Review for 10.1186/s12876-025-04168-4 (2025)

Title: The relationships between symptom clusters and contributing factors in patients with
esophageal cancer: Structural equation modelling based on theory of unpleasant symptoms
Version: 1 Date: 06 Feb 2025
Reviewer's report:
This study explored the characteristics of symptom clusters experienced by patients with
esophageal cancer undergoing radiotherapy or chemoradiotherapy. It also analyzed potential
associations between these symptom clusters and factors such as the neutrophil-to-lymphocyte
ratio (NLR), albumin level (ALB), psychological status (including anxiety and depression),
social support, self-care ability, and self-efficacy. While this article has academic value, it
requires improvement in several areas.
The specific review comments are as follows:
1. Abstract part: The results section lacks specific quantitative data, which diminishes its impact.
It would benefit from increased support through quantitative findings, while the conclusion is
too general and needs to be more precise.
2. Introduction part: The introduction does not adequately elucidate the interrelationships of the
involved variables or the necessity of this study. Although the findings indicate a significant
mediating effect, the background does not clarify why exploring such a mediating mechanism
is imperative.
3. Methods part:
#There are inconsistencies in the age ranges specified in both the inclusion and exclusion criteria
for study subjects. The inclusion criteria state an age range of 18-80 years, while the exclusion
criteria mention "children under 16 years," creating a conflict. It is recommended to establish
a uniform age range to avoid confusion. Additionally, the criteria for the Karnofsky score are
unclear. Although a score of 70 or higher is required, the specific timing of this scoring (e.g.,
whether it occurs before or after treatment) is not specified. A clear timeframe for scoring is
recommended.
# The research methods section lacks a description of the reliability and validity of the
scales employed. There is insufficient detail regarding the evaluation methods and results
concerning the reliability (stability and consistency) and validity (authenticity and accuracy)
of the measurement tools used. Supplementing this section with relevant information would
enhance the scientific validity and reliability of the study.
# In the statistical methods section, the authors do not explicitly mention the description and
analysis methods for classified data. It is suggested to include relevant statistical methods to
ensure the comprehensiveness and accuracy of the research findings.
4. Results part:
#The structural equation model diagram currently presented lacks standardization. It is advisable
to correct and optimize the diagram for clarity and adherence to guidelines.
#. In Table 1, the representation of symptom scores indicates that some scores appear to exhibit
a skewed distribution. To more accurately depict the data distribution, it is recommended
to express these scores as medians and interquartile ranges rather than means and standard
deviations to better reflect their statistical properties.
5. Discussion part:
The discussion section currently lacks depth. Its content is relatively simplistic and does not fully
explore the significance of the research results, possible influencing factors, or future research
directions. To enhance the discussion's depth and breadth, the authors should further investigate
the potential mechanisms behind the findings, conduct a more comprehensive comparative
analysis with existing literature, and provide forward-looking research prospects.
Overall, addressing these points will significantly improve the clarity, robustness, and academic
merit of the study.