Title: Prognostic value of hemoglobin to red blood cell distribution width ratio in pancreatic
ductal adenocarcinoma: A retrospective study
Version: 1 Date: 23 Jun 2024
Reviewer:  Jörg Kleeff
Reviewer's report:
The current manuscript presents a retrospective single center study on 128 patients with
pancreatic cancer. Various prognostic factors were analysed. It is shown that hemoglobin to red
blood cell distribution width ratio (HRR) was an independent predictor for overall and disease
free survival.
The identification of relevant prognostic markers for pancreatic cancer is an important topic.
There are, however, several concerns that the authors should address:
One major drawback of the present study is the relatively small cohort of 128 patients, and the
single center design. There is no training and validation cohort. Therefore, it is difficult to draw
meaningful conclusions.
Further, there is a lack of clinical implications. What can we do with this information. Do
the authors suggest to stratify patients depending on HRR (e.g. neoadjuvant therapy yes/no, or
prehabilitation, or RBC transfusion)?
It would be important to provide information on the HRR marker, besides its prognostic
relevance in various cancers. What is this ratio actually measuring? How is it related to chronic
blood loss and bone marrow function? The introduction is very short and not very informative
The cut-off value of HRR was set at 0.88. First, it is not clear how this was established (what
does it mean ‘based on the ROC cut-off value’?). Second, is this the best cut-off value? There
might be better values to identify patients with worse prognosis.
The authors could have also checked whether a combination of markers (e.g. CA19-9 plus HRR
plus other markers) would be superior to each marker alone.
Title: Prognostic value of hemoglobin to red blood cell distribution width ratio in pancreatic
ductal adenocarcinoma: A retrospective study
Version: 1 Date: 23 Jun 2024
Reviewer:  Jörg Kleeff
Reviewer's report:
The current manuscript presents a retrospective single center study on 128 patients with
pancreatic cancer. Various prognostic factors were analysed. It is shown that hemoglobin to red
blood cell distribution width ratio (HRR) was an independent predictor for overall and disease
free survival.
The identification of relevant prognostic markers for pancreatic cancer is an important topic.
There are, however, several concerns that the authors should address:
One major drawback of the present study is the relatively small cohort of 128 patients, and the
single center design. There is no training and validation cohort. Therefore, it is difficult to draw
meaningful conclusions.
Further, there is a lack of clinical implications. What can we do with this information. Do
the authors suggest to stratify patients depending on HRR (e.g. neoadjuvant therapy yes/no, or
prehabilitation, or RBC transfusion)?
It would be important to provide information on the HRR marker, besides its prognostic
relevance in various cancers. What is this ratio actually measuring? How is it related to chronic
blood loss and bone marrow function? The introduction is very short and not very informative
The cut-off value of HRR was set at 0.88. First, it is not clear how this was established (what
does it mean ‘based on the ROC cut-off value’?). Second, is this the best cut-off value? There
might be better values to identify patients with worse prognosis.
The authors could have also checked whether a combination of markers (e.g. CA19-9 plus HRR
plus other markers) would be superior to each marker alone.
Please review this paper.
user
Title: Prognostic value of hemoglobin to red blood cell distribution width ratio in pancreatic
ductal adenocarcinoma: A retrospective study
Version: 1 Date: 23 Jun 2024
Reviewer:  Jörg Kleeff
Reviewer's report:
The current manuscript presents a retrospective single center study on 128 patients with
pancreatic cancer. Various prognostic factors were analysed. It is shown that hemoglobin to red
blood cell distribution width ratio (HRR) was an independent predictor for overall and disease
free survival.
The identification of relevant prognostic markers for pancreatic cancer is an important topic.
There are, however, several concerns that the authors should address:
One major drawback of the present study is the relatively small cohort of 128 patients, and the
single center design. There is no training and validation cohort. Therefore, it is difficult to draw
meaningful conclusions.
Further, there is a lack of clinical implications. What can we do with this information. Do
the authors suggest to stratify patients depending on HRR (e.g. neoadjuvant therapy yes/no, or
prehabilitation, or RBC transfusion)?
It would be important to provide information on the HRR marker, besides its prognostic
relevance in various cancers. What is this ratio actually measuring? How is it related to chronic
blood loss and bone marrow function? The introduction is very short and not very informative
The cut-off value of HRR was set at 0.88. First, it is not clear how this was established (what
does it mean ‘based on the ROC cut-off value’?). Second, is this the best cut-off value? There
might be better values to identify patients with worse prognosis.
The authors could have also checked whether a combination of markers (e.g. CA19-9 plus HRR
plus other markers) would be superior to each marker alone.
assistant