Title: Risk of Lymph Node Metastasis and Feasibility of Endoscopic Submucosal Dissection
in Undifferentiated-type Early Gastric Cancer
Version: 1 Date: 30 Dec 2022
Reviewer's report:
Ref: Submission ID 524eff8e-6a96-4340-995a-b865a21e8094
Title:
"Risk of Lymph Node Metastasis and Feasibility of Endoscopic Submucosal Dissection in
Undifferentiated-type Early Gastric Cancer"
The authors examined a relatively large set of undifferentiated-type early gastric cancer and
revealed that LNM occurred in 69 of 346 patients (19.94%).  I believe the paper will potentially
be of interest to the readership of BMC Gastroenterology and may be acceptable after the points
listed below are addressed.
1. When discussing the potential risk of lymph node metastasis, it is recommended that eCura
system be mentioned.
Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa
M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada
J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakaya N, Nakamura T, Shimosegawa
T. A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early
Gastric Cancer: "eCura system". Am J Gastroenterol. 2017 Jun;112(6):874-881. doi: 10.1038/
ajg.2017.95. Epub 2017 Apr 11. Erratum in: Am J Gastroenterol. 2019 Dec;114(12):1925-1926.
PMID: 28397873.
2. Although the following paragraph appear under the subheading "Risk of exceeding the ESD
expanded indications in UEGC," the content does not match the subheading: Further analysis
showed that three cases (4.10%) in the ESD indications group still had LNM, including two
cases invading the M but not the SM; the clinicopathological features are listed in Table 4. All
lesions were flat, two were cases of por mixed with mucinous components, and the other was a
case of pure muc. Notably, the largest diameter in all three lesions was 2.0 cm, which may be a
specific feature to differentiate from lymph node-negative patients.
3. In the Abstract, the term "submucosal tumors" should be revised, since "submucosal tumors"
generally indicate subepithelial lesions, rather than tumors invating into the submucosal layer.
4. In Table 3., the styles of "Smoking" and "Drinking" should be same as that of "Ulcer."
5. It is recommended that the number of patients with undifferentiated-type early gastric cancer
who underwent ESD during the study period (between January 2014 and December 2021) be
described, because it results in overestimation of the rate of LNM.
Title: Risk of Lymph Node Metastasis and Feasibility of Endoscopic Submucosal Dissection
in Undifferentiated-type Early Gastric Cancer
Version: 1 Date: 30 Dec 2022
Reviewer's report:
Ref: Submission ID 524eff8e-6a96-4340-995a-b865a21e8094
Title:
"Risk of Lymph Node Metastasis and Feasibility of Endoscopic Submucosal Dissection in
Undifferentiated-type Early Gastric Cancer"
The authors examined a relatively large set of undifferentiated-type early gastric cancer and
revealed that LNM occurred in 69 of 346 patients (19.94%).  I believe the paper will potentially
be of interest to the readership of BMC Gastroenterology and may be acceptable after the points
listed below are addressed.
1. When discussing the potential risk of lymph node metastasis, it is recommended that eCura
system be mentioned.
Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa
M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada
J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakaya N, Nakamura T, Shimosegawa
T. A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early
Gastric Cancer: "eCura system". Am J Gastroenterol. 2017 Jun;112(6):874-881. doi: 10.1038/
ajg.2017.95. Epub 2017 Apr 11. Erratum in: Am J Gastroenterol. 2019 Dec;114(12):1925-1926.
PMID: 28397873.
2. Although the following paragraph appear under the subheading "Risk of exceeding the ESD
expanded indications in UEGC," the content does not match the subheading: Further analysis
showed that three cases (4.10%) in the ESD indications group still had LNM, including two
cases invading the M but not the SM; the clinicopathological features are listed in Table 4. All
lesions were flat, two were cases of por mixed with mucinous components, and the other was a
case of pure muc. Notably, the largest diameter in all three lesions was 2.0 cm, which may be a
specific feature to differentiate from lymph node-negative patients.
3. In the Abstract, the term "submucosal tumors" should be revised, since "submucosal tumors"
generally indicate subepithelial lesions, rather than tumors invating into the submucosal layer.
4. In Table 3., the styles of "Smoking" and "Drinking" should be same as that of "Ulcer."
5. It is recommended that the number of patients with undifferentiated-type early gastric cancer
who underwent ESD during the study period (between January 2014 and December 2021) be
described, because it results in overestimation of the rate of LNM.
Please review this paper.
user
Title: Risk of Lymph Node Metastasis and Feasibility of Endoscopic Submucosal Dissection
in Undifferentiated-type Early Gastric Cancer
Version: 1 Date: 30 Dec 2022
Reviewer's report:
Ref: Submission ID 524eff8e-6a96-4340-995a-b865a21e8094
Title:
"Risk of Lymph Node Metastasis and Feasibility of Endoscopic Submucosal Dissection in
Undifferentiated-type Early Gastric Cancer"
The authors examined a relatively large set of undifferentiated-type early gastric cancer and
revealed that LNM occurred in 69 of 346 patients (19.94%).  I believe the paper will potentially
be of interest to the readership of BMC Gastroenterology and may be acceptable after the points
listed below are addressed.
1. When discussing the potential risk of lymph node metastasis, it is recommended that eCura
system be mentioned.
Hatta W, Gotoda T, Oyama T, Kawata N, Takahashi A, Yoshifuku Y, Hoteya S, Nakagawa
M, Hirano M, Esaki M, Matsuda M, Ohnita K, Yamanouchi K, Yoshida M, Dohi O, Takada
J, Tanaka K, Yamada S, Tsuji T, Ito H, Hayashi Y, Nakaya N, Nakamura T, Shimosegawa
T. A Scoring System to Stratify Curability after Endoscopic Submucosal Dissection for Early
Gastric Cancer: "eCura system". Am J Gastroenterol. 2017 Jun;112(6):874-881. doi: 10.1038/
ajg.2017.95. Epub 2017 Apr 11. Erratum in: Am J Gastroenterol. 2019 Dec;114(12):1925-1926.
PMID: 28397873.
2. Although the following paragraph appear under the subheading "Risk of exceeding the ESD
expanded indications in UEGC," the content does not match the subheading: Further analysis
showed that three cases (4.10%) in the ESD indications group still had LNM, including two
cases invading the M but not the SM; the clinicopathological features are listed in Table 4. All
lesions were flat, two were cases of por mixed with mucinous components, and the other was a
case of pure muc. Notably, the largest diameter in all three lesions was 2.0 cm, which may be a
specific feature to differentiate from lymph node-negative patients.
3. In the Abstract, the term "submucosal tumors" should be revised, since "submucosal tumors"
generally indicate subepithelial lesions, rather than tumors invating into the submucosal layer.
4. In Table 3., the styles of "Smoking" and "Drinking" should be same as that of "Ulcer."
5. It is recommended that the number of patients with undifferentiated-type early gastric cancer
who underwent ESD during the study period (between January 2014 and December 2021) be
described, because it results in overestimation of the rate of LNM.
assistant