High-Volume Hospitals’ Ovarian Cancer Care—Less Individual Approach or Better Treatment Results?

Round 1

Reviewer 1 Report

Sonja et al, have submitted a well-structured article that compares treatment results of
patients with OC in one centre with those treated in different centres. Their observations
established the fact that treatment outcome is better when patients are not referred to
another cancer centre during their treatment and the high-volume hospitals have more
expertise in managing the disease.
The article has lack of novelty as similar data with single centre studies have been
previously published.
The paper needs some corrections:
1. Omit the “we” and “our” unless extremely necessary.
2. Title should be modified
3. Abstract should be written in the proper manner.
4. The discussion should be slightly modified and points that are not in line with the
study objectives should be removed. The focus should be maintained on the current
study outcomes.

Author Response

Dear Reviewer,

thank you for your very constructive comment that helped us improve the initial version of the manuscript.  Please see our replies below. The corrected manuscript is attached.

1. Omit the “we” and “our” unless extremely necessary.

Answer: The article was sent to the editor recommended by Current Oncology - the English language and the layout were improved.

2. Title should be modified

Answer: new title proposal- High-volume hospitals’ ovarian cancer care - less individual approach or better treatment results?

3. Abstract should be written in the proper manner.

Answer: It is corrected now.

4. The discussion should be slightly modified, and points that are not in line with the study objectives should be removed. The focus should be maintained on the current study outcomes.

Answer:
The discussion was redrafted. The paragraph regarding mutations detected in patients was omitted. It was an issue unrelated to the main topic. In the future, after expanding it, it can be used.

Author Response File: Author Response.docx

Reviewer 2 Report

Even laparoscopy is one of a surgical procedure method in the treatment of ovarian cancer surgery, in this study is there any case that treated by laparoscopy then converted and continued completing to an open surgery procedure. 

Also the question is there any serious peri-operative complication especially mortality after surgery for the patients treated in the PPSK so it might change total number of subject.

Author Response

Dear Reviewer,

thank you for your very constructive comment that helped us improve the initial version of the manuscript.  Please see our replies below. The corrected manuscript is attached.

In all patients qualified for primary debulking surgery after laparoscopic resectability assessment, conversion to laparotomy was performed. Laparoscopy was used to assess whether radical resection is feasible to avoid burdening laparotomy in all patients. Only patients not qualified for enough radical operation ended with only laparoscopy-directed biopsy. No deaths caused by surgery were observed in this research group. When it comes to the most severe postoperative complications, included: infection and dehiscence of the postoperative wound as well as vesicovaginal and entero-vaginal fistulas.

As for the mortality of patients in the ward, we recorded one death. However, it concerned an interventional patient with disseminated disease in a moribund state who underwent surgery in other oncological centers.

Author Response File: Author Response.docx

Reviewer 3 Report

 

 

Figure 1: Include the patient inclusion criteria alongside the patients on the top of the figure or any suitable location in the figure.
What was the stages of ovarian cancer in the patients recruited in the study? Was the stage considered as an inclusion or exclusion factor?
Also, were there any patients rejected for the following if so, mention it in the figure.                                            

·       Patients who did not qualify for a specific type of chemotherapy due to their poor general condition and did not accept the proposed treatment

·       The final exclusion criterion was fertility-conserving treatment (FCT)

Figure2 and 3: write percentages or number of patients on the pie chart. Line 94 says Figure 2 and 3 shows percentage breakdown of histopathological types of OC, but the pie chart is missing percentages. If writing percentage mention n=135 in the figure.

Figure 4-8: The y axis label is different from the figure legend. Is it relapse free survival or progression free survival? Please insert the P value wherever significance is seen.

Table 5: Title is RR while the legend has HR.

Please Comment:

Can you comment about the treatments done in other hospital before the patients were transferred to SKPP and how different where those hospitals compared to SKPP? Also, was SKPP in a more densely populated area thus it is having more funds and more facilities than the other hospitals? What makes the other hospitals different than SKPP and the reason for patients being transferred – is it lack of infrastructure or unavailability of surgery dates etc.?

 

 

 

 

Author Response

Dear Reviewer,

thank you for your very constructive comment that helped us improve the initial version of the manuscript.  Please see our replies below. The corrected manuscript is attached.

1) Figure 1: Include the patient inclusion criteria alongside the patients on the top of the figure or any suitable location in the figure.

Answer: We added the inclusion criteria below Figure 1 with a flowchart.

2) What were the stages of ovarian cancer in the patients recruited in the study? Was the stage considered as an inclusion or exclusion factor?

Answer: We recruited patients in all stages according to FIGO classification, so the stage was neither an inclusion nor exclusion factor.

3) Were there any patients rejected for the following if so, mention it in the figure.                                            

• Patients who did not qualify for a specific type of chemotherapy due to their poor general condition and did not accept the proposed treatment
• The final exclusion criterion was fertility-conserving treatment (FCT)

 

Answer: Due to the retrospective nature of the work, patients who did not consent to the study were not taken into account.

4) Figure2 and 3: write percentages or number of patients on the pie chart.

Answer: The pie charts have been swapped. As suggested, percentages have been added.

5) Line 94 says Figure 2 and 3 shows percentage breakdown of histopathological types of OC, but the pie chart is missing percentages. If writing percentage mention n=135 in the figure.

Answer: It is corrected now.

6) Figure 4-8: The y axis label is different from the figure legend. Is it relapse free survival or progression free survival?

Answer: The figure legend is corrected now.

7) Please insert the P value wherever significance is seen.

Answer: We inserted p-value wherever significance was observed, especially regarding data presented in Figure 4.

8) Table 5: Title is RR while the legend has HR.

Answer: Now corrected to HR.

9) Please Comment: Can you comment about the treatments done in other hospital before the patients were transferred to SKPP and how different where those hospitals compared to SKPP? Also, was SKPP in a more densely populated area thus it is having more funds and more facilities than the other hospitals? What makes the other hospitals different than SKPP and the reason for patients being transferred – is it lack of infrastructure or unavailability of surgery dates etc.?

 Answer:

Procedures performed in other centres varied from exploratory laparotomy and ovarian biopsy to hysterectomy with appendages or radical surgery. However, these hospitals had a much smaller number of patients with ovarian cancer a year - usually a few / a year. Apart from the two cases, most of them were district hospitals located in smaller towns. This may result in different hospital accessibility. In addition, other centres, due to fewer ovarian cancer patients, have less funding for clinical trials and targeted therapy. The most common reasons for transferring patients are two - no possibility of chemotherapy treatment in other centres or less experience in surgery and the willingness to consult a reference centre.

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

The revised version of the manuscript is found to be suitable for publication in Current Oncology.