Title: Inflammatory Biomarker Correlations and Prognosis in High-risk Gastrointestinal
Stromal Tumor Patients: A Multicenter Retrospective Analysis
Version: 4 Date: 06 Dec 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED ADEQUATELY TO
EACH OF THE QUESTIONS YOU RAISED IN YOUR COMMENTS
I want to very strongly and respectfully compliment  the authors on such an erudite,
comprehensive (and polite) complete response to all the comments made to improve this
excellent paper. This is exactly how the review system should work. Very nice job authors!!!!!
Also your use of the English language is to be envied! CONGRATULATIONS
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE MANUSCRIPT
Yes
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED MANUSCRIPT
This is a beautifully designed and carried out study addressing whether inflammatory markers
in specifically the high risk GIST population . In fortunately they are of no prognostic important
in treatment unlike other malignant neoplasms. Preoperatively nutritional index was important
and this offers a potential role for an aggressive preoperative nutritional rescue that needs to be
designed and studied
ADDITIONAL REQUESTS/SUGGESTIONS:
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD MAKE
AUTHORS MY COMENTS ARE MINOR AND CAN EASILY BE INCORP0RATED
WONDERFUL CAREFUL STUDY
Again have re-read  the entire manuscript
1. Line 44 please add the phrase “ lack of IM treatment had” after the second word on that line
of “and”  and delete “ whether or not IM and”
2. Line 54, 63, and elsewhere when referring to true neoplasms I would change “tumors” to
“neoplasms”.  Off the record GIST really should be GISN but unfortunately even in one of my
publications of GISTS I could. It convince my coauthors to say GISN!  A good example of what
I am saying is IPMN which originally was called  IPMT( I lost that battle as well! And 2 years
later it was called IPMN!
3. Line 108 I would add the grass “that might limit postoperative survival “ after the word
“failures”
4. Line 101. Shouldn’t you add a reference in the literature defining the classification of
GISTs into extremely low, low, intermediate, and high risk categories based on postoperative
evaluations and pathologic findings   Did you use the classification you describe on line 169 if
so best to add a reference here
5. You have stressed the importance of inflammatory markers and indexes in building treatment
of several malignant neoplasms. But with GISTs, you really only looked at high risk GISTs. Do
these markers have importance in patients with low and intermediate  risk patients; are these
markers of import in their treatment like in say gastric cancer?
6. In lines 277-335 you do not say that unfortunately the inflammatory factors we evaluated in
these high risk patients had any positive correlation with RFS or OS. I think you should say that
because one of your hypotheses (and even the title) was that inflammatory factors do play a role
in prognosis; you found other markers but not inflammatory ones.  Also this needs to be added
to the conclusions saying on line 340 that "but unfortunately not the inflammatory markers  that
have proven to be important in other gastrointestinal malignancies" and that your hypothesis
was not proven correct.  No one will criticize you for not proving your hypothesis indeed that
is why hypothesis driven research is the standard approach.
Title: Inflammatory Biomarker Correlations and Prognosis in High-risk Gastrointestinal
Stromal Tumor Patients: A Multicenter Retrospective Analysis
Version: 4 Date: 06 Dec 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED ADEQUATELY TO
EACH OF THE QUESTIONS YOU RAISED IN YOUR COMMENTS
I want to very strongly and respectfully compliment  the authors on such an erudite,
comprehensive (and polite) complete response to all the comments made to improve this
excellent paper. This is exactly how the review system should work. Very nice job authors!!!!!
Also your use of the English language is to be envied! CONGRATULATIONS
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE MANUSCRIPT
Yes
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED MANUSCRIPT
This is a beautifully designed and carried out study addressing whether inflammatory markers
in specifically the high risk GIST population . In fortunately they are of no prognostic important
in treatment unlike other malignant neoplasms. Preoperatively nutritional index was important
and this offers a potential role for an aggressive preoperative nutritional rescue that needs to be
designed and studied
ADDITIONAL REQUESTS/SUGGESTIONS:
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD MAKE
AUTHORS MY COMENTS ARE MINOR AND CAN EASILY BE INCORP0RATED
WONDERFUL CAREFUL STUDY
Again have re-read  the entire manuscript
1. Line 44 please add the phrase “ lack of IM treatment had” after the second word on that line
of “and”  and delete “ whether or not IM and”
2. Line 54, 63, and elsewhere when referring to true neoplasms I would change “tumors” to
“neoplasms”.  Off the record GIST really should be GISN but unfortunately even in one of my
publications of GISTS I could. It convince my coauthors to say GISN!  A good example of what
I am saying is IPMN which originally was called  IPMT( I lost that battle as well! And 2 years
later it was called IPMN!
3. Line 108 I would add the grass “that might limit postoperative survival “ after the word
“failures”
4. Line 101. Shouldn’t you add a reference in the literature defining the classification of
GISTs into extremely low, low, intermediate, and high risk categories based on postoperative
evaluations and pathologic findings   Did you use the classification you describe on line 169 if
so best to add a reference here
5. You have stressed the importance of inflammatory markers and indexes in building treatment
of several malignant neoplasms. But with GISTs, you really only looked at high risk GISTs. Do
these markers have importance in patients with low and intermediate  risk patients; are these
markers of import in their treatment like in say gastric cancer?
6. In lines 277-335 you do not say that unfortunately the inflammatory factors we evaluated in
these high risk patients had any positive correlation with RFS or OS. I think you should say that
because one of your hypotheses (and even the title) was that inflammatory factors do play a role
in prognosis; you found other markers but not inflammatory ones.  Also this needs to be added
to the conclusions saying on line 340 that "but unfortunately not the inflammatory markers  that
have proven to be important in other gastrointestinal malignancies" and that your hypothesis
was not proven correct.  No one will criticize you for not proving your hypothesis indeed that
is why hypothesis driven research is the standard approach.
Please review this paper.
user
Title: Inflammatory Biomarker Correlations and Prognosis in High-risk Gastrointestinal
Stromal Tumor Patients: A Multicenter Retrospective Analysis
Version: 4 Date: 06 Dec 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED ADEQUATELY TO
EACH OF THE QUESTIONS YOU RAISED IN YOUR COMMENTS
I want to very strongly and respectfully compliment  the authors on such an erudite,
comprehensive (and polite) complete response to all the comments made to improve this
excellent paper. This is exactly how the review system should work. Very nice job authors!!!!!
Also your use of the English language is to be envied! CONGRATULATIONS
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE MANUSCRIPT
Yes
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED MANUSCRIPT
This is a beautifully designed and carried out study addressing whether inflammatory markers
in specifically the high risk GIST population . In fortunately they are of no prognostic important
in treatment unlike other malignant neoplasms. Preoperatively nutritional index was important
and this offers a potential role for an aggressive preoperative nutritional rescue that needs to be
designed and studied
ADDITIONAL REQUESTS/SUGGESTIONS:
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD MAKE
AUTHORS MY COMENTS ARE MINOR AND CAN EASILY BE INCORP0RATED
WONDERFUL CAREFUL STUDY
Again have re-read  the entire manuscript
1. Line 44 please add the phrase “ lack of IM treatment had” after the second word on that line
of “and”  and delete “ whether or not IM and”
2. Line 54, 63, and elsewhere when referring to true neoplasms I would change “tumors” to
“neoplasms”.  Off the record GIST really should be GISN but unfortunately even in one of my
publications of GISTS I could. It convince my coauthors to say GISN!  A good example of what
I am saying is IPMN which originally was called  IPMT( I lost that battle as well! And 2 years
later it was called IPMN!
3. Line 108 I would add the grass “that might limit postoperative survival “ after the word
“failures”
4. Line 101. Shouldn’t you add a reference in the literature defining the classification of
GISTs into extremely low, low, intermediate, and high risk categories based on postoperative
evaluations and pathologic findings   Did you use the classification you describe on line 169 if
so best to add a reference here
5. You have stressed the importance of inflammatory markers and indexes in building treatment
of several malignant neoplasms. But with GISTs, you really only looked at high risk GISTs. Do
these markers have importance in patients with low and intermediate  risk patients; are these
markers of import in their treatment like in say gastric cancer?
6. In lines 277-335 you do not say that unfortunately the inflammatory factors we evaluated in
these high risk patients had any positive correlation with RFS or OS. I think you should say that
because one of your hypotheses (and even the title) was that inflammatory factors do play a role
in prognosis; you found other markers but not inflammatory ones.  Also this needs to be added
to the conclusions saying on line 340 that "but unfortunately not the inflammatory markers  that
have proven to be important in other gastrointestinal malignancies" and that your hypothesis
was not proven correct.  No one will criticize you for not proving your hypothesis indeed that
is why hypothesis driven research is the standard approach.
assistant