph Node Metastasis in Rectal Cancer
Patients: a retrospective cohort study
Version: 1 Date: 18 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While retrospective cohort studies are valuable, they are inherently subject to biases such as
selection bias and missing data. The retrospective nature of this study means that causality cannot
be established, and the results may not be generalizable to other settings or patient populations.
-The study does not mention if the findings were validated externally or if the findings are
applicable beyond the study cohort. External validation using an independent cohort would help
confirm the robustness and generalizability of the results.
-Although the exclusion criteria are robust, the study may still have unaccounted confounding
factors. For instance, factors like body mass index (BMI), comorbidities, or other inflammatory
conditions may influence NLR and PLR, but these are not mentioned as variables considered
in the analysis.
-The study includes only patients who underwent laparoscopic radical resection. However,
variations in surgical techniques could influence postoperative inflammatory responses and thus
the biomarkers, though this potential confounding factor isn't addressed.
-The study focuses primarily on preoperative inflammatory markers but does not provide in-
depth information on postoperative treatments, such as chemotherapy, which could influence
NLR and PLR. Follow-up data would also be helpful to assess how these biomarkers predict
long-term outcomes, including recurrence or survival.
-While NLR and PLR are the focus, the study does not discuss the role of other potential
inflammatory biomarkers, such as C-reactive protein (CRP) or interleukins, which may provide
additional insights or reinforce the findings of NLR and PLR.
-Although NLR and PLR were assessed independently, the study does not explore the potential
interactions of these markers with other known risk factors, such as PNI and LVI. A multivariate
analysis could provide more insight into the role of these markers when adjusted for other
important variables.
-The study could have mentioned other inflammatory markers, such as C-reactive protein (CRP),
interleukins, or tumor markers (e.g., CEA), which may play a role in predicting LNM. Including
a broader set of biomarkers would have provided more context and possibly enhanced the
predictive value of the study.
-The study does not provide a clear pathway for clinical application of NLR and PLR in rectal
cancer management. It would have been helpful to discuss how clinicians might use these
biomarkers, especially since other factors (e.g., PNI and LVI) were shown to be more significant.
Please review this paper.
user
Title: Association of clinicopathological factor with Lymph Node Metastasis in Rectal Cancer
Patients: a retrospective cohort study
Version: 1 Date: 18 Mar 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-While retrospective cohort studies are valuable, they are inherently subject to biases such as
selection bias and missing data. The retrospective nature of this study means that causality cannot
be established, and the results may not be generalizable to other settings or patient populations.
-The study does not mention if the findings were validated externally or if the findings are
applicable beyond the study cohort. External validation using an independent cohort would help
confirm the robustness and generalizability of the results.
-Although the exclusion criteria are robust, the study may still have unaccounted confounding
factors. For instance, factors like body mass index (BMI), comorbidities, or other inflammatory
conditions may influence NLR and PLR, but these are not mentioned as variables considered
in the analysis.
-The study includes only patients who underwent laparoscopic radical resection. However,
variations in surgical techniques could influence postoperative inflammatory responses and thus
the biomarkers, though this potential confounding factor isn't addressed.
-The study focuses primarily on preoperative inflammatory markers but does not provide in-
depth information on postoperative treatments, such as chemotherapy, which could influence
NLR and PLR. Follow-up data would also be helpful to assess how these biomarkers predict
long-term outcomes, including recurrence or survival.
-While NLR and PLR are the focus, the study does not discuss the role of other potential
inflammatory biomarkers, such as C-reactive protein (CRP) or interleukins, which may provide
additional insights or reinforce the findings of NLR and PLR.
-Although NLR and PLR were assessed independently, the study does not explore the potential
interactions of these markers with other known risk factors, such as PNI and LVI. A multivariate
analysis could provide more insight into the role of these markers when adjusted for other
important variables.
-The study could have mentioned other inflammatory markers, such as C-reactive protein (CRP),
interleukins, or tumor markers (e.g., CEA), which may play a role in predicting LNM. Including
a broader set of biomarkers would have provided more context and possibly enhanced the
predictive value of the study.
-The study does not provide a clear pathway for clinical application of NLR and PLR in rectal
cancer management. It would have been helpful to discuss how clinicians might use these
biomarkers, especially since other factors (e.g., PNI and LVI) were shown to be more significant.
assistant