Title: Preoperative CA19-9 and GGT ratio as a prognostic indicator in ampullary carcinoma
Version: 4 Date: 12 Nov 2022
Reviewer's report:
With the present paper the Authors aimed at assess the prognostic significance  of CA19.9-GGT
ratio in ampullary cancer  patients undergoing radical resection.
Even if the retrospective design of the study and the relatively small number of patients enrolled
could affect the power of the study, I think that the topic is interesting and the statistical analysis
is very well performed and therefore it deserved to be published.
However I have some comments:
- In the results section is written that jaundice was present in 67  patients. Few lines later is
written that jaundice was present in 138 patients. Pleas check.
- How the authors decided to measure the CA 19.9/GGT the first day after surgery?  should be
useful assess its modification during the next days?
- What about dose it before surgery? Could it have some predictive value?
- Given the possible influence of biliary obstruction and cholestasis on the CA 19.9 and GGT
maybe it could be more indicate  to conduct a different analysis considering patients with
jaundice and patients without it.
Title: Preoperative CA19-9 and GGT ratio as a prognostic indicator in ampullary carcinoma
Version: 4 Date: 12 Nov 2022
Reviewer's report:
With the present paper the Authors aimed at assess the prognostic significance  of CA19.9-GGT
ratio in ampullary cancer  patients undergoing radical resection.
Even if the retrospective design of the study and the relatively small number of patients enrolled
could affect the power of the study, I think that the topic is interesting and the statistical analysis
is very well performed and therefore it deserved to be published.
However I have some comments:
- In the results section is written that jaundice was present in 67  patients. Few lines later is
written that jaundice was present in 138 patients. Pleas check.
- How the authors decided to measure the CA 19.9/GGT the first day after surgery?  should be
useful assess its modification during the next days?
- What about dose it before surgery? Could it have some predictive value?
- Given the possible influence of biliary obstruction and cholestasis on the CA 19.9 and GGT
maybe it could be more indicate  to conduct a different analysis considering patients with
jaundice and patients without it.
Please review this paper.
user
Title: Preoperative CA19-9 and GGT ratio as a prognostic indicator in ampullary carcinoma
Version: 4 Date: 12 Nov 2022
Reviewer's report:
With the present paper the Authors aimed at assess the prognostic significance  of CA19.9-GGT
ratio in ampullary cancer  patients undergoing radical resection.
Even if the retrospective design of the study and the relatively small number of patients enrolled
could affect the power of the study, I think that the topic is interesting and the statistical analysis
is very well performed and therefore it deserved to be published.
However I have some comments:
- In the results section is written that jaundice was present in 67  patients. Few lines later is
written that jaundice was present in 138 patients. Pleas check.
- How the authors decided to measure the CA 19.9/GGT the first day after surgery?  should be
useful assess its modification during the next days?
- What about dose it before surgery? Could it have some predictive value?
- Given the possible influence of biliary obstruction and cholestasis on the CA 19.9 and GGT
maybe it could be more indicate  to conduct a different analysis considering patients with
jaundice and patients without it.
assistant