Review for 10.1186/s12876-020-01431-8 (2020)

Reviewer’ s report
Title: Metastatic Pancreatic Adenocarcinomas Could be Classified into M1a and M1b Category
by the Number of Metastatic Organs
Version: 0Date: 04 Jul 2020
Reviewer's report:
In the present study, the authors are presenting the results of a retrospective analysis of metastatic
pancreatic cancer patients derived from the SEER database. Here, they subclassified the patientsbased on the number of distant metastases, particularly classifying them is M1a if the patients hasa single metastasis, or as M1b if they had more than one. Based on this stratification, the authorsfound that patients with M1a status had a better overall survival in the multivariate analysis.Moreover, they also showed that patients who underwent surgery for M1a status had an improvedsurvival when compared to those M1a patients who did not undergo surgery. Based on theseobservations, the authors proposed a revised and novel classification of M1 status in the UICCsystem and consideration of surgical therapy for patients with limited metastatic disease.
The topic that the authors is investigated is of increasing and emerging importance in clinical
pancreatology. Indeed, prospective randomized trials are currently being initiated that shall addressthe role of a multimodal therapy including surgery for the treatment of oligo-metastatic disease inpancreatic cancer. The rationale for such studies is the repeated demonstration of a survival benefitfor biologically fit pancreatic cancer patients with oligo-metastases. Towards this end, the study ofthe authors is of importance.
However, the authors need to perform a major revision of their study to ensure clinical relevance:
1) the orders need to stratify the patience based on the type of treatment, particularly based on
whether or not the patient received an adjuvant, neoadjuvant therapy, considering the specifictreatment regimes.
2) The authors should also differentiate between pancreatic head vs bod or tail cancer, and need to
consider the type of surgery performed.
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Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
YesDoes the work include the necessary controls?
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NoAre the conclusions drawn adequately supported by the data shown?
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NoAre you able to assess any statistics in the manuscript or would you recommend an
additional statistical review?If an additional statistical review is recommended, please specify what aspects require further
assessment in your comments to the editors.
I recommend additional statistical reviewQuality of written English
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Needs some language corrections before being publishedDeclaration of competing interests
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