Review for 10.1186/s12876-025-03635-2 (2025)

Title: The Prognostic Value of Systemic Inflammation Response Index in Digestive System
Carcinomas: A Systematic Review and Meta-Analysis
Version: 2 Date: 07 Oct 2024
Reviewer's report:
This article by Niu et al. looks into the applicability and relevance of the systemic inflammation
response index (SIRI) in gastrointestinal cancers (digestive system carcinomas). The subject is
relevant and interesting. This reviewer think that the manuscript and work done has potential
to be published. However there are some major and minor considerations that this reviewer
recommend changes applied to.
In general; the English language is unfortunately not very well. There are several wrongly
constructed sentences, inappropriate  use of adjectives, grammatical errors and hard to
understand phrases. E.g. "Digestive system carcinomas (DSC) are important parts of solid
tumors.", "There was an increase in malignant tumors associated with the digestive tract due
to changes...", "However, it was a pity that these studies did not delve into whether SIRI had a
similar predictive value for DSC, given its specificities and hazards", "and that did not divided
subjects into high ",  etc.
Introduction:
The introduction is fine but again it needs proper language editing.
The authors could add a sentence or two about  the differences between systemic and local
prognostic immune markers, e.g., TILs versus NLR, SIRI etc.
Methods:
The methods in general are good and well conducted. But there are some concerns:
The authors state that they excluded studies that did not provide HRs and CIs on the outcomes of
interest. This is wrong. The authors should still include these studies, at they can be used as par
of the systemic review only. Studies not reporting on HRs and CIs can be used in the systematic
review part which evaluates the included literature qualitatively and not quantitatively - which
the meta analysis does.
Please state where the definitions of the outcomes are from? NCI?
Why did you not use the Newcastle Ottowa scale for risk of bias/quality assessment?
Which specific codes or packages were used to conduct the statistics?
Results:
I don't understand this sentence: "There were 26 articles included in the period 2016-2023, with
9628 participants. A total of 34 cohort studies were included, with six articles[13, 14, 18, 25-27]
containing two cohort studies and one article[12] containing three cohort studies."
Don't start sentences with numbers. Start with "In total, 21 of 26 articles ..." etc.
What is not research studies? What does this mean in the PRISMA flowchart, can you please
elaborate?
Authors could have included an assessment of the quality of the cumulative data by using the
modified GRADE approach. Especially for the OS analysis.
Discussion:
The discussion is ok. Please again, do an extensive grammatical error check.
Please rephrase: "To our limited knowledge..."
Please rephrase: "Another study also identified that unresectable pancreatic ductal
adenocarcinoma patients with high SIRI" to "...patients with  unresectable pancreatic ductal
adenocarcinoma".
Could you please remove the subheadings "Advantages"  and "Limitations" and instead let these
sections be a part of the discussion without any subheadings.
Another limitations is that most of the studies were from a specific continent, making it less
representative for other regions of the World. If there were more studies from other continents
as well, the results would be more globally applicable.
Do you have any explanation on why this topic is not examined as much in other regions of the
world as it is for instance in Asia?
What would be the ideal design of a clinical trial/study examining the prognostic value of SIRI?
The authors include the REMARK guidelines as a potential tool to examine the biomarker role of
SIRI  in the methods section but never really comment on the REMARK guidelines/tool again.
Could be relevant to include in the discussion section at least.