Nomogram Based on Monocyte-to-Lymphocyte Ratio to Predict Survival of Unresectable Esophageal Squamous Cell Carcinoma Who Receive First-Line PD-1/PD-L1 Inhibitors Combined with Chemotherapy
, Yongfeng Ding †, Jiong Qian, Mingyu Wan, Ning Li, Chenyu Mao, Cheng Xiao, Haiping Jiang, Yulong Zheng, Luntao Wu, Xiaoyu Chen and Nong Xu *
Round 1
Reviewer 1 Report
Ma et al`s work had established a nomogram based on monocyte-to-lymphocyte ratio to predict the survival of ESCC patients who received PD-1/PD-L1 inhibition treatment. The conclusion was made by retrospective study, which is very common for studies with these aspects.
The major question: authors should clarify how to use this nomogram? And when to use it? There are numerous various predictors, bioinformatic tools have been established in recent studies to predict the survival of patients with different end-stage diseases, few of which show their application potential in real clinical scenario. It will be greatly appreciated if the authors could add one or two paragraph in the discussion section to talk about this issue.
Another major issue of the manuscript is about the data, it all present as numbers without showing the replication or repetitive. For example, on Line 25, please use “mean±sdv” to present the data of OS rates. Same requirement should be meet by all data through out of the text, i.e. Line 163-185, etc.
Minor:
On Line 14, please give the full name of ESCC.
On Line 21-22 “Out of 81 patients enrolled, patients with a lower MLR had significantly longer progression free survival (PFS) and OS than patients with a higher pretreatment MLR.” Please add the statistical values the match this statement.
On Line 34, an extra “.” should be removed. Same to Lines161, 281,359.
Author Response
Please see the attachment.
Author Response File: 
Author Response.pdf
Reviewer 2 Report
The manuscript entitled "Nomogram based on monocyte-to-lymphocyte ratio to predict survival of unresectable esophageal squamous cell carcinoma who receive first-line PD-1/PD-L1 inhibitors combined with chemotherapy" was reviewed. The study design is reasonable and the result was statistically acceptable. I have few comments.
1. NLR and MLR were not a novel issue for cancer prognosis prediction. Though the authors try to create a new nomogram prediction model, however, what is the clinical significance and usefulness in the real word? Please emphsize your suggestion and possible management (or different treatment protocol?) when facing a high score (high risk) patient. Otherwise, the need of this model is limited.
2. NLR or MLR may be an indicator for systemic inflammation and prognosis prediction. But, what is the role of NLR or MLR in patient using PD-1 or PD-L1 inhibitor? Is there any crosstalk between NLR or MLR and PD-1/PD-L1 signaling? The detail discussion may be necessary.
3. You mentioned that obesity upregulates PD-1 and the effect of ICIs is improved. But your dichotomy was located at BMI>18.5, not for obesity patients. Maybe this should be discussed from the nutritional status in discussion area.
Author Response
Please see the attachment.
Author Response File: Author Response.pdf
Round 2
Reviewer 1 Report
The manuscript had been greatly improved. The authors` efforts are appreciated. Wish the readers will be benefit from reading this work.
Thank you.
