Title: Survival after Curative Resection for Stage I Colorectal Mucinous Adenocarcinoma
Version: 1 Date: 17 Nov 2021
Reviewer:  Jihun Kim
Reviewer's report:
Authors investigated clinicopathologic factors affecting long-term patient outcome in stage
I colorectal cancer (CRC) focusing on mucinous histology. Overall methods look good.
However, there are not so much novel findings here. In addition, there are many awkward
English expressions making this manuscript not suitable for publication. Some suggestions for
improvement are listed below.
Major comments
1. Mucinous adenocarcinoma (MAC) is quite heterogeneous in terms of tumor morphology
and biologic behavior. Some tumors might have well differentiated tumor cell strips lining
mucin pools with scarce tumor cells floating in mucin pools while others might have abundant,
moderately differentiated tumor cell clusters or signet ring cells in mucin pools. I recommend
that authors stratify MACs into two or three groups according to tumor differentiation and/or the
presence of signet ring cells. By doing so, authors may provide useful insights for stage I MAC.
2. Disease recurrence or metastasis that eventually leads to patient death in stage I CRC is
intriguing and prediction of such cases is important for patient management. Detailed analysis
of stage I CRCs that led to aggressive systemic metastases or patient death might be very
informative in this sense. Thus, more detailed investigation of 22 patients who died of stage I
CRC is strongly recommended.
3. Authors did not mention the presence and the grade of tumor budding in this manuscript.
The importance of tumor budding can never be overemphasized. CRCs, that did not have
lymphovascular invasion (LVI) but did recur or metastasize, might have tumor budding in many
cases. Thus, authors should investigate tumor budding and its prognostic impact.
Minor comments
1. Insertion of percentage information in parenthesis is recommended in the Table 1.
2. In the Table 2, Hazard ratio would be much better than the mean OS for univariate analysis.
Also, what does MSI positive mean? Please use MSS vs. MSI-H instead. The same thing applies
to the Table 3.
3. Page 7, Paragraph 2, Line7: “appeared to be found significantly more locate at colon…” ->
“was found to be more frequently located at colon…”
4. “higher MSI status” (Page 8, 1st paragraph of the Discussion section, Line 8) ->” a higher
number of MSI-H status.”
5. Many other awkward expressions throughout the manuscript. Please consult a native English
speaking medical doctor for appropriate English expressions.
Title: Survival after Curative Resection for Stage I Colorectal Mucinous Adenocarcinoma
Version: 1 Date: 17 Nov 2021
Reviewer:  Jihun Kim
Reviewer's report:
Authors investigated clinicopathologic factors affecting long-term patient outcome in stage
I colorectal cancer (CRC) focusing on mucinous histology. Overall methods look good.
However, there are not so much novel findings here. In addition, there are many awkward
English expressions making this manuscript not suitable for publication. Some suggestions for
improvement are listed below.
Major comments
1. Mucinous adenocarcinoma (MAC) is quite heterogeneous in terms of tumor morphology
and biologic behavior. Some tumors might have well differentiated tumor cell strips lining
mucin pools with scarce tumor cells floating in mucin pools while others might have abundant,
moderately differentiated tumor cell clusters or signet ring cells in mucin pools. I recommend
that authors stratify MACs into two or three groups according to tumor differentiation and/or the
presence of signet ring cells. By doing so, authors may provide useful insights for stage I MAC.
2. Disease recurrence or metastasis that eventually leads to patient death in stage I CRC is
intriguing and prediction of such cases is important for patient management. Detailed analysis
of stage I CRCs that led to aggressive systemic metastases or patient death might be very
informative in this sense. Thus, more detailed investigation of 22 patients who died of stage I
CRC is strongly recommended.
3. Authors did not mention the presence and the grade of tumor budding in this manuscript.
The importance of tumor budding can never be overemphasized. CRCs, that did not have
lymphovascular invasion (LVI) but did recur or metastasize, might have tumor budding in many
cases. Thus, authors should investigate tumor budding and its prognostic impact.
Minor comments
1. Insertion of percentage information in parenthesis is recommended in the Table 1.
2. In the Table 2, Hazard ratio would be much better than the mean OS for univariate analysis.
Also, what does MSI positive mean? Please use MSS vs. MSI-H instead. The same thing applies
to the Table 3.
3. Page 7, Paragraph 2, Line7: “appeared to be found significantly more locate at colon…” ->
“was found to be more frequently located at colon…”
4. “higher MSI status” (Page 8, 1st paragraph of the Discussion section, Line 8) ->” a higher
number of MSI-H status.”
5. Many other awkward expressions throughout the manuscript. Please consult a native English
speaking medical doctor for appropriate English expressions.
Please review this paper.
user
Title: Survival after Curative Resection for Stage I Colorectal Mucinous Adenocarcinoma
Version: 1 Date: 17 Nov 2021
Reviewer:  Jihun Kim
Reviewer's report:
Authors investigated clinicopathologic factors affecting long-term patient outcome in stage
I colorectal cancer (CRC) focusing on mucinous histology. Overall methods look good.
However, there are not so much novel findings here. In addition, there are many awkward
English expressions making this manuscript not suitable for publication. Some suggestions for
improvement are listed below.
Major comments
1. Mucinous adenocarcinoma (MAC) is quite heterogeneous in terms of tumor morphology
and biologic behavior. Some tumors might have well differentiated tumor cell strips lining
mucin pools with scarce tumor cells floating in mucin pools while others might have abundant,
moderately differentiated tumor cell clusters or signet ring cells in mucin pools. I recommend
that authors stratify MACs into two or three groups according to tumor differentiation and/or the
presence of signet ring cells. By doing so, authors may provide useful insights for stage I MAC.
2. Disease recurrence or metastasis that eventually leads to patient death in stage I CRC is
intriguing and prediction of such cases is important for patient management. Detailed analysis
of stage I CRCs that led to aggressive systemic metastases or patient death might be very
informative in this sense. Thus, more detailed investigation of 22 patients who died of stage I
CRC is strongly recommended.
3. Authors did not mention the presence and the grade of tumor budding in this manuscript.
The importance of tumor budding can never be overemphasized. CRCs, that did not have
lymphovascular invasion (LVI) but did recur or metastasize, might have tumor budding in many
cases. Thus, authors should investigate tumor budding and its prognostic impact.
Minor comments
1. Insertion of percentage information in parenthesis is recommended in the Table 1.
2. In the Table 2, Hazard ratio would be much better than the mean OS for univariate analysis.
Also, what does MSI positive mean? Please use MSS vs. MSI-H instead. The same thing applies
to the Table 3.
3. Page 7, Paragraph 2, Line7: “appeared to be found significantly more locate at colon…” ->
“was found to be more frequently located at colon…”
4. “higher MSI status” (Page 8, 1st paragraph of the Discussion section, Line 8) ->” a higher
number of MSI-H status.”
5. Many other awkward expressions throughout the manuscript. Please consult a native English
speaking medical doctor for appropriate English expressions.
assistant