Title: Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally
advanced rectal adenocarcinoma
Version: 2 Date: 17 Apr 2024
Reviewer:  Shigeo Toda
Reviewer's report:
Dear authors,
This study investigates the impact of mucinous differentiation on the effectiveness of
preoperative chemoradiation for rectal cancer. The manuscript is well-written in clear and
understandable English. However, the results closely align with those of the meta-analysis
conducted by McCawley et al. (1) in 2016. As a result, it appears that there is limited novelty
in this study.
I have some comments as follows.
While mucinous adenocarcinoma may exhibit resistance to chemoradiation, advanced mucinous
rectal adenocarcinoma still presents as a candidate for preoperative chemoradiotherapy (CRT).
This is supported by a large-scale study utilizing the SEER database, which suggests that patients
with mucinous adenocarcinoma may derive survival benefits from preoperative CRT. (2)
However, if the treatment goal is non-operative management ("watch and wait" strategy), it
may be inappropriate to include patients with mucinous adenocarcinoma, since the rate of
pathological complete response is rare.
In Figures 2, 3, and 4, the forest plot demonstrates that the odds ratios favour mucinous
adenocarcinoma (MAC). However, it contradicts with the results, as adenocarcinoma (AC)
shows greater susceptibility to chemoradiotherapy (CRT) compared to MAC.
Regards,
1. McCawley N, Clancy C, O'Neill BD, Deasy J, McNamara DA, Burke JP. Mucinous Rectal
Adenocarcinoma Is Associated with a Poor Response to Neoadjuvant Chemoradiotherapy: A
Systematic Review and Meta-analysis. Dis Colon Rectum. 2016;59(12):1200-8.
2. Chen C, Chen X, Jiang J. Long-term effect of neoadjuvant radiotherapy in patients with locally
advanced rectal mucinous adenocarcinoma: a population-based study of 1514 patients. Scientific
reports. 2023;13(1):11696.
Title: Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally
advanced rectal adenocarcinoma
Version: 2 Date: 17 Apr 2024
Reviewer:  Shigeo Toda
Reviewer's report:
Dear authors,
This study investigates the impact of mucinous differentiation on the effectiveness of
preoperative chemoradiation for rectal cancer. The manuscript is well-written in clear and
understandable English. However, the results closely align with those of the meta-analysis
conducted by McCawley et al. (1) in 2016. As a result, it appears that there is limited novelty
in this study.
I have some comments as follows.
While mucinous adenocarcinoma may exhibit resistance to chemoradiation, advanced mucinous
rectal adenocarcinoma still presents as a candidate for preoperative chemoradiotherapy (CRT).
This is supported by a large-scale study utilizing the SEER database, which suggests that patients
with mucinous adenocarcinoma may derive survival benefits from preoperative CRT. (2)
However, if the treatment goal is non-operative management ("watch and wait" strategy), it
may be inappropriate to include patients with mucinous adenocarcinoma, since the rate of
pathological complete response is rare.
In Figures 2, 3, and 4, the forest plot demonstrates that the odds ratios favour mucinous
adenocarcinoma (MAC). However, it contradicts with the results, as adenocarcinoma (AC)
shows greater susceptibility to chemoradiotherapy (CRT) compared to MAC.
Regards,
1. McCawley N, Clancy C, O'Neill BD, Deasy J, McNamara DA, Burke JP. Mucinous Rectal
Adenocarcinoma Is Associated with a Poor Response to Neoadjuvant Chemoradiotherapy: A
Systematic Review and Meta-analysis. Dis Colon Rectum. 2016;59(12):1200-8.
2. Chen C, Chen X, Jiang J. Long-term effect of neoadjuvant radiotherapy in patients with locally
advanced rectal mucinous adenocarcinoma: a population-based study of 1514 patients. Scientific
reports. 2023;13(1):11696.
Please review this paper.
user
Title: Mucinous histology is a negative predictor of neoadjuvant chemoradiotherapy for locally
advanced rectal adenocarcinoma
Version: 2 Date: 17 Apr 2024
Reviewer:  Shigeo Toda
Reviewer's report:
Dear authors,
This study investigates the impact of mucinous differentiation on the effectiveness of
preoperative chemoradiation for rectal cancer. The manuscript is well-written in clear and
understandable English. However, the results closely align with those of the meta-analysis
conducted by McCawley et al. (1) in 2016. As a result, it appears that there is limited novelty
in this study.
I have some comments as follows.
While mucinous adenocarcinoma may exhibit resistance to chemoradiation, advanced mucinous
rectal adenocarcinoma still presents as a candidate for preoperative chemoradiotherapy (CRT).
This is supported by a large-scale study utilizing the SEER database, which suggests that patients
with mucinous adenocarcinoma may derive survival benefits from preoperative CRT. (2)
However, if the treatment goal is non-operative management ("watch and wait" strategy), it
may be inappropriate to include patients with mucinous adenocarcinoma, since the rate of
pathological complete response is rare.
In Figures 2, 3, and 4, the forest plot demonstrates that the odds ratios favour mucinous
adenocarcinoma (MAC). However, it contradicts with the results, as adenocarcinoma (AC)
shows greater susceptibility to chemoradiotherapy (CRT) compared to MAC.
Regards,
1. McCawley N, Clancy C, O'Neill BD, Deasy J, McNamara DA, Burke JP. Mucinous Rectal
Adenocarcinoma Is Associated with a Poor Response to Neoadjuvant Chemoradiotherapy: A
Systematic Review and Meta-analysis. Dis Colon Rectum. 2016;59(12):1200-8.
2. Chen C, Chen X, Jiang J. Long-term effect of neoadjuvant radiotherapy in patients with locally
advanced rectal mucinous adenocarcinoma: a population-based study of 1514 patients. Scientific
reports. 2023;13(1):11696.
assistant