Title: The effect of menopausal hormone therapy on gastrointestinal cancer risk and mortality
in South Korea: a population based cohort study
Version: 3 Date: 05 May 2021
Reviewer's report:
This retrospective cohort study investigates the association between menopausal hormone
therapy (MHT) and gastrointestinal (GI) cancer risks in South Korea. The author concluded that
menopausal hormone therapy was associated with decreased incidence of GI cancer. A dose-
response relationship was identified in the landmark analysis. Overall, the study is interesting
and has significant clinical value. I have only some minor comments.
1. In Figure 2, Figure S2, and Figure 3, some survival curves seem to cross. As the authors
choose Cox proportional hazards regression model to calculate the HR, please examine whether
the proportional hazards assumption was violated.
2. P.12: “The association between MHT use and GC diagnosis hepatobiliary or pancreatic cancer
(HR: 0.847 and HR: 1.163, respectively).” Some words seem to be missing.
3. P.23: “Third, we used Landmark analysis …… to minimize the possibility of lead-time bias.”
Did the authors mean immortal time bias? The lead-time bias and the immortal time bias are
different concepts.
Title: The effect of menopausal hormone therapy on gastrointestinal cancer risk and mortality
in South Korea: a population based cohort study
Version: 3 Date: 05 May 2021
Reviewer's report:
This retrospective cohort study investigates the association between menopausal hormone
therapy (MHT) and gastrointestinal (GI) cancer risks in South Korea. The author concluded that
menopausal hormone therapy was associated with decreased incidence of GI cancer. A dose-
response relationship was identified in the landmark analysis. Overall, the study is interesting
and has significant clinical value. I have only some minor comments.
1. In Figure 2, Figure S2, and Figure 3, some survival curves seem to cross. As the authors
choose Cox proportional hazards regression model to calculate the HR, please examine whether
the proportional hazards assumption was violated.
2. P.12: “The association between MHT use and GC diagnosis hepatobiliary or pancreatic cancer
(HR: 0.847 and HR: 1.163, respectively).” Some words seem to be missing.
3. P.23: “Third, we used Landmark analysis …… to minimize the possibility of lead-time bias.”
Did the authors mean immortal time bias? The lead-time bias and the immortal time bias are
different concepts.
Please review this paper.
user
Title: The effect of menopausal hormone therapy on gastrointestinal cancer risk and mortality
in South Korea: a population based cohort study
Version: 3 Date: 05 May 2021
Reviewer's report:
This retrospective cohort study investigates the association between menopausal hormone
therapy (MHT) and gastrointestinal (GI) cancer risks in South Korea. The author concluded that
menopausal hormone therapy was associated with decreased incidence of GI cancer. A dose-
response relationship was identified in the landmark analysis. Overall, the study is interesting
and has significant clinical value. I have only some minor comments.
1. In Figure 2, Figure S2, and Figure 3, some survival curves seem to cross. As the authors
choose Cox proportional hazards regression model to calculate the HR, please examine whether
the proportional hazards assumption was violated.
2. P.12: “The association between MHT use and GC diagnosis hepatobiliary or pancreatic cancer
(HR: 0.847 and HR: 1.163, respectively).” Some words seem to be missing.
3. P.23: “Third, we used Landmark analysis …… to minimize the possibility of lead-time bias.”
Did the authors mean immortal time bias? The lead-time bias and the immortal time bias are
different concepts.
assistant