Review for 10.1186/s12876-025-03964-2 (2025)

Title: Dual energy CT-derived quantitative parameters and hematological characteristics predict
pathological complete response in neoadjuvant chemoradiotherapy esophageal squamous cell
carcinoma patients
Version: 6 Date: 30 Mar 2025
Reviewer's report:
This manuscript presents a retrospective analysis evaluating the predictive value of dual-
energy computed tomography (DECT)-derived imaging biomarkers and hematological
characteristics in determining pathological complete response (pCR) following neoadjuvant
chemoradiotherapy (nCRT) in patients with esophageal squamous cell carcinoma (ESCC).
The integration of quantitative imaging and hematological parameters into a predictive model
addresses an important clinical challenge in the context of personalized oncologic treatment.
The study is well-conceived, the objectives are clearly stated, and the statistical analyses
are generally appropriate. The findings are promising and have the potential to contribute
meaningfully to the field. However, several revisions are necessary to improve clarity,
methodological transparency, and clinical interpretation prior to acceptance.
Major Comments
Language and Clarity
While the manuscript has improved in grammatical structure, further language editing by
a native English speaker or professional service is recommended. Certain sentences remain
awkward or syntactically unclear, particularly in the Introduction and Discussion sections.
Avoid redundant phrasing and lengthy sentences that may obscure meaning. Improve sentence
structure for conciseness and clarity.
Statistical and Methodological Reporting
The handling of missing data is appropriately described; however, this should be stated clearly
in the Methods section rather than only in the reviewer response.
Include details about bootstrapping procedures and calibration curve evaluation in the Methods.
How many iterations were used? What metrics were used for calibration assessment?
The cut-off selection process for predictors (AEF, ECV, RBC, LMR) should be justified. Was
Youden’s index or another criterion applied?
The VIF values provided support the absence of multicollinearity, but the rationale for initial
variable selection should be clarified in the text (e.g., threshold p-values, clinical rationale, or
stepwise selection method).
Figures and Tables
The image quality of Figures 1–3 must be verified to meet publication standards (#300 dpi).
Ensure Figure legends are descriptive and standalone. Each figure should be interpretable
without referring to the main text.
In Table 3, include sample sizes (n) for each group within each model for transparency.
Discussion and Interpretation
The biological basis for including AEF and ECV is well explained. Expand the discussion
to emphasize the clinical utility of DECT versus traditional imaging, particularly in resource-
limited settings where PET/MRI may not be feasible.
Consider integrating a decision threshold framework (e.g., optimal cutoff values) to guide
clinical application.
Address the economic or logistical feasibility of DECT implementation in standard preoperative
evaluation protocols.
Limitations
The authors have acknowledged the retrospective design and small sample size, which is
appreciated. Consider reinforcing this by proposing a multi-center prospective validation
strategy in future work.
Abstract and Conclusion
The Abstract should briefly mention the study limitations (as per reviewer suggestion) and
highlight the AUC of the combined model.
The Conclusion should not overstate findings. Rephrase to reflect that the results are promising
but require external validation before clinical implementation.
Minor Comments
Ensure consistent use of statistical terminology and units (e.g., “Mean ± SD,” “×10#/L”).
Re-check references for accuracy and formatting in accordance with the journal’s style guide.
The phrase “may don’t receive surgery” should be corrected to “may not undergo surgery.”
Recommendation:
Major Revision
The manuscript presents important, novel findings with potential clinical implications. However,
revisions are necessary to enhance clarity, strengthen methodological reporting, and ensure the
figures and narrative are publication-ready. The authors are encouraged to address all points
above in detail.