Small Bowel Adenocarcinoma: 10-Year Experience in a Cancer Center—The Ottawa Hospital (TOH)

Round 1

Reviewer 1 Report

 

A)   General comments:

The authors presented a retrospective analysis of 115 patients with small bowel adenocarcinoma, particularly by analyzing the clinical outcomes such as overall survival.

The manuscript is well-written, with an excellent introductory and discussion sections. The subject discussed is highly topical and covers an essential subject for the medical oncology community. Nonetheless, the manuscript suffers from minor flaws that the authors must address prior to the publication.

 

B)   Specific comments:

Abstract:

1)     Page 1, line 24 p = 0.0002

2)     Page 1, line 28 p = 0.00008

Do you need to be that precise! Can you describe it as a follow p < 0.05? This would be sufficient to describe your level of confidence.

Materials and Methods:

3)     Page 2, line 75 “(stage)” & table 2 “staging data”, was the classification on this study based on the 7th TNM system or based on the newly proposed 8th TNM system? Please clarify.

4) The patient selection is poorly described, can you please describe it in a greater depth?

5)     This section has to be re-structured to include sup-sections (see below example for an additional clarity):

 

2.1 Patient selection criteria

2.1.1 Search strategy

2.1.2 Study selection criteria

2.1.3 Study exclusion criteria

2.1.4   Clinical data extraction etc...

2.2 Statistical analysis

 Results:

6) Page 6, line 152, please check captions. Suppose to be Figure 2 not Figure1. 

Author Response

Response to Reviewer 1 Comments

We would like to thank you for your valuable comments and recommendation, which will add to our paper.

Point 1:

Abstract:

1)     Page 1, line 24 p = 0.0002

2)     Page 1, line 28 p = 0.00008

Do you need to be that precise! Can you describe it as a follow p < 0.05? This would be sufficient to describe your level of confidence.

Response 1: Thank you for your suggestion. we described p value as < 0.05 as following

1)     Page 1, line 24 p <0.05

2)     Page 1, line 28 p <0.05

Furthermore

1)     Page 5, line 139 p <0.05

2)     Page 7, line 168 p <0.05

 Please see track changes.

 

Point 2:

Materials and Methods:

3)     Page 2, line 75 “(stage)” & table 2 “staging data”, was the classification on this study based on the 7th TNM system or based on the newly proposed 8th TNM system? Please clarify.

4) The patient selection is poorly described, can you please describe it in a greater depth?

5)     This section has to be re-structured to include sup-sections (see below example for an additional clarity):

 2.1 Patient selection criteria

2.1.1 Search strategy

2.1.2 Study selection criteria

2.1.3 Study exclusion criteria

2.1.4   Clinical data extraction etc...

2.2 Statistical analysis

 

Response 2: Thank you for correctly highlighting this. The staging was based on American Joint Committee on Cancer (AJCC) TNM Staging Classification for Small Intestine Adenocarcinoma 8th ed . we added this to methods section. Moreover , the methology section was re-structered as following :

2.1 Study design and setting

2.2 Study inclusion criteria

2.3 Study exclusion criteria

2.4  Clinical data extraction

2.5 Statistical analysis

Please see track changes.

Point 3:

 Results:

6) Page 6, line 152, please check captions. Suppose to be Figure 2 not Figure1. 

Response 3: Thank you for correctly highlighting this. This is corrected to Figure 2 . Please see track changes.

 

 

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

Dear Authors,

 

I really enjoyed this paper

The only thing that is not in the paper are the exact number of the death patients, these they can not find, because if they were able to do it they were doing it!

1. What is the main question addressed by the research?

The outcome of a rare disease, also the clinical presentation, the means for a better survival

2. Do you consider the topic original or relevant in the field, and if so, why?

This is a rare disease, you find scarce numbers in the literature, they have a good experience

3. What does it add to the subject area compared with other published material?

They analyze various pathology variables

4. What specific improvements could the authors consider regarding the methodology?

Exact death number

5. Are the conclusions consistent with the evidence and arguments presented and do they address the main question posed?

Yes, they are

6. Are the references appropriate?

yes

7. Please include any additional comments on the tables and figures.

The main issue is when you calculate survival and you have 30% people most likely death, but you consider them alive, maybe they were afraid that nobody will publish a paper with 70% mortality

This is not the best paper in the world, but has only one major problem – the exact death number

I think this is a good paper for beginners, as for advanced surgeons.

Congratulation

 

Author Response

Response to Reviewer 2 Comments

We would like to thank you for your valuable comments and recommendation, which will add to our paper.

Point :

What specific improvements could the authors consider regarding the methodology?

Exact death number

 Response 1: Thanks for your comment. Unfortunately, these data were not available in the hospital's medical records.

Author Response File: Author Response.docx

Reviewer 3 Report

This study analyzes the clinical and pathological data and outcomes of a relatively large number of patients diagnosed with small bowel adenocarcinoma (SBA) in a single-center experience. SBA is widely considered a relatively rare pathology. Furthermore, a multivariate analysis was performed to identify potential prognostic factors that can be used in clinical decision-making. Although this paper has no significant novelty (the results are comparable with those reported in the previous papers), the study is well conducted, the methods are adequately used, and the results mainly sustain the conclusions. Thus, the results of the present study would potentially add value to the current literature. Furthermore, the paper is well written and well organized. In conclusion, the paper would be of interest to journal readers. However, a few modifications should be made before potential acceptance for publication.

Major concerns:

The results of the uni and multivariate analyses of potential prognostic factors for both overall and recurrence-free survivals are not provided.

The clinical and pathological data and outcomes should be provided differently for duodenal and small bowel cancers (i.e., jejunum + ileum) because there are different surgical techniques and prognoses. Furthermore, a separate analysis of potential prognostic factors should be made.

Minor comments:

Please consider modifying the presentation of data in the number of patients (%). Providing data only as “(70)” can confuse the references’ citations.

Reference number 12 appears not to be cited in the text.

Abbreviations should be defined in Table 1-2.

Table 2 is not cited in the text.

In Figures 1-4, please consider replacing “cum survival” with “overall survival” end eliminating “Survival Functions.”

A native English speaker should revise the manuscript to correct a few minor grammar, spelling, or editing errors.

Author Response

Response to Reviewer 3 Comments

We would like to thank you for your valuable comments and recommendation, which will add to our paper.

Point 1: The results of the uni and multivariate analyses of potential prognostic factors for both overall and recurrence-free survivals are not provided.

Response 1: Thank you for your comment. The results of the uni and multivariate analyses were provided in the prognostic factors section; on page 8, line 195.

Point 2: The clinical and pathological data and outcomes should be provided differently for duodenal and small bowel cancers (i.e., jejunum + ileum) because there are different surgical techniques and prognoses. Furthermore, a separate analysis of potential prognostic factors should be made.

Response 2: Thank you for your comments and recommendation. We added comparison between duodenum and other SBA sites to SBA site section. As following

The duodenum compared to other SBA sites had more non-metastatic disease at presentation (p= 0.001) and less IBD (p=0.033). There was no significant association between SBA sites (duodenum Vs. Others) and gender, recurrence rate, PNI, LVI, or secondary malignancy.

Furthermore, we added the Kaplan Meier curve of OS for duodenum vs other (figure 4 ).

Please see track changes.

Point 3: Please consider modifying the presentation of data in the number of patients (%). Providing data only as “(70)” can confuse the references’ citations.

Response 3: Thank you for your comments and recommendation. We modified the presentation of data where applicable in the number of patients by adding ( n= ) to avoid confusion with reference citation. Please see track changes.

Point 4: Reference number 12 appears not to be cited in the text.

Response 4: Thank you for your comments. Reference number 12 is correctly provided. please see track changes.

Point 5: Abbreviations should be defined in Table 1-2.

Response 5: Thank you for your comments. We provided definitions of abbreviations for table 1-2 . please see track changes.

Point 6: Table 2 is not cited in the text.

Response 6: Thank you for your comments. We added the citation for table 2 . please see track changes.

Point 7: In Figures 1-4, please consider replacing “cum survival” with “overall survival” end eliminating “Survival Functions.”

Response 7: Thank you for your comments and suggestion. We replaced “cum survival” with “overall survival” and “Survival Functions” were eliminated.

Point 8: A native English speaker should revise the manuscript to correct a few minor grammar, spelling, or editing errors.

Response 8: Dr. Asmis has reviewed this version of the manuscript.

 

Author Response File: Author Response.docx

Round 2

Reviewer 3 Report

The authors properly addressed all the concerns raised by the reviewers