Review for 10.1186/s12876-025-03766-6 (2025)

Title: Using a nomogram based on the controlling nutritional status score to predict prognosis
after surgery in patients with resectable gastric cancer
Version: 1 Date: 23 Jan 2025
Reviewer's report:
"PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Yes - current version is technically sound
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: HAVE THE AUTHORS RESPONDED ADEQUATELY TO
EACH OF THE QUESTIONS YOU RAISED IN YOUR COMMENTS?
Please note. I was not one of the original reviewers but I do support their comments.  The authors
have responded to all the comments.
HAVE THEY MADE THE APPROPRIATE CHANGES IN THE MANUSCRIPT?
Yes. And I think they agree that those comments were appropriate and improved the manuscript.
WHAT IS YOUR OVERALL IMPRESSION OF THE REVISED MANUSCRIPT?
Excellent improvement over use of single variables to predict survival (such as just the TMN
CLASSIFICATION or tumor cell differentiation, etc. One question that the authors may theorize
is that the nomogram score may very well serve to guide the aggressiveness of the postoperative
therapy and also the CONUT. Score alone may serve to identify a modifiable variable to be
addressed and treated preoperatively.
ADDITIONAL REQUESTS/SUGGESTIONS:
ARE THERE ANY ADDITIONAL REVISIONS THE AUTHORS SHOULD MAKE?
Again I was not an original reviewer but will review this submission as if it was the first review.
1. Page 1 line 8 I think you should add the phrase “and several other important parameters based
on patient age and tumor characteristics"" after the word “score”
2. Page 2 line 4. I ask you-  Do you think that this improved predictive score may also indirectly
affect postoperative treatment ? For instance, more aggressive chemotherapy, resection of
metastases, re-operation for HIPEC, etc.? This would make the use of such a predictive score
much more clinically relevant? I will think about this as I read on.
OK now I have read on! I am returning to this comment after having finished reading the study
and I will add this thought- See page 13 lines 11-12 here is where there might be a beneficial
potential trial on survival based on the nomogram.  I would suggest that you might add a
sentence something like “use of the nomogram score (or even just the CONUT score) might
also be beneficial in supporting a more aggressive operative approach or postoperative adjuvant
therapeutic approach to those with a higher nomogram score such as consideration of HIPEC,
a different more aggressive chemotherapeutic protocol, or even a more aggressive approach to
resection of localized recurrences;  this use of the nomogram of course would first require more
study to determine if such a use of the nomogram is beneficial.   Page 14 Conclusion: Also you
could consider adding a statement cc the possibility of using the nomogram to help to guide
postoperative therapy.
3. Page 2 line 13 also elsewhere in the text such as but not limited to line 21. Use of the word
“significantly” can be interpreted to mean statistical significance, and therefore in scientific
writing, I strongly suggest that instead of the words significant and significantly, I would use
the words  “ considerable(ably), substantial(ly), marked(ly), appreciable(ly) when you want to
emphasize differences but there has been no formal statistical analysis.  And when referring
to statistically significant values use the  words “statistically  significant” ; that way no one
misunderstands your phrase.
4. Page 3 line 12 shouldn’t age also be in that sentence?
5. Page 3 line 15.  Again at the end might this nomogram actually affect further or different
treatment protocols and there thereby also affect survival? See comment 2 above.
6.  Page 3 line 21 should it be “potentially curative radical gastrectomy""? In other words, did
you include tumors where you did not do a potentially curative gastrectomy ? Best to explain
this here.
7. Page 4 line 6 change gender to sex. Gender is the phenotype while sex is the more important
genotype.
8. Page 4 line 9. For tumor differentiation did you separate out signet cell carcinoma in the
differentiation classification or was it co side red poorly differentiated ? As on page 6 line 2.
9. Page 10 line 3 and page 5 line 13. The abbreviation DCA. While this I assume is an
obvious abbreviation for statisticians, for clinicians this is not a common abbreviation and the
methodology is not well understood by clinicians. Therefore, I would suggest that you do not use
the abbreviation but rather in both places (you only use it twice!). Write out the phrase decision
curve analysis rather than the abbreviation.
10. Page 12  line 7 I would add the phrase “that can be determined preoperatively” after the
word “tool” because you are discussing a modifiable risk factor that in theory could be modified
preoperatively.
11. Table 3 all the percentages under the CONUT score of >3 (n=67) need to be rounded off to
a whole number with only 67 patients you cannot claim a tenth of a percentage.
12 table 4 again change gender to sex."