Title: Development and validation of Comprehensive Nomograms from the SEER Database for
Predicting Early Mortality in Metastatic Rectal Cancer Patients
Version: 0 Date: 24 Dec 2023
Reviewer:  Xianggao Zhu
Reviewer's report:
Since there have been no reports of nomograms based on risk models for predicting the incidence
of early mortality in metastatic rectal cancer patients, in this study the authors constructed a
Nomogram model for predicting early mortality in advanced rectal cancer based on data from
the SEER database, which is innovative and clinically significant, but some of the content in the
text needs to be appropriately modified:
1. In the second paragraph of “Population”, the author extracted 19 clinical variables, It is always
known that the patient's own physical condition, e.g., ECOG score or KPS score, correlates with
both prognosis and treatment strategy, and it is recommended to add.
2. In the second paragraph of “Population”, the inclusion criteria include#(1)the M stage of
primary tumor was M1, I recommend the author to state whether the inclusion criteria are
simultaneous or heterochronous metastases of rectal cancer.
3. In the second paragraph of “Population”, the "cancer-specific early mortality" was specified
as an early mortality attributed to cancer-related causes within the same 3-month window post-
diagnosis. It is recommended that the authors state whether the time of diagnosis was a diagnosis
of rectal cancer or a diagnosis of distant metastasis.
4. In all tables, among the risk factors, it is recommended that "Radiation" be replaced with
"Radiotherapy".
5. In the paragraph of “Risk factors for early mortality in the training cohort”, In Table 2/3,
the metastases to brain didn’t effect the both all-cause(P=0.949) and cancer-specific early
mortality(P=0.975) for univariate analysis. I recommend the authors to check relevant results.
6. In the paragraph of “Risk factors for early mortality in the training cohort”, the authors point
out that the radiotherapy and surgery significant influence the early mortality, since surgery
and radiotherapy are used as localized treatments strategy, and the authors are advised to state
whether the surgery and radiotherapy dealt with a primary rectal cancer or metastases lesions.
7. In this article, for stage IV rectal cancer patients, metastases to bone, liver and lung all
have higher early mortality, as previous results in the literature have shown that the overall
prognosis of rectal cancer patients with lung metastases alone is relatively good, it is suggested
that the authors clarify whether most of the patients with lung metastases in this study also had
metastases from other sites.
Title: Development and validation of Comprehensive Nomograms from the SEER Database for
Predicting Early Mortality in Metastatic Rectal Cancer Patients
Version: 0 Date: 24 Dec 2023
Reviewer:  Xianggao Zhu
Reviewer's report:
Since there have been no reports of nomograms based on risk models for predicting the incidence
of early mortality in metastatic rectal cancer patients, in this study the authors constructed a
Nomogram model for predicting early mortality in advanced rectal cancer based on data from
the SEER database, which is innovative and clinically significant, but some of the content in the
text needs to be appropriately modified:
1. In the second paragraph of “Population”, the author extracted 19 clinical variables, It is always
known that the patient's own physical condition, e.g., ECOG score or KPS score, correlates with
both prognosis and treatment strategy, and it is recommended to add.
2. In the second paragraph of “Population”, the inclusion criteria include#(1)the M stage of
primary tumor was M1, I recommend the author to state whether the inclusion criteria are
simultaneous or heterochronous metastases of rectal cancer.
3. In the second paragraph of “Population”, the "cancer-specific early mortality" was specified
as an early mortality attributed to cancer-related causes within the same 3-month window post-
diagnosis. It is recommended that the authors state whether the time of diagnosis was a diagnosis
of rectal cancer or a diagnosis of distant metastasis.
4. In all tables, among the risk factors, it is recommended that "Radiation" be replaced with
"Radiotherapy".
5. In the paragraph of “Risk factors for early mortality in the training cohort”, In Table 2/3,
the metastases to brain didn’t effect the both all-cause(P=0.949) and cancer-specific early
mortality(P=0.975) for univariate analysis. I recommend the authors to check relevant results.
6. In the paragraph of “Risk factors for early mortality in the training cohort”, the authors point
out that the radiotherapy and surgery significant influence the early mortality, since surgery
and radiotherapy are used as localized treatments strategy, and the authors are advised to state
whether the surgery and radiotherapy dealt with a primary rectal cancer or metastases lesions.
7. In this article, for stage IV rectal cancer patients, metastases to bone, liver and lung all
have higher early mortality, as previous results in the literature have shown that the overall
prognosis of rectal cancer patients with lung metastases alone is relatively good, it is suggested
that the authors clarify whether most of the patients with lung metastases in this study also had
metastases from other sites.
Please review this paper.
user
Title: Development and validation of Comprehensive Nomograms from the SEER Database for
Predicting Early Mortality in Metastatic Rectal Cancer Patients
Version: 0 Date: 24 Dec 2023
Reviewer:  Xianggao Zhu
Reviewer's report:
Since there have been no reports of nomograms based on risk models for predicting the incidence
of early mortality in metastatic rectal cancer patients, in this study the authors constructed a
Nomogram model for predicting early mortality in advanced rectal cancer based on data from
the SEER database, which is innovative and clinically significant, but some of the content in the
text needs to be appropriately modified:
1. In the second paragraph of “Population”, the author extracted 19 clinical variables, It is always
known that the patient's own physical condition, e.g., ECOG score or KPS score, correlates with
both prognosis and treatment strategy, and it is recommended to add.
2. In the second paragraph of “Population”, the inclusion criteria include#(1)the M stage of
primary tumor was M1, I recommend the author to state whether the inclusion criteria are
simultaneous or heterochronous metastases of rectal cancer.
3. In the second paragraph of “Population”, the "cancer-specific early mortality" was specified
as an early mortality attributed to cancer-related causes within the same 3-month window post-
diagnosis. It is recommended that the authors state whether the time of diagnosis was a diagnosis
of rectal cancer or a diagnosis of distant metastasis.
4. In all tables, among the risk factors, it is recommended that "Radiation" be replaced with
"Radiotherapy".
5. In the paragraph of “Risk factors for early mortality in the training cohort”, In Table 2/3,
the metastases to brain didn’t effect the both all-cause(P=0.949) and cancer-specific early
mortality(P=0.975) for univariate analysis. I recommend the authors to check relevant results.
6. In the paragraph of “Risk factors for early mortality in the training cohort”, the authors point
out that the radiotherapy and surgery significant influence the early mortality, since surgery
and radiotherapy are used as localized treatments strategy, and the authors are advised to state
whether the surgery and radiotherapy dealt with a primary rectal cancer or metastases lesions.
7. In this article, for stage IV rectal cancer patients, metastases to bone, liver and lung all
have higher early mortality, as previous results in the literature have shown that the overall
prognosis of rectal cancer patients with lung metastases alone is relatively good, it is suggested
that the authors clarify whether most of the patients with lung metastases in this study also had
metastases from other sites.
assistant