Review for 10.1186/s12876-025-03748-8 (2025)

Title: Factors associated with lymph node metastasis and survival in T2 colon cancer
Version: 0 Date: 09 Jan 2025
Reviewer's report:
This study investigates the clinical factors associated with lymph node metastasis and survival
in T2 colon cancer, with an analysis of imaging features. It has certain clinical significance.
The study design is generally well-rounded, and the data analysis methods are appropriate.
The results provide valuable clinical insights. However, some aspects of the manuscript need
to be further refined to enhance its scientific rigor and clarity.1.In the introduction, more
background information is needed on the importance of choosing appropriate treatment options
for T2 colon cancer, as well as the current gaps in predicting LNM, particularly regarding
the limitations of imaging parameters. More recent and high-impact studies should be cited
to enhance the authority and comprehensiveness of the references. 2. In the "Results" section,
while the pathological results of the LNM and non-LNM groups are presented, a more specific
description is needed, particularly with respect to the incidence rates of LVI and heterogeneity,
as well as their statistical differences. The Kaplan-Meier survival curve should be explained
in conjunction with the figure to clearly indicate statistical significance. 3. The presentation of
tables and figures needs to be further optimized. For example: In Table 1, significant variables
(such as those with P-values less than 0.05) should be marked with asterisks or bold font. In
Figure 1, it is recommended to add a risk table showing the number of patients at each time
point of follow-up to improve readability. 4. The construction of the logistic and Cox regression
models is not sufficiently detailed. Please clarify the criteria for selecting variables for inclusion
and exclusion, and specify the relationship between univariate and multivariate analyses. 5. The
study mentions "imaging heterogeneity" as an independent risk factor for LNM, but the specific
classification criteria or measurement methods for this parameter are not clearly defined. Please
provide more detailed steps and evaluation standards in the Methods section, and explain how
the results' reproducibility was ensured. 6. The Discussion section could further elaborate on
the clinical implications for surgical decision-making, specifically regarding patients with high-
risk factors. Please provide more concrete recommendations on when "extended surgery" should
be considered and discuss how imaging heterogeneity plays a role in preoperative diagnosis. A
standardized imaging evaluation protocol should also be suggested. 7. The "Ethical Approval"
section should clearly indicate whether the study complies with the Declaration of Helsinki.
The "Data Availability" section should specify how the data can be accessed or provide reasons
if the data cannot be shared. 8. There are several grammatical errors or unclear expressions
throughout the manuscript. For example, the sentence “significantly less patients in the LNM
group received hemicolectomy” should be revised to “Significantly fewer patients in the LNM
group underwent hemicolectomy.” It is recommended to improve the language quality to ensure
professionalism and fluency. 9. The limitations of the study, such as the "single-center design"
and the potential biases due to "subjective imaging evaluations of heterogeneity," should be
discussed more thoroughly. Suggestions for addressing these issues, such as conducting multi-
center studies or using AI-based algorithms for standardized evaluation, would be beneficial
10. The current reference list is somewhat limited, particularly in the introduction where the
review of LNM prediction methods is insufficient. It is recommended to add more recent high-
quality studies on risk factors for LNM in T2 colon cancer. Furthermore, studies on the use of
imaging parameters in predicting LNM should also be included. Adding relevant references will
strengthen the theoretical foundation of the research and enhance the manuscript's credibility.