Review for 10.1186/s12876-025-04014-7 (2025)

Title: Comprehensive Analysis of Risk Factors and Nomogram Development for Predicting
Hepatic Metastasis Following Radical Resection of Adenocarcinoma of the Esophagogastric
Junction
Version: 1 Date: 28 Mar 2025
Reviewer:  Manabu Ohashi
Reviewer's report:
The reviewer really appreciates having an opportunity to evaluate this manuscript entitled
“Comprehensive Analysis of Risk Factors and Nomogram Development for Predicting Hepatic
Metastasis Following Radical Resection of Gastric Cardia Cancer” written by Dr. Deng et al.
The reviewer's personal opinion is that, although many nomograms have been published, it
is questionable whether any of them are effectively used in clinical practice. How will this
nomogram be useful in clinical practice, and how might it change current clinical practices?
These considerations are important when developing a nomogram, and research and papers
should be created with these points in mind. The specific comments are listed below.
1. The detection of liver metastasis is relatively easy with imaging tests. The reviewer believes
that it is important to detect liver metastasis as early as possible through regular tumor marker
checks and imaging tests. While the likelihood of liver metastasis can be estimated to some
extent by referring to classical indicators (depth of invasion, lymph node metastasis, histological
type, vascular invasion, tumor markers), how would more detailed risk information be clinically
useful? Why did the authors think it was necessary to develop a nomogram that only predicts the
risk of liver metastasis, and how do they think this nomogram could change clinical practice?
This should be thoroughly discussed in the introduction section.
2. The reviewer could not understand what was gastric cardia cancer. However, the explanation
of gastric cardia cancer is included in the text, and it is understood to be adenocarcinoma of the
esophagogastric junction cancer. Therefore, it is necessary to indicate the number of patients for
each type according to the Siewert classification or Nishi classification.
3. The number of patients with liver metastasis is mentioned, but the total number of recurrent
patients and the number of patients with other recurrences should also be indicated.
4. The document does not contain specific data about the tumor marker AFP (Alpha-fetoprotein).
However, it is reasonable to hypothesize that AFP could be related to liver metastasis.
Additionally, it may be necessary to investigate the relationship between other tumor markers
and liver metastasis.
5. It is necessary to include descriptions of the indications and actual techniques for each surgical
procedure in the Method section.
6. It is also necessary to include descriptions of the methods for postoperative follow-up in the
Method section. Specifically, it should detail the intervals at which follow-up is conducted and
the types of examinations performed during these follow-ups.
7. The authors should include descriptions of the types of adjuvant chemotherapy administered
postoperatively and the proportion of patients who received these treatments in the current study.
8. The Results section includes an evaluation of the obtained results (descriptions regarding
C-index, ROC, AUC and DCA). However, only the obtained results should be included in
the Results section (The word "suggesting" should be avoided), and the evaluation should be
included in the Discussion section.
9. An example case is not necessary in the Results section.
10. I understand that this model is highly accurate. However, if this model is used to predict only
postoperative liver metastasis, what should clinicians do? Should they perform more imaging
tests than usual during follow-up? Should they strengthen adjuvant therapy after surgery? This
point should be thoroughly discussed. Namely, if the one-year liver metastasis-free survival rate
for example case XX is 45.5% and the three-year rate is 6.49%, what should clinicians do with
this data? Should they perform more frequent imaging tests during follow-up than usual? Should
they strengthen adjuvant therapy after surgery? This point should be thoroughly discussed.
11. The Discussion section contains many repetitions of the results, and there is no effective
discussion of the findings of this study.
12. The method of inserting figures and tables in the text is different from the usual method. If
this was edited by the editor, there is no problem.