Review for 10.1186/s12876-025-04056-x (2025)

Title: Correlation between neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio with
prognosis in gastric cancer patients undergoing neoadjuvant chemotherapy: a meta-analysis
Version: 0 Date: 21 Apr 2025
Reviewer's report:
This is an interesting study regarding the prognostic role of NLR and PLR in gastric cancer
patients after receiving NAC. Overall, the study protocol is good, and the statistical analysis
is acceptable. However, there are some flaws in the results section and overstatements in the
discussion and conclusion that need to be revised. More specifically,
Abstract
Line 4: “Sensitivity analysis was conducted by a removal study”. This sentence requires
improvement. Do you mean reconducting the meta-analysis by removing a different study each
time?
Line 7: “Pre-NAC NLR level was associated with poorer overall survival”. Pre-NAC high or
low NLR? Please specify in the whole abstract.
Materials and methods
Please mention in the materials and methods section the utilization of PRISMA algorithm. Also
add citations for the PRISMA and NOS. Also define NLR and PLR and how they are calculated.
Results
Page 6, line 1-2: You report twice title and abstract screening. Please combine the number of
studies and report one title and abstract screening. Update accordingly the Figure 1. I would
suggest referring to the PRISMA website and use the preformed PRISMA flowchart available
there for best quality.
In the “Pre-NAC” section of the results please provide the p values of the significant results.
Also, you need to mention how you divide the patients (e.g. according to high/low NLR) and
maybe compare their demographics to reveal confounders.
Same in the last paragraph regarding the PLR. In page 7, line 5 “there MAY not be a correlation
between”. Since your analysis revealed no correlation, you should not state “may”.
In page 7, line 12: “high-level NLR group suggested significant…” -> suggested is the wrong
verb to be used here. Please correct both in that sentence and the rest of the text.
Sensitivity analysis and bias assessment.
This section is poorly written. The last sentence is contrasted. Is there or not publication bias?
Supplementary figure 1 is lacking data in order to be comprehensible.
Please rewrite in a cohesive manner and explain how significant or not significant results were
obtained.
Clinical implications
Is NLR correlated to the response to treatment? There are no data in your paper to support this
claim in line 17.
Discussion
Page 8, line 6: the results did not indicate the same for pre and post NAC nlr. Multivariate
analysis did not show statistical significance, and you should discuss that result.
Page 9, line 6-7 “…responsible for this outcome”: Which outcome are you reffering to?
Line 15-17: use correct grammar in the sentence “these parameters…blood cell count”
The second paragraph of the discussion needs significant language improvement.
The limitations section is very short. Retrospective studies have limitations other than need for
validation by RCTs. This statement is not correct. Furthermore, there are many more limitations
to your study that need to be acknowledged (type of chemotherapy, stage of disease, was the
survival estimated after surgery or not?, you report high heterogeneity of data but do not discuss
about it). DFS and RFS were not included in your initial data extraction, why did you mention
them in limitations? Please provide a thorough discussion on the real limitations of that study.
Verdict
The results and discussion sections require revision in many aspects as mentioned before in order
to be acceptable for publication. The Discussion section specifically needs major revision and
significant improvement both regarding the language and the scientific quality of the study. The
authors should discuss more about the existing literature and provide details on the usefulness
of biomarkers in clinical practice. Below are some suggestions that the authors should take into
consideration but not only be limited to them:
1. Provide a paragraph on the role of inflammation in cancer and how biomarkers such as NLR
and PLR could be correlated to this.
2. Another one with other similar studies to yours. Report their findings and compare them to
yours.
3. A third one on the benefits of using those biomarkers in clinical practice (which is the same
as your clinical implications), but all the relevant information will be provided in the same
paragraph.