Title: Local Resection Versus Radical Resection After Neoadjuvant Chemoradiotherapy for
Patients with Locally Advanced Rectal Cancer: A Propensity-score Matched Cohort Analysis
Version: 6 Date: 21 Apr 2023
Reviewer:  Guilherme Pagin São Juliao
Reviewer's report:
I disagree with the authors. Removing the patients with ypT3 from the local resection group
is misleading because: a) they had local resection because ypT0-2 was suspected (inherent
limitation of local staging tests); b) completion TME was the following treatment proposed for
these patients, there was no other patients excluded due to subsequent treatment (adjuvant Ct,
salvage TME); c) PSM considered correctly pre-op (ycT staging), not ypT staging; d) there are
ypT3 patients in the radical resection group; e) ypT2 patients that had salvage TME instead of
completion TME were (correctly) not excluded. Even though this is not a randomized trial with
analyses on intention to treat bases, ypT3 can not be an exclusion criteria. The readers need to
have a reliable group to be able to interpret the data, removing the patients at increased risk of
unfavorable outcomes is not fair.
Minors:
1) Abstract. Results:
“After propensity-core matching (PSM), in the Kaplan–Meier curves, local resection (n=52) or
radical resection (n=193) was not significantly associated with 1-, 3-, and 5-year cumulative
incidence of overall survival (OS) (HR=0.785, 95% CI: 0.336~4.239), disease-free survival
(DFS) (HR=1.082, 95% CI: 0.405~2.885), local recurrence (HR=1.623, 95% CI: 0.331~7.961),
and distant metastasis (HR=0.836, 95% CI: 0.242~2.889) (all log-rank P<0.001)”. Is p value
correct?
2) Results; Patients characteristics; 3rd paragraph: “After PSM, Among locally resection
patients, 71.2% (37/52) in ypT1, 7.7% (4/52) in ypT2 and 21.1% (11/52) in ypT3.” Is these
values correct? It does not correspond to Table 2. Please review it.
Title: Local Resection Versus Radical Resection After Neoadjuvant Chemoradiotherapy for
Patients with Locally Advanced Rectal Cancer: A Propensity-score Matched Cohort Analysis
Version: 6 Date: 21 Apr 2023
Reviewer:  Guilherme Pagin São Juliao
Reviewer's report:
I disagree with the authors. Removing the patients with ypT3 from the local resection group
is misleading because: a) they had local resection because ypT0-2 was suspected (inherent
limitation of local staging tests); b) completion TME was the following treatment proposed for
these patients, there was no other patients excluded due to subsequent treatment (adjuvant Ct,
salvage TME); c) PSM considered correctly pre-op (ycT staging), not ypT staging; d) there are
ypT3 patients in the radical resection group; e) ypT2 patients that had salvage TME instead of
completion TME were (correctly) not excluded. Even though this is not a randomized trial with
analyses on intention to treat bases, ypT3 can not be an exclusion criteria. The readers need to
have a reliable group to be able to interpret the data, removing the patients at increased risk of
unfavorable outcomes is not fair.
Minors:
1) Abstract. Results:
“After propensity-core matching (PSM), in the Kaplan–Meier curves, local resection (n=52) or
radical resection (n=193) was not significantly associated with 1-, 3-, and 5-year cumulative
incidence of overall survival (OS) (HR=0.785, 95% CI: 0.336~4.239), disease-free survival
(DFS) (HR=1.082, 95% CI: 0.405~2.885), local recurrence (HR=1.623, 95% CI: 0.331~7.961),
and distant metastasis (HR=0.836, 95% CI: 0.242~2.889) (all log-rank P<0.001)”. Is p value
correct?
2) Results; Patients characteristics; 3rd paragraph: “After PSM, Among locally resection
patients, 71.2% (37/52) in ypT1, 7.7% (4/52) in ypT2 and 21.1% (11/52) in ypT3.” Is these
values correct? It does not correspond to Table 2. Please review it.
Please review this paper.
user
Title: Local Resection Versus Radical Resection After Neoadjuvant Chemoradiotherapy for
Patients with Locally Advanced Rectal Cancer: A Propensity-score Matched Cohort Analysis
Version: 6 Date: 21 Apr 2023
Reviewer:  Guilherme Pagin São Juliao
Reviewer's report:
I disagree with the authors. Removing the patients with ypT3 from the local resection group
is misleading because: a) they had local resection because ypT0-2 was suspected (inherent
limitation of local staging tests); b) completion TME was the following treatment proposed for
these patients, there was no other patients excluded due to subsequent treatment (adjuvant Ct,
salvage TME); c) PSM considered correctly pre-op (ycT staging), not ypT staging; d) there are
ypT3 patients in the radical resection group; e) ypT2 patients that had salvage TME instead of
completion TME were (correctly) not excluded. Even though this is not a randomized trial with
analyses on intention to treat bases, ypT3 can not be an exclusion criteria. The readers need to
have a reliable group to be able to interpret the data, removing the patients at increased risk of
unfavorable outcomes is not fair.
Minors:
1) Abstract. Results:
“After propensity-core matching (PSM), in the Kaplan–Meier curves, local resection (n=52) or
radical resection (n=193) was not significantly associated with 1-, 3-, and 5-year cumulative
incidence of overall survival (OS) (HR=0.785, 95% CI: 0.336~4.239), disease-free survival
(DFS) (HR=1.082, 95% CI: 0.405~2.885), local recurrence (HR=1.623, 95% CI: 0.331~7.961),
and distant metastasis (HR=0.836, 95% CI: 0.242~2.889) (all log-rank P<0.001)”. Is p value
correct?
2) Results; Patients characteristics; 3rd paragraph: “After PSM, Among locally resection
patients, 71.2% (37/52) in ypT1, 7.7% (4/52) in ypT2 and 21.1% (11/52) in ypT3.” Is these
values correct? It does not correspond to Table 2. Please review it.
assistant