Review for 10.1186/s12876-022-02131-1 (2022)

Reviewer’s report
Title: 
Nomogram to predict cause-specific mortality of patients with rectal
adenocarcinoma undergoing surgery: a competing risk analysis.
Version: 
2 
Date: 
23 Dec 2021
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses one
or several testable research questions? (Brief or other article types: is there a
clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient
technical rigor to allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your
concerns sufficiently for you to now recommend the work as a technically sound
contribution? If not, can further revisions be made to make the work technically
sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: The authors have been moderately responsive to my
concerns. The use of race as a prognostic indicator without control for
confounding is a contentious issue (e.g. Ioannidis JPA, Powe NR, Yancy C.
Recalibrating the Use of Race in Medical Research. JAMA. 2021;325(7):623-
624. doi:10.1001/jama.2021.0003 and related commentary, also VanderWeele
TJ, Robinson WR. On the causal interpretation of race in regressions adjusting
for confounding and mediating variables. Epidemiology. 2014;25(4):473-484.
doi:10.1097/EDE.0000000000000105). It is also contentious outside of the
medical field for similar concerns regarding confounding (e.g.
https://harvardcrcl.org/the-problem-with-defining-tort-harms-in-terms-of-race-
and-gender/ ). In the case of this nomogram, it would be unfortunate if clinicians
were to use a model that does not control for confounders to predict worse
outcomes among individual African Americans/U.S. Black patients. The effect
might be due to racial differences in insurance status, sociodemographics, or
unmeasured clinical factors. Hence, using a nomogram that does not control for
confounders could simply perpetuate systematic bias. However, it seems that the
authors are unwilling to change the model much (e.g. by removing race from the
nomogram), so not much more can be said.
ADDITIONAL REQUESTS/SUGGESTIONS: 
No further comments.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
No
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes