Reviewer ’s report  
 
Title: Comparison of five tumor regression grading systems for gastric adenocarcinoma after  
neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in  
China  
 
Version: 0 Date: 09 Oct 2016  
 
Reviewer: C Gutschow  
 
Reviewer's report:  
 
Zhu T et al.: Comparison of four tumor regression grading systems for gastric adenocarcinoma 
after neoadjuvant chemo therapy: a retrospective study of 192 cases from National Cancer Center 
in China.  
 
 
 
Thank you for the opportunity to review this interesting manuscript. In this retrospective single 
center study on 192 gastric cancer patients that underwent neoadjuvant chem otherapy, the 
clinical significance of four histological tumor regression grading systems was compared. 
Different grades of histological tumor regression were correlated to overall and recurrence -free 
survival and other oncological parameters. The authors recommend the use of the Mandard 
tumor regression grading system because of superior correlation to patient survival.  
 
 
 
The results and conclusions are clear, the manuscript is well structured and the reading comfort 
is good. Also, I think that the subject is well chosen and would be of substantial interest for the 
readership. However, there are some typos and wrong expressions, so that we recommend proof 
reading by a native English speaking person.  
 
 
 
Furthermore, we have a few remarks and we would be gratef ul if the authors could comment on 
them.  
 
 
 
 
 
 
 
 
 
 
1. TRG systems were correlated to OS and RFS; therefore, it would be important to comment on 
the following points:  
 
 
 
a. How many patients from which groups underwent postoperative (adjuvant) chemo - or 
radiochemothera py? What was the impact of adjuvant therapy on survival?  
 
 
 
b. How radical was the surgery? Please describe some technical details of the operations 
(types of gastrectomy and lymphadenectomy, number of lymph nodes removed etc.)  
 
 
 
c. Please comment on the policy  for oncological follow -up: which investigations were 
carried out and when?  
 
 
 
 
2. Scoring systems using a semiquantitative assessment of tumor regression (for example Becker 
et al.) were not included in this analysis. Please explain the reasons for this approach.  
 
 
In summary, we think that manuscript may be suitable for publication after revisions.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is acce pted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: Comparison of five tumor regression grading systems for gastric adenocarcinoma after  
neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in  
China  
 
Version: 0 Date: 09 Oct 2016  
 
Reviewer: C Gutschow  
 
Reviewer's report:  
 
Zhu T et al.: Comparison of four tumor regression grading systems for gastric adenocarcinoma 
after neoadjuvant chemo therapy: a retrospective study of 192 cases from National Cancer Center 
in China.  
 
 
 
Thank you for the opportunity to review this interesting manuscript. In this retrospective single 
center study on 192 gastric cancer patients that underwent neoadjuvant chem otherapy, the 
clinical significance of four histological tumor regression grading systems was compared. 
Different grades of histological tumor regression were correlated to overall and recurrence -free 
survival and other oncological parameters. The authors recommend the use of the Mandard 
tumor regression grading system because of superior correlation to patient survival.  
 
 
 
The results and conclusions are clear, the manuscript is well structured and the reading comfort 
is good. Also, I think that the subject is well chosen and would be of substantial interest for the 
readership. However, there are some typos and wrong expressions, so that we recommend proof 
reading by a native English speaking person.  
 
 
 
Furthermore, we have a few remarks and we would be gratef ul if the authors could comment on 
them.  
 
 
 
 
 
 
 
 
 
 
1. TRG systems were correlated to OS and RFS; therefore, it would be important to comment on 
the following points:  
 
 
 
a. How many patients from which groups underwent postoperative (adjuvant) chemo - or 
radiochemothera py? What was the impact of adjuvant therapy on survival?  
 
 
 
b. How radical was the surgery? Please describe some technical details of the operations 
(types of gastrectomy and lymphadenectomy, number of lymph nodes removed etc.)  
 
 
 
c. Please comment on the policy  for oncological follow -up: which investigations were 
carried out and when?  
 
 
 
 
2. Scoring systems using a semiquantitative assessment of tumor regression (for example Becker 
et al.) were not included in this analysis. Please explain the reasons for this approach.  
 
 
In summary, we think that manuscript may be suitable for publication after revisions.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is acce pted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: Comparison of five tumor regression grading systems for gastric adenocarcinoma after  
neoadjuvant chemotherapy: a retrospective study of 192 cases from National Cancer Center in  
China  
 
Version: 0 Date: 09 Oct 2016  
 
Reviewer: C Gutschow  
 
Reviewer's report:  
 
Zhu T et al.: Comparison of four tumor regression grading systems for gastric adenocarcinoma 
after neoadjuvant chemo therapy: a retrospective study of 192 cases from National Cancer Center 
in China.  
 
 
 
Thank you for the opportunity to review this interesting manuscript. In this retrospective single 
center study on 192 gastric cancer patients that underwent neoadjuvant chem otherapy, the 
clinical significance of four histological tumor regression grading systems was compared. 
Different grades of histological tumor regression were correlated to overall and recurrence -free 
survival and other oncological parameters. The authors recommend the use of the Mandard 
tumor regression grading system because of superior correlation to patient survival.  
 
 
 
The results and conclusions are clear, the manuscript is well structured and the reading comfort 
is good. Also, I think that the subject is well chosen and would be of substantial interest for the 
readership. However, there are some typos and wrong expressions, so that we recommend proof 
reading by a native English speaking person.  
 
 
 
Furthermore, we have a few remarks and we would be gratef ul if the authors could comment on 
them.  
 
 
 
 
 
 
 
 
 
 
1. TRG systems were correlated to OS and RFS; therefore, it would be important to comment on 
the following points:  
 
 
 
a. How many patients from which groups underwent postoperative (adjuvant) chemo - or 
radiochemothera py? What was the impact of adjuvant therapy on survival?  
 
 
 
b. How radical was the surgery? Please describe some technical details of the operations 
(types of gastrectomy and lymphadenectomy, number of lymph nodes removed etc.)  
 
 
 
c. Please comment on the policy  for oncological follow -up: which investigations were 
carried out and when?  
 
 
 
 
2. Scoring systems using a semiquantitative assessment of tumor regression (for example Becker 
et al.) were not included in this analysis. Please explain the reasons for this approach.  
 
 
In summary, we think that manuscript may be suitable for publication after revisions.  
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional s tatistical review is recommended, please specify what aspects require further  
assessment in your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
 
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain  or lose financially from the publication of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that may in any way gain or lose  
financially from the publication of this manuscript, either now or in the fut ure? 
 
3. Do you hold or are you currently applying for any patents relating to the content of the  
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of  the manuscript?  
 
5. Do you have any other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
 
If you can answer no to all of the above, write 'I declare that I have no competing interests' 
below.  If your reply is yes to any, please give details below.  
 
I declare that I have no competing interests.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included  
on my report to the authors and, if the manuscript is acce pted for publication, my named report  
including any attachments I upload will be posted on the website along with the authors'  
responses. I agree for my report to be made available under an Open Access Creative Commons  
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments  
which I do not wish to be included in my named report can be included as confidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant