Title: Prognostic model for oversurvival and tumor-specific survival prediction in patients with
advanced extrahepatic cholangiocarcinoma: a population-based analysis
Version: 1 Date: 10 Sep 2023
Reviewer's report:
In this study, authors developed a prognostic model using SEER database in extrahepatic
cholangiocarcinoma. The subject of the study was somewhat interesting and the results were
clearly described. However, there are some concerns that arise from our analysis, and I hope to
make more constructive suggestions about the clinical use of this prognostic model.
1. Is the AJCC stage included in the seer data? Distal bile duct cancer and perihilar bile duct
cancer have different TNM stage criteria, how the AJCC TNM stages were identified? T1 and
T2 T1 and T2 stages are unlikely to be distinguishable on CT/MR imaging.
2. Why was the AJCC analysed as 7th edition and not 8th edition?
3. Authors described inclusion and exclusion criteria in materials and methods, and a total of
403 patients were analyzed in this study. Please present the patient flow chart as Figure 1 (how
many ECCA patients were identified and excluded for this study).
4. Please check some errors.
e.g. Cancer-special mortality in Table 1. Same values of AUC were presented in Figure 5A and
5B.
5. In multivariate analyses, did lymph node metastasis was included? Authors mentioned that N
stage was linked with OS and CSS, but it was not shown in the Figure 3.
6. Authors included the T, N, M stage, and AJCC stage (III or IV) in the prognostic model.
However, AJCC stage derived from the combination of T, N, and M stages, shouldn't they be
included together in the model?
7. Authors divided the patients into groups with high and low risk using the nomogram. What
was the value on which the classification is based?
8. The clinical significance of the derived model could have been presented more specifically.
Authors said that nomogram would offers more precise prognostic predictions, then how should
physicians use this model specifically? For example, in patients who have undergone surgery, if
the model is able to divide the prognosis into two groups, it can provide a basis for recommending
adjuvant treatment.
Title: Prognostic model for oversurvival and tumor-specific survival prediction in patients with
advanced extrahepatic cholangiocarcinoma: a population-based analysis
Version: 1 Date: 10 Sep 2023
Reviewer's report:
In this study, authors developed a prognostic model using SEER database in extrahepatic
cholangiocarcinoma. The subject of the study was somewhat interesting and the results were
clearly described. However, there are some concerns that arise from our analysis, and I hope to
make more constructive suggestions about the clinical use of this prognostic model.
1. Is the AJCC stage included in the seer data? Distal bile duct cancer and perihilar bile duct
cancer have different TNM stage criteria, how the AJCC TNM stages were identified? T1 and
T2 T1 and T2 stages are unlikely to be distinguishable on CT/MR imaging.
2. Why was the AJCC analysed as 7th edition and not 8th edition?
3. Authors described inclusion and exclusion criteria in materials and methods, and a total of
403 patients were analyzed in this study. Please present the patient flow chart as Figure 1 (how
many ECCA patients were identified and excluded for this study).
4. Please check some errors.
e.g. Cancer-special mortality in Table 1. Same values of AUC were presented in Figure 5A and
5B.
5. In multivariate analyses, did lymph node metastasis was included? Authors mentioned that N
stage was linked with OS and CSS, but it was not shown in the Figure 3.
6. Authors included the T, N, M stage, and AJCC stage (III or IV) in the prognostic model.
However, AJCC stage derived from the combination of T, N, and M stages, shouldn't they be
included together in the model?
7. Authors divided the patients into groups with high and low risk using the nomogram. What
was the value on which the classification is based?
8. The clinical significance of the derived model could have been presented more specifically.
Authors said that nomogram would offers more precise prognostic predictions, then how should
physicians use this model specifically? For example, in patients who have undergone surgery, if
the model is able to divide the prognosis into two groups, it can provide a basis for recommending
adjuvant treatment.
Please review this paper.
user
Title: Prognostic model for oversurvival and tumor-specific survival prediction in patients with
advanced extrahepatic cholangiocarcinoma: a population-based analysis
Version: 1 Date: 10 Sep 2023
Reviewer's report:
In this study, authors developed a prognostic model using SEER database in extrahepatic
cholangiocarcinoma. The subject of the study was somewhat interesting and the results were
clearly described. However, there are some concerns that arise from our analysis, and I hope to
make more constructive suggestions about the clinical use of this prognostic model.
1. Is the AJCC stage included in the seer data? Distal bile duct cancer and perihilar bile duct
cancer have different TNM stage criteria, how the AJCC TNM stages were identified? T1 and
T2 T1 and T2 stages are unlikely to be distinguishable on CT/MR imaging.
2. Why was the AJCC analysed as 7th edition and not 8th edition?
3. Authors described inclusion and exclusion criteria in materials and methods, and a total of
403 patients were analyzed in this study. Please present the patient flow chart as Figure 1 (how
many ECCA patients were identified and excluded for this study).
4. Please check some errors.
e.g. Cancer-special mortality in Table 1. Same values of AUC were presented in Figure 5A and
5B.
5. In multivariate analyses, did lymph node metastasis was included? Authors mentioned that N
stage was linked with OS and CSS, but it was not shown in the Figure 3.
6. Authors included the T, N, M stage, and AJCC stage (III or IV) in the prognostic model.
However, AJCC stage derived from the combination of T, N, and M stages, shouldn't they be
included together in the model?
7. Authors divided the patients into groups with high and low risk using the nomogram. What
was the value on which the classification is based?
8. The clinical significance of the derived model could have been presented more specifically.
Authors said that nomogram would offers more precise prognostic predictions, then how should
physicians use this model specifically? For example, in patients who have undergone surgery, if
the model is able to divide the prognosis into two groups, it can provide a basis for recommending
adjuvant treatment.
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