Prognostic Performance of Three Lymph-Node Staging Systems on Gastric Signet-Ring-Cell Carcinoma

Round 1

Reviewer 1 Report

Thank you for the beautiful work. You are dealing with a very important issue. However, the following questions arise for me when reading your work:

-Why did you choose the groups with early carcinoma and advanced carcinoma? In the usual classification, advanced carcinoma is only mentioned from the T3 stage onwards. Please justify this in your text.

-What was the R-status of your patients?

-the groups you have formed significant differences in tumour spread, age, sex, neutral invasion ...? I think they are therefore not comparable. Maybe a match pair analysis would make sense.

-The histological definition of a SRCC is pathologically difficult, please address this in your introduction and please describe more precisely in material and methods when a tumour was defined as a SRCC.

Author Response

Dear reviewer 1:

 

Thank you very much for giving us an opportunity to revise our manuscript.We revised our manuscript according to your comments. Attached please find the revised version (All changes are marked as red color), which we would like to submit for your kind consideration. We have carefully revised according to your suggestions, and now the replies are as follows:

 

1. Why did you choose the groups with early carcinoma and advanced carcinoma? In the usual classification, advanced carcinoma is only mentioned from the T3 stage onwards. Please justify this in your text.

 

Response: Thank you for your appropriate recommendations. GASTRIC CANCER has shown that the prognosis of early SRCC and advanced SRCCs is still controversial in different studies. Therefore, we refer to the classification of GASTRIC CANCER. In addition, early and advanced SRCCs have different prognostic features, especially in lymph node metastases. Studies have shown that SRCC has different prognostic characteristics than non-SRCC for tumors with different depths of invasion. The prognosis of early SRCC is better than that of non-SRCC, while the prognosis of advanced SRCC is lower than that of non-SRCC. Furthermore, meta-analysis suggested that the frequency of lymph node metastasis in early SRCC is lower than that non-SRCC, while there no significant difference in the frequency of lymph node metastasis between advanced SRCC and non-SRCC. This suggests that the difference in prognosis between SRCCs and non-SRCCs with different invasion depths may be affected by lymph node metastasis. Therefore, accurate assessment of lymph node metastases in SRCC can help improve outcomes in patients with SRCC. At the same time, we also refer to the classification of GASTRIC CANCER in early stage and advanced SRCC. We also added in the article.

 

2. What was the R-status of your patients?

 

Response: Thank you for your suggestion. The R-status of patients is the Spearman coefficient. We added it in the article.

 

3. The groups you have formed significant differences in tumour spread, age, sex, neutral invasion ...? I think they are therefore not comparable. Maybe a match pair analysis would make sense.

 

Response: Thank you for your suggestion. As you said, there are significant differences in tumor spread, age, gender, neutral invasion, etc. This is because the aggressiveness of advanced SRCC is significantly higher than that of early SRCC. However, in this study, we explored which nodal staging system is more suitable for assessing the prognosis of early versus advanced SRCC. Therefore, we compared early SRCC separately with advanced SRCC. The aim is to select the appropriate lymph node evaluation tool more accurately. Hence, in order to more realistically reflect the biological behavior of tumors, we did not perform PSM on either group. In addition, our analysis of differences in the biological behavior of SRCC is consistent with most studies. Thanks again for your comments.

 

4. The histological definition of a SRCC is pathologically difficult, please address this in your introduction and please describe more precisely in material and methods when a tumour was defined as a SRCC.

 

Response: Thank you for your suggestion, we have supplemented in the introduction, materials and methods.

 

Reviewer 2 Report

In the current manuscript, the authors aimed to determine the optimal nodal staging system for predicting overall survival in patients with both early and advanced signet ring cell carcinoma (SRCC). They conducted a comparative analysis of the prognostic performance of three staging systems: pN staging, lymph node metastasis rate (LNR), and log odds of positive lymph nodes (LODDS). The evaluation was done using receiver characteristic operating curve analysis. 

However, it is worth noting that the manuscript suffers from poor writing, particularly in the results section. The results fail to provide sufficient elaboration to support the conclusion that LODDS outperforms the other two staging systems (pN staging and LNR). Consequently, the results are not robust enough to substantiate the authors' claim.

 Furthermore, it is recommended that the authors improve the readability of the labels in Figure 5, specifically in panels A and D. Increasing the font size would greatly enhance their visibility and legibility.

 

The quality of English language in the provided abstract is fairly good. However, there are a few minor improvements that could be made to enhance clarity and readability:

Author Response

Dear reviewer 2:

 

Thank you very much for giving us an opportunity to revise our manuscript.We revised our manuscript according to your comments. Attached please find the revised version (All changes are marked as red color), which we would like to submit for your kind consideration. We have carefully revised according to your suggestions, and now the replies are as follows:

 

 

In the current manuscript, the authors aimed to determine the optimal nodal staging system for predicting overall survival in patients with both early and advanced signet ring cell carcinoma (SRCC). They conducted a comparative analysis of the prognostic performance of three staging systems: pN staging, lymph node metastasis rate (LNR), and log odds of positive lymph nodes (LODDS). The evaluation was done using receiver characteristic operating curve analysis.

 

1. However, it is worth noting that the manuscript suffers from poor writing, particularly in the results section. The results fail to provide sufficient elaboration to support the conclusion that LODDS outperforms the other two staging systems (pN staging and LNR). Consequently, the results are not robust enough to substantiate the authors' claim.

 

Response: Thank you for your advice, which is essential to improve the quality of our manuscript. We revised the results to supplement the C-index and also explored the predictive performance of different nodal staging systems at different numbers of lymph nodes retrieved. At the same time, we have revised the results, conclusions, and discussion.

 

2. Furthermore, it is recommended that the authors improve the readability of the labels in Figure 5, specifically in panels A and D. Increasing the font size would greatly enhance their visibility and legibility.

 

Response: Thank you for your suggestion. We have modified Figure 5.

Round 2

Reviewer 1 Report

Thank you for the edits to the comments .the comments have been incorporated into the paper by the authors and from my side nothing stands in the way of publication.

Reviewer 2 Report

Accepted.

The scientific writing looks good but needs a native English speaker to check grammar and polish writing. Thanks!