Review for 10.1186/s12876-025-04186-2 (2025)

Title: The Value of Systemic Inflammatory Response Index in Evaluating the Prognosis of
Postoperative Patients with Stage II Colon Cancer
Version: 2 Date: 14 May 2025
Reviewer:  Mohamed H. Zidan
Reviewer's report:
Dear Authors,
Re: The Value of Systemic Inflammatory Response Index in Evaluating the Prognosis of
Postoperative Patients with Stage II Colon Cancer
Thank you for this oppurtunity. The study is well-structured, the methodology is sound, and the
statistical analysis appears appropriate for the data.
Nevertheless, there are several areas that require clarification and improvement:
1) While the discussion of SIRI in other malignancies is extensive, the specific rationale for
its utility in colon cancer needs to be more explicitly linked to existing literature. As SIRI has
been previously evaluated in other gastrointestinal tumors, a more targeted discussion comparing
those findings to your own would strengthen the clinical interpretation.
2) There is some inconsistency in how NLR is interpreted. Your results show a lower NLR in
the poor prognosis group, yet you describe it as a "protective factor" in multivariate analysis.
This seems contradictory, as NLR is traditionally associated with worse outcomes in multiple
cancer types. This discrepancy should be discussed and, if necessary, clarified by rechecking
the raw data or stratification logic.
3)  With only 28 events in the poor prognosis group, the risk of overfitting in multivariate Cox
regression is nontrivial. This limitation should be explicitly acknowledged, and readers should
be cautioned about the need for external validation in larger, multi-center cohorts. Additionally,
more details regarding how recurrence or metastasis was confirmed would add robustness.
4)  Please clarify the units used for NEUT, MONO, and LYC in the SIRI formula. If these are
absolute counts (×10#/L), that should be stated explicitly. Additionally, indicate the laboratory
reference ranges and any quality control measures that ensure the reliability of hematological
data.
5) The ROC curve and Kaplan-Meier figures are referenced appropriately and add value to
the manuscript. However, the legends are minimal and would benefit from brief explanatory
descriptions. In Table 4, the confidence intervals for AUC values are implausibly wide and
sometimes do not match expected lower-upper bounds (e.g., SIRI AUC 0.828 with lower CI
“0.000” and upper “0.726” is mathematically invalid). Please revisit the calculations and ensure
the CIs are correctly reported using appropriate statistical software.
6) The manuscript is largely understandable but contains several grammatical errors, awkward
phrasing, and stylistic redundancies that would benefit from professional language editing.
Examples include incorrect subject-verb agreement, repetitive phrasing (e.g., “predict the
prognosis of prognosis”), and excessive use of passive voice. Improved clarity and conciseness
will enhance the manuscript's readability.
7) While the conclusion reiterates the findings effectively, it may be overly assertive given
the single-center, retrospective design. Rather than stating that SIRI “can predict” prognosis,
consider more cautious language such as “may serve as a useful predictor pending further
validation.”
8) The statement regarding data availability is appropriate; however, including a supplementary
table with the anonymized patient-level data (if permitted) would significantly enhance the
reproducibility of your findings.