Title: Clinical applicability of a new scoring system for population-based screening and risk
factors of gastric cancer in the Wannan region
Version: 4 Date: 03 Apr 2022
Reviewer's report:
Overall, this could be a good study to illustrate the distribution of biomarker indifferent gastric
pathology among Chinese male. There are several questions that remains to be clarify.
Although gastric cancer often presented as gastric ulcers, most gastric ulcers are not associated
with malignancy. The term precancerous disease is misleading. Furthermore, gastric polyps is
a very diverse entity, the risk of malignancy vary significantly. I am also curious about why the
author would group all gastric ulcers and all gastric polyps into one entity.
It is well established that proton pump inhibitor will rise the level of pepsinogen and gastrin. In
recent years, level of pepsinogen and gastric are affected by PPI far more often than underlying
disease. Although the author has excluded patient with antacid within 2 weeks, it would be very
helpful to elucidate further along with PPI status prior to that.
It would be helpful to know if this is a prospective or retrospective study and how enrollment
is done.
Overall the scoring system might have built-in bias including gender bias. The scoring system
weighted male four times higher than H. pylori, resulting in disproportionately high male to
female ratio. It would be very helpful if the author could explain further about the study design
to justify the bias. The author would need to clarify the discrepancy between Table 2 and table 3.
There are 186 male with medium to high risk on table, out of which 853 underwent gastroscopy?
There is a missing data on table 3, unknown patient number on column G-17  (1.50-5.70).
Interestingly, author did not include biomarker in risk analysis, which is the soul of the project.
Many practitioners would be curious about the hazard ratio of biomarker which would help
incorporating the new scoring system to daily practice.
Title: Clinical applicability of a new scoring system for population-based screening and risk
factors of gastric cancer in the Wannan region
Version: 4 Date: 03 Apr 2022
Reviewer's report:
Overall, this could be a good study to illustrate the distribution of biomarker indifferent gastric
pathology among Chinese male. There are several questions that remains to be clarify.
Although gastric cancer often presented as gastric ulcers, most gastric ulcers are not associated
with malignancy. The term precancerous disease is misleading. Furthermore, gastric polyps is
a very diverse entity, the risk of malignancy vary significantly. I am also curious about why the
author would group all gastric ulcers and all gastric polyps into one entity.
It is well established that proton pump inhibitor will rise the level of pepsinogen and gastrin. In
recent years, level of pepsinogen and gastric are affected by PPI far more often than underlying
disease. Although the author has excluded patient with antacid within 2 weeks, it would be very
helpful to elucidate further along with PPI status prior to that.
It would be helpful to know if this is a prospective or retrospective study and how enrollment
is done.
Overall the scoring system might have built-in bias including gender bias. The scoring system
weighted male four times higher than H. pylori, resulting in disproportionately high male to
female ratio. It would be very helpful if the author could explain further about the study design
to justify the bias. The author would need to clarify the discrepancy between Table 2 and table 3.
There are 186 male with medium to high risk on table, out of which 853 underwent gastroscopy?
There is a missing data on table 3, unknown patient number on column G-17  (1.50-5.70).
Interestingly, author did not include biomarker in risk analysis, which is the soul of the project.
Many practitioners would be curious about the hazard ratio of biomarker which would help
incorporating the new scoring system to daily practice.
Please review this paper.
user
Title: Clinical applicability of a new scoring system for population-based screening and risk
factors of gastric cancer in the Wannan region
Version: 4 Date: 03 Apr 2022
Reviewer's report:
Overall, this could be a good study to illustrate the distribution of biomarker indifferent gastric
pathology among Chinese male. There are several questions that remains to be clarify.
Although gastric cancer often presented as gastric ulcers, most gastric ulcers are not associated
with malignancy. The term precancerous disease is misleading. Furthermore, gastric polyps is
a very diverse entity, the risk of malignancy vary significantly. I am also curious about why the
author would group all gastric ulcers and all gastric polyps into one entity.
It is well established that proton pump inhibitor will rise the level of pepsinogen and gastrin. In
recent years, level of pepsinogen and gastric are affected by PPI far more often than underlying
disease. Although the author has excluded patient with antacid within 2 weeks, it would be very
helpful to elucidate further along with PPI status prior to that.
It would be helpful to know if this is a prospective or retrospective study and how enrollment
is done.
Overall the scoring system might have built-in bias including gender bias. The scoring system
weighted male four times higher than H. pylori, resulting in disproportionately high male to
female ratio. It would be very helpful if the author could explain further about the study design
to justify the bias. The author would need to clarify the discrepancy between Table 2 and table 3.
There are 186 male with medium to high risk on table, out of which 853 underwent gastroscopy?
There is a missing data on table 3, unknown patient number on column G-17  (1.50-5.70).
Interestingly, author did not include biomarker in risk analysis, which is the soul of the project.
Many practitioners would be curious about the hazard ratio of biomarker which would help
incorporating the new scoring system to daily practice.
assistant