Title: Survival after Curative Resection for Stage I Colorectal Mucinous Adenocarcinoma
Version: 5 Date: 04 Mar 2022
Reviewer:  Jihun Kim
Reviewer's report:
Authors resolved most raised concerns well. However, I found a few new major and minor
concerns. Please check and correct them.
Major comments
According to the results, dMMR positive group showed significantly worse overall and disease-
free survivals than dMMR negative group (that is pMMR) in the Table 2 & 3, and Figure 2
& 3. However, in the discussion section (the last paragraph), authors stated that “Our study
revealed that stage I CRC patients with dMMR status showed a much better survival compared
with the pMMR group.” Thus, the results and the discussion do not match. Which side is true?
Although there have been controversies about the prognostic impacts of dMMR status in CRC,
the general trend is that dMMR CRCs behave better than pMMR CRCs in early stage. If the
results are true (dMMR CRCs are more aggressive in stage I CRCs), they contradict the previous
reports. Regarding this, I personally observed that mucinous adenocarcinomas could not benefit
from host immune surveillance probably because host immune cells cannot get access to the
tumor cells due to the intervening mucin pools (thus, dMMR mucinous adenocarcinomas show
aggressive clinical behavior and poor response to immunotherapy). Authors should get this thing
straight (which one is true? Results or Discussion?) and discuss the scientific significance of
the related data.
Minor comments
Page 7, 5th line from the bottom: “There were nearly significantly more LVI in MAC patients
than non-MAC patients.” # “LVI tended to be more frequent in MAC patients than in non-MAC
patients.” (more clear expression about statistically insignificant trends)
Title: Survival after Curative Resection for Stage I Colorectal Mucinous Adenocarcinoma
Version: 5 Date: 04 Mar 2022
Reviewer:  Jihun Kim
Reviewer's report:
Authors resolved most raised concerns well. However, I found a few new major and minor
concerns. Please check and correct them.
Major comments
According to the results, dMMR positive group showed significantly worse overall and disease-
free survivals than dMMR negative group (that is pMMR) in the Table 2 & 3, and Figure 2
& 3. However, in the discussion section (the last paragraph), authors stated that “Our study
revealed that stage I CRC patients with dMMR status showed a much better survival compared
with the pMMR group.” Thus, the results and the discussion do not match. Which side is true?
Although there have been controversies about the prognostic impacts of dMMR status in CRC,
the general trend is that dMMR CRCs behave better than pMMR CRCs in early stage. If the
results are true (dMMR CRCs are more aggressive in stage I CRCs), they contradict the previous
reports. Regarding this, I personally observed that mucinous adenocarcinomas could not benefit
from host immune surveillance probably because host immune cells cannot get access to the
tumor cells due to the intervening mucin pools (thus, dMMR mucinous adenocarcinomas show
aggressive clinical behavior and poor response to immunotherapy). Authors should get this thing
straight (which one is true? Results or Discussion?) and discuss the scientific significance of
the related data.
Minor comments
Page 7, 5th line from the bottom: “There were nearly significantly more LVI in MAC patients
than non-MAC patients.” # “LVI tended to be more frequent in MAC patients than in non-MAC
patients.” (more clear expression about statistically insignificant trends)
Please review this paper.
user
Title: Survival after Curative Resection for Stage I Colorectal Mucinous Adenocarcinoma
Version: 5 Date: 04 Mar 2022
Reviewer:  Jihun Kim
Reviewer's report:
Authors resolved most raised concerns well. However, I found a few new major and minor
concerns. Please check and correct them.
Major comments
According to the results, dMMR positive group showed significantly worse overall and disease-
free survivals than dMMR negative group (that is pMMR) in the Table 2 & 3, and Figure 2
& 3. However, in the discussion section (the last paragraph), authors stated that “Our study
revealed that stage I CRC patients with dMMR status showed a much better survival compared
with the pMMR group.” Thus, the results and the discussion do not match. Which side is true?
Although there have been controversies about the prognostic impacts of dMMR status in CRC,
the general trend is that dMMR CRCs behave better than pMMR CRCs in early stage. If the
results are true (dMMR CRCs are more aggressive in stage I CRCs), they contradict the previous
reports. Regarding this, I personally observed that mucinous adenocarcinomas could not benefit
from host immune surveillance probably because host immune cells cannot get access to the
tumor cells due to the intervening mucin pools (thus, dMMR mucinous adenocarcinomas show
aggressive clinical behavior and poor response to immunotherapy). Authors should get this thing
straight (which one is true? Results or Discussion?) and discuss the scientific significance of
the related data.
Minor comments
Page 7, 5th line from the bottom: “There were nearly significantly more LVI in MAC patients
than non-MAC patients.” # “LVI tended to be more frequent in MAC patients than in non-MAC
patients.” (more clear expression about statistically insignificant trends)
assistant