Review for 10.1186/1471-230X-14-105 (2014)

Reviewer's report
Title:Sub-dividing high-risk gastrointestinal stromal tumors help to precisely
predict prognosis and efficiency of imatinib adjuvant therapy
Version:2Date:28 April 2014
Reviewer: Gurjeet Kaur
Reviewer's report:
- Major Compulsory Revisions
English language revision.
- Minor Essential Revisions
1. Is the question posed by the authors well defined?
Most of the work is aimed at defining the most important clinicopathological
indicators associated with prognosis/recurrence-free survival (RFS) of GIST
patients and high-risk GIST patients without imatinib therapy. Only a small part
looks at two factors that may be associated with RFS in 48 imatinib-treated
patients. I think the aims can be stated more clearer.
2. Are the methods appropriate and well described?
Generally clear. However, there are some parts which can be more clearer.
i) RO resection can be defined in the initial part.
ii) Paragraph 1 - Under patient inclusion criteria no.5) informed consent obtained.
The ethics approval should be in another sentence, and not part of inclusion
criteria.
iii) Paragraph 1 – Did the database also include presence or absence of serosal
invasion? Did all cases have this information in the pathology records? What
about tumour rupture, which is listed in Revised NIH risk stratification (Joensuu,
2008)?
iv) Paragraph 2 – The purpose of test cohort and validation cohort can be
mentioned.
v) Paragraph 4 – last sentence is not understandable.
vi) Paragraph 5 – last sentence – It is mentioned that KIT and PDGFR gene
analysis were done. However this was not alluded to in results or analysis. KIT
mutations results are mentioned in methods, but PDGFR mutations are not
mentioned. Also it should be stated as ‘KIT exon 11 mutation’ rather than ‘KIT 11
exon mutation’.
3. Are the data sound?
Yes, but I do not feel adequately qualified to assess the statistics.
In results section, paragraph 2, ‘Figures 1C & 1D’ should be corrected to ‘Figures
2C & 2D’
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition?
Yes.
5. Are the discussion and conclusions well balanced and adequately supported
by the data?
i) Discussion, paragraph 1. The authors mentioned their own 10 year follow up
database, which should be referenced. The data should be more specific.
ii) Discussion, Paragraph 3, line 11. Authors mention ‘serosa invasion not
mentioned in GISTs before’. However there is an article published by Vallbohmer
D et al. Serosal penetration is an important prognostic factor for GIST. Oncology
Reports 2008; 20:779-783 This can be alluded to.
iii) Discussion, Paragraph 7. Unable to clearly understand what authors wish to
convey. The paragraph needs English language revision and a clearer message.
iv) Conclusion. Mitotic count > 10/50HPF is already used as an indicator for high
risk of recurrence (Revised NIH Riesk, Joensuu, 2008).
In the current study, serosal invasion appears to improve the modified NIH
criteria and predicts an unfavourable outcome in high-risk GIST patients, with or
without imatinib treatment.
6. Are limitations of the work clearly stated?
Limitations are stated.
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
As mentioned in No. 5 (i).
8. Do the title and abstract accurately convey what has been found?
The title of manuscript can be more accurate and specific. Suggestion Eg.
Evaluation of high-risk clinicopathological indicators in gastrointestinal stromal
tumours for prognosis and imatinib treatment outcome.
A more appropriate word in the original title is “efficacy” and not “efficiency” of
imatinib therapy.
9. Is the writing acceptable?
English language review of whole manuscript is necessary.
‘Serosa invasion’ should be written as “serosal invasion”
“prognostic diagnosis” should be replaced with ‘prognostic indicator”.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Needs some language corrections before being
published
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests in relation to the paper reviewed.