Clinical Profile and Predictors of Survival in Carcinoma Penis Patients

Round 1

Reviewer 1 Report

Nicely written manuscript

The main selling point in the manuscript is addressing the lacuna of   Impact of education status, rural versus urban dwelling and distance from the treatment centre. Other findings are well known facts and lack anything new or are worth reader’s time.

In my opinion the logical sequence would thus be -

all the results need to be focussed around these three important variables

Please give some tables where all clinical and outcome characteristics are compared between – rural/urban, different distances, education statuses

Then a multivariate analysis that shows how these are not important to predict survival

 

Some tables the way they are can go as supplementary tables

Also, non relevant clinical details can also go to supplementary files

Also, please be very sure that literature search about previous Indian studies is thorough and you are not wrong in your claim that such things have not been analysed before. You might need to visit NML nearby and see paper prints of old journals as many old Indian abstracts are not available online.

For example – read this paper – it may talk about literacy etc -

Gajalakshmi CK, Shanta V. Association between cervical and penile cancers in Madras, India. Acta Oncol. 1993;32(6):617-20. doi: 10.3109/02841869309092439. PMID: 8260177.

Author Response

Dear reviewers,

We are grateful for your consideration of our manuscript. We sincerely appreciate your efforts and time devoted by you in improving the manuscript and making it suitable for the readers. Kindly find the point wise reply to your answers. We have tried to address the questions to the best of our knowledge.

 

Reviewer 1

The main selling point in the manuscript is addressing the lacuna of Impact of education status, rural versus urban dwelling and distance from the treatment centre. Other findings are well known facts and lack anything new or are worth reader’s time.

Comment 1: In my opinion the logical sequence would thus be -all the results need to be focussed around these three important variables

Reply: Results have been rearranged with an emphasis on education status, rural versus urban dwelling and distance from the treatment centre.

Comment 2: Please give some tables where all clinical and outcome characteristics are compared between – rural/urban, different distances, education statuses

Reply: Table (Table 3) has been added on clinical and outcome characteristics are compared between – rural/urban, different distances, education statuses.

Comment 3: Then a multivariate analysis that shows how these are not important to predict survival.

Reply: Table (Table 5) added on multivariate analysis highlighting rural/urban, distance, education statuses.

Comment 4: Some tables the way they are can go as supplementary tables. Also, non relevant clinical details can also go to supplementary files.

Reply: As suggested by the reviewer, tables moved to supplementary as supplementary tables 1 and 2.

Comment 5: Also, please be very sure that literature search about previous Indian studies is thorough and you are not wrong in your claim that such things have not been analysed before. You might need to visit NML nearby and see paper prints of old journals as many old Indian abstracts are not available online.

Reply: We did thorough literature search about previous Indian studies on impact of distance from treatment centre, rural/urban habitation and education on the characteristics and outcomes of carcinoma penis. We have included the reference suggested by reviewer in the discussion.

Thank you again for providing the opportunity to revise the manuscript.

Let me know if any other clarification is needed.

Atul Batra

Author Response File: Author Response.docx

Reviewer 2 Report

Authors should be congratulated for their work. The topic is interesting and intriguing. The manuscript is well-written and the tables are good. The role of  both, education status and rural habitation, is noteworthy for cancer like the penile one. No previous investigator address these knowledge gaps in the Indian population. Therefore, the manuscript is suitable for publication, even if the number of observations is not so high.

Author Response

Dear reviewer,

We are grateful for your consideration of our manuscript. We sincerely appreciate your efforts and time devoted by you in improving the manuscript and making it suitable for the readers. Kindly find the point wise reply to your answers. We have tried to address the questions to the best of our knowledge.

Reviewer 2

Comment 1: Authors should be congratulated for their work. The topic is interesting and intriguing. The manuscript is well-written and the tables are good. The role of both, education status and rural habitation, is noteworthy for cancer like the penile one. No previous investigator address these knowledge gaps in the Indian population. Therefore, the manuscript is suitable for publication, even if the number of observations is not so high.

Reply: We thank and appreciate reviewer for encouraging comments and for devoting precious time to review our manuscript.

Thank you again for providing the opportunity to revise the manuscript.

Let me know if any other clarification is needed.

Atul Batra

Author Response File: Author Response.docx

Reviewer 3 Report

Thank you for giving me the opportunity to review this article.     The authors investigated the relationship between the malignancy of penile cancer (stage and survival rate), patients' schooling history, and the distance of the hospital visit. And the authors reported many patients with LN-positive or M-positive had lived in a rural area, and their schooling history was primary school or less. This report indicated the impact of patients' living environment on cancer progress, especially penile cancer. I think this study would be meaningful to readers. The followings are my comments.     -The authors described "In 80 patients with non-metastatic disease ---" at the head of "3.5. Survival." However, Table 2 shows the number of M0-patients was 96. Are there any differences between "M0" and "non-metastatic"? -What is palliative chemotherapy? The word "palliative chemotherapy" seems to be an ambiguous term. Please describe different points between regular and palliative chemotherapy (e.g., dose or interval). Terms used in research papers should be defined clearly.

Author Response

Dear reviewer,

We are grateful for your consideration of our manuscript. We sincerely appreciate your efforts and time devoted by you in improving the manuscript and making it suitable for the readers. Kindly find the point wise reply to your answers. We have tried to address the questions to the best of our knowledge.

Reviewer 3

The authors investigated the relationship between the malignancy of penile cancer (stage and survival rate), patients' schooling history, and the distance of the hospital visit. And the authors reported many patients with LN-positive or M-positive had lived in a rural area, and their schooling history was primary school or less. This report indicated the impact of patients' living environment on cancer progress, especially penile cancer. I think this study would be meaningful to readers. The followings are my comments.     –

Comment 1: The authors described "In 80 patients with non-metastatic disease ---" at the head of "3.5. Survival." However, Table 2 shows the number of M0-patients was 96. Are there any differences between "M0" and "non-metastatic"?

Reply: We thank reviewer for pointing this out. We have modified the statement to make it clear. “In 80 patients treated with curative intent, 40 patients had relapsed at the last follow-up.” Relapse free survival is calculated for patients who were treated with curative intent with either surgery, or radiation alone or in combination with chemotherapy. M0 is used to denote if there is no distant metastasis.

Comment 2: What is palliative chemotherapy? The word "palliative chemotherapy" seems to be an ambiguous term. Please describe different points between regular and palliative chemotherapy (e.g., dose or interval). Terms used in research papers should be defined clearly.

Reply: We apologise for the ambiguity caused by the term palliative chemotherapy. We used “palliative chemotherapy” to describe the intent of treatment being palliative, and not curative. While adjuvant or neoadjuvant chemotherapy is used where chemotherapy was intended for curative intent. This has been added to the methodology section and highlighted.

Thank you again for providing the opportunity to revise the manuscript.

Let me know if any other clarification is needed.

Atul Batra

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

thank you for the revised manuscript