Development and Validation of Prognostic Nomograms for Periampullary Neuroendocrine Neoplasms: A SEER Database Analysis
Round 1
Reviewer 1 Report
Chen et al developed as well as confirmed nomogram models pertaining to patients suffering from periampullary neuroendocrine neoplasms, in this manuscript.
However, some suggestions to improve this manuscript are:
1. Figures 2, 3, 4, 5, 6 and 7 are very difficult to visualize. Kindly improve the quality of all the figures.
2. The figure legends require significant elaboration.
3. The conclusion section should include future directions.
Author Response
Dear Reviewers and Editors:
Thanks for your comments concerning our manuscript entitled "Development and Validation of Prognostic Nomograms for Periampullary Neuroendocrine Neoplasms: A SEER Database Analysis" (ID: curroncol-1965226). We are pleased to know that there is an opportunity for our work to be properly revised. We thank the reviewers for the time and effort that they have put into reviewing the previous version of the manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our research. We have studied comments carefully and have made corrections which we hope to meet with approval. Below, please find the comments in black, followed by our responses in red. The exact changes in the manuscript are presented in red.
Point 1: Figures 2, 3, 4, 5, 6 and 7 are very difficult to visualize. Kindly improve the quality of all the figures.
Response 1: Thank you for underlining this deficiency. We have improved the quality of figures 2, 3, 4, 5, 6, and 7 for better visualization. We are very sorry for this kind of problem. Thank you again for helping us improve the quality of the article.
Point 2: The figure legends require significant elaboration.
Response 2: Special thanks for your comment. We have refined the graphic legends and described the picture in more detail, hoping to show the content of the picture more intuitively.
Point 3: The conclusion section should include future directions.
Response 3: Many thanks for your comment. We have added the relevant content (see page 14, line 356-359). In the future, external verifications of the prediction models were needed to prove the good prediction ability, and the universality of this models should be confirmed through prospective or multi-center studies. We will collect data of ampulla NENs patients from multiple centers for external validation of the model, so as to help clinicians make individualized prediction of patient survival and give individualized treatment recommendations.
Author Response File: 
Author Response.docx
Reviewer 2 Report
In the present study, the author developed and validated a prognostic nomograms for periampullary neuroendocrine neoplasms.
Comment:
Please evaluate the effeciency of prognostic nomograms with the external group which collected from other platform.
Author Response
Dear Reviewers and Editors:
Thanks for your comments concerning our manuscript entitled "Development and Validation of Prognostic Nomograms for Periampullary Neuroendocrine Neoplasms: A SEER Database Analysis" (ID: curroncol-1965226). We are pleased to know that there is an opportunity for our work to be properly revised. We thank the reviewers for the time and effort that they have put into reviewing the previous version of the manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our research. We have studied comments carefully and have made corrections which we hope to meet with approval. Below, please find the comments in black, followed by our responses in red. The exact changes in the manuscript are presented in red.
Point 1: Please evaluate the effeciency of prognostic nomograms with the external group which collected from other platform.
Response 1: Thank you for pointing this question out. As you suggested to us, we also hope to verify our conclusion through external data. The original plan was to collect the data of NENs patients in the ampulla of our center, but due to the low incidence and the loss of follow-up of some patients, the amount of data that can be collected is too small to be calculated. But this is the next step. We plan to collaborate with other centers to conduct multi-center data collection and analysis to validate our work. However, we are very sorry that this process will take some time. At present, we are still in the stage of data collection and cannot complete the verification of external data. We will complete the data collection as soon as possible and continue to improve the prognosis prediction model of ampulla NENs in future work.
Author Response File: Author Response.docx
Reviewer 3 Report
In the present manuscript entitled “Development and Validation of Prognostic Nomograms for Periampullary Neuroendocrine Neoplasms: A SEER Database Analysis” the authors address an interesting topic which has relevance in Periampullary neuroendocrine neoplasms (NENs), reporting the lack of clinical evidence regarding NENs prognosis. They have successfully performed an in depth in silico/statistical analysis of a sufficient cohort with an extensive follow-up, in order to identify accurate and comprehensive results. This is the first study to develop nomogram tools for NENs prognosis which could be further included in NENs therapeutic decision making which is considerably novel and interesting. The manuscript is greatly written, the study is diligently performed, and the conclusions are supported by the results.
However, I have a major concern which significantly lowers the quality of the study and the overall merit of the manuscript.
The quality of all the figures is clearly insufficient. The figures are not readable and cannot be published in their present form. They significantly lower the overall strength of the study.
The illustration and presentation of the results is of utmost importance for a manuscript to be appealing to the reader and to deliver the conclusions.
Please significantly improve the quality of all the figures.
Author Response
Dear Reviewers and Editors:
Thanks for your comments concerning our manuscript entitled "Development and Validation of Prognostic Nomograms for Periampullary Neuroendocrine Neoplasms: A SEER Database Analysis" (ID: curroncol-1965226). We are pleased to know that there is an opportunity for our work to be properly revised. We thank the reviewers for the time and effort that they have put into reviewing the previous version of the manuscript. Those comments are all valuable and very helpful for revising and improving our paper, as well as the important guiding significance to our research. We have studied comments carefully and have made corrections which we hope to meet with approval. Below, please find the comments in black, followed by our responses in red. The exact changes in the manuscript are presented in red.
Point 1: The quality of all the figures is clearly insufficient. The figures are not readable and cannot be published in their present form. They significantly lower the overall strength of the study.
Response 1: Thank you for the suggestion. We are very sorry for this problem. We have improved the quality of all our figures so that they become readable and publishable.
Point 2: The illustration and presentation of the results is of utmost importance for a manuscript to be appealing to the reader and to deliver the conclusions.
Response 2: Special thanks for your comment. We are very sorry that the presentation of the results may not be very clear, which may cause problems in attracting readers and conveying the conclusion. We have revised part of the results (see page 8, line184-196), hoping to express it more clearly and get relevant conclusions better.
Point 3: Please significantly improve the quality of all the figures.
Response 3: Many thanks for your comment. We have modified the picture, improved the quality of the picture, and improved the relevant content, hoping to meet the requirements for publication.
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
The revised manuscript looks better.
Reviewer 3 Report
The authors have successfully addressed the reviewer's suggestions. The quality of the figures is significantly improved. I recommend this manuscript to be accepted for publication at its present form.
