Review for 10.1186/s12876-020-01529-z (2020)

Reviewer’s report
Title: 
Comparison of metastasis between early-onset and late-onset gastric signet
ring cell carcinoma
Version: 
0 
Date: 
17 Sep 2020
Reviewer's report:
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This study compared early onset SRC diagnosed before 45 years of age and late
onset SRC diagnosed after 45 years of age in 2052 SRC and 403 SRC patients
diagnosed at SEER and local hospitals, respectively.
1. major
1) Authors should accurately understand and describe the definition of early
onset GC used in cited papers. The cited paper (Bergquist JR, Leiting JL,
Habermann EB, Cleary SP, Kendrick ML, Smoot RL,Nagorney DM, Truty MJ
and Grotz TE. Early-onset gastric cancer is a distinct disease
with worrisome trends and oncogenic features. Surgery 2019; 166: 547-555.)
that analyzed early-onset gastric cancer using SEER data has a cut-off value of
60. There is a significant difference from the 45-year-old used in this manuscript.
Therefore, attention should be paid to interpretation and application.
2) If possible, compare survival with early onset SRC for each stage., I saw some
studies that there is no difference in survival between early onset SRC or late
onset SRC in stage I.
3) Please clearly state whether patients with early-onset SRCC had more distant
metastasis at the time of diagnosis or during follow-up after treatment.
4) There is inconsistency in the use of terminology in describing the results. For
example, in 'Survival analysis and identifing risk factors for metastasis' the term
'the patients diagnosed at less than 45 year-old ' was used instead of the term
'early onset'. It gives considerable confusion to the reader.
5) 
2. minor
1) Introduction, family histology--> family history
2) A considerable amount of misspellings are noted, so overall correction is
required, and English grammer need to be also revised.
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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?
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