Does an Autoimmune Disorder Following Ovarian Cancer Diagnosis Affect Prognosis?

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Ovarian cancer did not show promising results when immune checkpoint blockade therapy was applied. The authors did a retrospective study to investigate the association between development of autoimmune disease prior to or after disease onset with clinical parameters and patient survival. Interestingly, they found that the development of AID after cancer diagnosis in high-grade ovarian patients was significantly associated with longer overall survival and better prognosis, although the number of these cases was low.

Here are a few comments:

1.       The authors tried to connect the presence of AID with potential increased immune response that may target the tumor cells and thereby benefit the patients. To better demonstrate that, it would be great if FFPE samples can be obtained from some of these patients and use IHC to show that there are more infiltrating lymphocytes in the tumors from patients with newly developed AID than in those with prior AID or those without.

2.       As the number of cases with AID was low, is it possible to dig into the literature to see if there are other studies that mentioned AID in ovarian patients without doing the analysis?

3.       Patients with AID after cancer diagnosis seemed to be entirely serous type, with higher likelihood of having no residual tumor, and more likely to have the pN0 nodal status, although without statistical significance. To make this finding translational, it is important to find out what is associated with AID development, and these patients may be the ones that can benefit from immune checkpoint blockade.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript entitled “Does an autoimmune disorder following ovarian cancer diagnosis affect prognosis?” evaluates whether developing an autoimmune disorder (AID) following high-grade epithelial ovarian cancer diagnosis improves overall survival. The study is a first in its kind to speculate and study the co-relation. Although the results and conclusions are based on very small population of samples (9 in AID group), it can be helpful as base line for scaling the study to other sites with meaningful higher participation. This is a preliminary finding, so it should be followed with more research to validate the findings and more research is required to understand the mechanisms of action. This study and its outcome would be a pilot study for larger multicentered study in future.

I would suggest authors to add and discuss in detail the limitations of the study at the end of the discussion.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf