Title: Efficacy of AS vs SOX regimen as first-line chemotherapy for gastric cancer patients with
peritoneal metastasis: a real-world study
Version: 2 Date: 19 Apr 2022
Reviewer's report:
This is a retrospective study on the clinical effects of AS regimen as compared with SOX, one of
the standard regimen, for peritoneal metastases (PM) of gastric cancer. The results contain novel
finding, although data interpretation is limited. I suggest some points to be addressed before
publication.
1. Outcome of the patients with PM is strongly dependent on the severity of macroscopic or
microscopic metastases in peritoneum. Unfortunately, there is no information on peritoneal
tumor burden, such as peritoneal cytology (CY), peritoneal cancer index (PCI) or Japanese
classification (P1a,b,c). As laparoscopy was performed in some patients, comparison in those
selected patients with similar levels of PM is preferable. Similarly, the volume of ascites is
crucial factor to determine their outcome and patients could be divided into high, middle, and
low volume of ascites due to the CT image. Those factors should be included in PSM survival
analysis.
2. The assessment of real progression time is exceedingly difficult in PM. They described
progression was based on RECIST v1.1. However, in most patients with PM, especially in
Lauren diffuse type, PM are too small to be appropriately evaluated by CT image. Therefore,
progression is often determined as the appearance or increase of ascites, appearance of new
lesions in some cases, or even by worsening of clinical findings. The authors should clarify how
they really determine the progression.
3. I suppose the OS of these patients is dependent on the response to the treatment after
progression and thus information on the second line should be presented together. In fact, how
often nabPTX is used in SOX group and how were they treated after the failure to AS?
4. There are many grammatical errors in texts which should be corrected.
Title: Efficacy of AS vs SOX regimen as first-line chemotherapy for gastric cancer patients with
peritoneal metastasis: a real-world study
Version: 2 Date: 19 Apr 2022
Reviewer's report:
This is a retrospective study on the clinical effects of AS regimen as compared with SOX, one of
the standard regimen, for peritoneal metastases (PM) of gastric cancer. The results contain novel
finding, although data interpretation is limited. I suggest some points to be addressed before
publication.
1. Outcome of the patients with PM is strongly dependent on the severity of macroscopic or
microscopic metastases in peritoneum. Unfortunately, there is no information on peritoneal
tumor burden, such as peritoneal cytology (CY), peritoneal cancer index (PCI) or Japanese
classification (P1a,b,c). As laparoscopy was performed in some patients, comparison in those
selected patients with similar levels of PM is preferable. Similarly, the volume of ascites is
crucial factor to determine their outcome and patients could be divided into high, middle, and
low volume of ascites due to the CT image. Those factors should be included in PSM survival
analysis.
2. The assessment of real progression time is exceedingly difficult in PM. They described
progression was based on RECIST v1.1. However, in most patients with PM, especially in
Lauren diffuse type, PM are too small to be appropriately evaluated by CT image. Therefore,
progression is often determined as the appearance or increase of ascites, appearance of new
lesions in some cases, or even by worsening of clinical findings. The authors should clarify how
they really determine the progression.
3. I suppose the OS of these patients is dependent on the response to the treatment after
progression and thus information on the second line should be presented together. In fact, how
often nabPTX is used in SOX group and how were they treated after the failure to AS?
4. There are many grammatical errors in texts which should be corrected.
Please review this paper.
user
Title: Efficacy of AS vs SOX regimen as first-line chemotherapy for gastric cancer patients with
peritoneal metastasis: a real-world study
Version: 2 Date: 19 Apr 2022
Reviewer's report:
This is a retrospective study on the clinical effects of AS regimen as compared with SOX, one of
the standard regimen, for peritoneal metastases (PM) of gastric cancer. The results contain novel
finding, although data interpretation is limited. I suggest some points to be addressed before
publication.
1. Outcome of the patients with PM is strongly dependent on the severity of macroscopic or
microscopic metastases in peritoneum. Unfortunately, there is no information on peritoneal
tumor burden, such as peritoneal cytology (CY), peritoneal cancer index (PCI) or Japanese
classification (P1a,b,c). As laparoscopy was performed in some patients, comparison in those
selected patients with similar levels of PM is preferable. Similarly, the volume of ascites is
crucial factor to determine their outcome and patients could be divided into high, middle, and
low volume of ascites due to the CT image. Those factors should be included in PSM survival
analysis.
2. The assessment of real progression time is exceedingly difficult in PM. They described
progression was based on RECIST v1.1. However, in most patients with PM, especially in
Lauren diffuse type, PM are too small to be appropriately evaluated by CT image. Therefore,
progression is often determined as the appearance or increase of ascites, appearance of new
lesions in some cases, or even by worsening of clinical findings. The authors should clarify how
they really determine the progression.
3. I suppose the OS of these patients is dependent on the response to the treatment after
progression and thus information on the second line should be presented together. In fact, how
often nabPTX is used in SOX group and how were they treated after the failure to AS?
4. There are many grammatical errors in texts which should be corrected.
assistant