Review for 10.1186/s12876-025-03914-y (2025)

Title: Evaluation of the efficacy of probiotics in the chemoradiotherapy of colorectal cancer#a
meta-analysis of Randomized Controlled Trials
Version: 3 Date: 12 Mar 2025
Reviewer's report:
The manuscript presents a meta-analysis investigating the efficacy of probiotics in managing
adverse reactions during chemoradiotherapy in patients with colorectal cancer. The study is
timely and addresses an important clinical question that could potentially inform clinical practice
and patient management. The authors have adhered to the PRISMA guidelines and employed a
robust statistical approach using RevMan5.3 software. However, there are several areas in which
the manuscript could be improved to enhance clarity, validity, and applicability of the findings.
Major Comments:
Abstract
Please add more details of mthods.
Literature Search and Selection Criteria:
The authors mention that the literature search was conducted until July 27, 2024. It would be
helpful to include more details about the search strategy, including the specific search terms used
and databases searched. Providing a PRISMA flow diagram would enhance the transparency of
the study selection process.
The inclusion and exclusion criteria are broadly defined. More detailed definitions of what
constitutes relevant "adverse reactions" could help in replicating the study and understanding
the scope of the meta-analysis.
Data Extraction and Quality Assessment:
While the manuscript states that data extraction was performed by multiple authors, the specific
roles and how disagreements were resolved during data extraction are not detailed. Clarifying
this process would strengthen the validity of the data.
More information on the quality assessment of the included studies, particularly regarding the
risk of bias, is needed. A summary table or a risk of bias graph should be presented to provide
readers with clear insights into the quality of the evidence being synthesized.
Statistical Analysis:
The authors have used both RR and SMD for their analysis, which is appropriate. However, the
manuscript would benefit from a more detailed explanation of why these particular statistical
methods were chosen and how they contribute to the overall findings.
The heterogeneity of the included studies is mentioned, but there is limited discussion on
how this heterogeneity might affect the interpretation of the results. Further analysis, such
as subgroup analysis or sensitivity analysis, could be performed to explore the sources of
heterogeneity.
Results and Interpretation:
The results section is comprehensive but could be enhanced by more structured presentation,
such as using subheadings for different outcomes (e.g., diarrhea, pain index, quality of life).
This would improve readability and clarity.
Some results are presented with wide confidence intervals and borderline significant p-values,
which suggests uncertainty around the effect estimates. The clinical significance of these
findings should be discussed, not just the statistical significance.
Discussion and Contextualization:
The discussion adequately highlights the potential benefits of probiotics but could be improved
by a more balanced view that also discusses potential limitations and the implications of the
findings in the current clinical context.
Comparisons with existing literature are made, but a more thorough discussion on how this
study's findings align with or differ from previous research would be beneficial.
Minor Comments:
Formatting and Style:
Check for consistency in terminology and formatting throughout the manuscript. For example,
the use of "chemoradiotherapy" vs. "chemotherapy and radiotherapy" should be standardized.