Title: A Comprehensive Study on Non-Cancer-Related Mortality Risk Factors in Elderly
Gastric Cancer Patients Post-Curative Surgery
Version: 2 Date: 20 Dec 2023
Reviewer:  Manabu Ohashi
Reviewer's report:
Reviewer really appreciates having an opportunity to evaluate this manuscript titled A
Comprehensive Study on Other Disease Mortality Risk Factors in Elderly Gastric Cancer
Patients Post-Curative Surgery” written by Dr. Ushimaru et al. The manuscript is well written,
and the conclusions were properly derived from the results of this study. However, the study
has critical flaws, such as a single-institutional, retrospective study and small-sized study.
Furthermore, the study may have an essential problem. Reviewer would like to provide the
authors with some comments listed below.
1. First of all, the main results of this study: age (older age), BMI (malnutrition), and overall
complications were independent prognostic factors in elderly patients with curatively resected
gastric cancer, are quite natural. Reviewer believes that these factors may be prognostic factors
in elderly patients with another disease. Furthermore, these factors may be generally associated
with death of elderly people. Physicians are always concern that elderly patients, especially much
older, malnutritional patients or those with other comorbidities after gastrectomy get another
disease. Thus, reviewer is worried about whether the results of this study are new information
for potential readers. The authors should clearly describe in the introduction section what the
results have been reported regarding such an area so far, what information is insufficient and
what the authors will newly elucidate in this study. Moreover, in the discussion section, the
authors should also clearly describe how the information obtained from this study is different
from the past information, what may generate the differences between the results of present and
past studies and how the new information is useful in daily practice. If the authors can clearly
state such things, the study may be valuable even though it is a single-institutional, retrospective
and very-small-sized (only 33 patients were the final target) study.
2. In the multivariate analysis, the authors used the 4 variables. However, less than 10% of
the event number should be input to multivariate analysis generally. Otherwise, overfitting
phenomena will occur. In this study, the event (other-cause-death) number was 33. Thus, 3 or
less variables should be used in the multivariate analysis.
3. “Death within 5 years from non gastric cancer related death” is described at the bottom of
Figure 1. The word “death” is duplicated. A correction may be proper. The number of patients
at risk should be described in the Kaplan-Meyer’s curves.
Title: A Comprehensive Study on Non-Cancer-Related Mortality Risk Factors in Elderly
Gastric Cancer Patients Post-Curative Surgery
Version: 2 Date: 20 Dec 2023
Reviewer:  Manabu Ohashi
Reviewer's report:
Reviewer really appreciates having an opportunity to evaluate this manuscript titled A
Comprehensive Study on Other Disease Mortality Risk Factors in Elderly Gastric Cancer
Patients Post-Curative Surgery” written by Dr. Ushimaru et al. The manuscript is well written,
and the conclusions were properly derived from the results of this study. However, the study
has critical flaws, such as a single-institutional, retrospective study and small-sized study.
Furthermore, the study may have an essential problem. Reviewer would like to provide the
authors with some comments listed below.
1. First of all, the main results of this study: age (older age), BMI (malnutrition), and overall
complications were independent prognostic factors in elderly patients with curatively resected
gastric cancer, are quite natural. Reviewer believes that these factors may be prognostic factors
in elderly patients with another disease. Furthermore, these factors may be generally associated
with death of elderly people. Physicians are always concern that elderly patients, especially much
older, malnutritional patients or those with other comorbidities after gastrectomy get another
disease. Thus, reviewer is worried about whether the results of this study are new information
for potential readers. The authors should clearly describe in the introduction section what the
results have been reported regarding such an area so far, what information is insufficient and
what the authors will newly elucidate in this study. Moreover, in the discussion section, the
authors should also clearly describe how the information obtained from this study is different
from the past information, what may generate the differences between the results of present and
past studies and how the new information is useful in daily practice. If the authors can clearly
state such things, the study may be valuable even though it is a single-institutional, retrospective
and very-small-sized (only 33 patients were the final target) study.
2. In the multivariate analysis, the authors used the 4 variables. However, less than 10% of
the event number should be input to multivariate analysis generally. Otherwise, overfitting
phenomena will occur. In this study, the event (other-cause-death) number was 33. Thus, 3 or
less variables should be used in the multivariate analysis.
3. “Death within 5 years from non gastric cancer related death” is described at the bottom of
Figure 1. The word “death” is duplicated. A correction may be proper. The number of patients
at risk should be described in the Kaplan-Meyer’s curves.
Please review this paper.
user
Title: A Comprehensive Study on Non-Cancer-Related Mortality Risk Factors in Elderly
Gastric Cancer Patients Post-Curative Surgery
Version: 2 Date: 20 Dec 2023
Reviewer:  Manabu Ohashi
Reviewer's report:
Reviewer really appreciates having an opportunity to evaluate this manuscript titled A
Comprehensive Study on Other Disease Mortality Risk Factors in Elderly Gastric Cancer
Patients Post-Curative Surgery” written by Dr. Ushimaru et al. The manuscript is well written,
and the conclusions were properly derived from the results of this study. However, the study
has critical flaws, such as a single-institutional, retrospective study and small-sized study.
Furthermore, the study may have an essential problem. Reviewer would like to provide the
authors with some comments listed below.
1. First of all, the main results of this study: age (older age), BMI (malnutrition), and overall
complications were independent prognostic factors in elderly patients with curatively resected
gastric cancer, are quite natural. Reviewer believes that these factors may be prognostic factors
in elderly patients with another disease. Furthermore, these factors may be generally associated
with death of elderly people. Physicians are always concern that elderly patients, especially much
older, malnutritional patients or those with other comorbidities after gastrectomy get another
disease. Thus, reviewer is worried about whether the results of this study are new information
for potential readers. The authors should clearly describe in the introduction section what the
results have been reported regarding such an area so far, what information is insufficient and
what the authors will newly elucidate in this study. Moreover, in the discussion section, the
authors should also clearly describe how the information obtained from this study is different
from the past information, what may generate the differences between the results of present and
past studies and how the new information is useful in daily practice. If the authors can clearly
state such things, the study may be valuable even though it is a single-institutional, retrospective
and very-small-sized (only 33 patients were the final target) study.
2. In the multivariate analysis, the authors used the 4 variables. However, less than 10% of
the event number should be input to multivariate analysis generally. Otherwise, overfitting
phenomena will occur. In this study, the event (other-cause-death) number was 33. Thus, 3 or
less variables should be used in the multivariate analysis.
3. “Death within 5 years from non gastric cancer related death” is described at the bottom of
Figure 1. The word “death” is duplicated. A correction may be proper. The number of patients
at risk should be described in the Kaplan-Meyer’s curves.
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