Review for 10.1186/1471-230X-13-134 (2013)

Reviewer's report
Title:Improvement of long-term outcomes in pancreatic cancer within the
gemcitabine era: A collaborative retrospective multicenter clinical review of 1,082
patients
Version: 1Date:15 May 2013
Reviewer: Lorraine chantrill
Reviewer's report:
Minor Discretionary revisions
General comment
Overall this is a paper that delivers what it says it does, that is, a retrospective
review of pancreas cancer in a Japanese community setting.
Because of the large number of cases analysed, it does contribute to the field.
The authors themselves point out some of the deficiencies which mainly relate to
the lack of detailed data about any biological or laboratory markers and response
to chemotherapy. If these had been available, it would be a more important
contribution.
1.The third sentence of the introduction states:
“Until the introduction of GEM, the overall 5-year survival rate for PC was <5%,
but the overall survival has significantly improved since this drug was introduced
worldwide in 1996”. I would argue that although overall survival has increased,
the 5year survival rate for PC has not changed significantly. The references cited
to back up the sentence are a few years old and I don’t think back up this claim.
Indeed your own observation is that the benefit of chemotherapy was only 35
days on average.
I think a reasonable argument could be made that chemotherapy has an
inadequate benefit in your community- in fact I would have interpreted that as the
main message of the paper!
2.What was the rationale for dividing the population into the 2 groups A and B?
Could this be explained more clearly? Was there a difference in practice in Japan
for pancreas cancer that happened in 2006? Your data presented in the paper
show that there is no difference in outcome before and after 2006. Perhaps the
paper would be better without this comparison?
Minor Essential Revisions
1.In the Abstract, I would like to see a clearer breakdown of the numbers of
patients included in analysis. Out of 1082 patients, 647 had head of pancreas
tumours and 401 had tail (1048). 31 had other tumour types eg intraductal etc.
Did the remaining 31 patients have adenocarcinoma of the body of the
pancreas? This could all be a little more clearly stated.
2.How many patients had their radiological diagnosis confirmed with pathology?
Was it 87% as stated in the discussion? Or was that a different study group –
please make this clearer. As the authors point out in the discussion, FNABs have
only recently been approved in Japan – it may be useful to illustrate what the
uptake of this technique has been since its approval and make a comment on
utility. If very few of the radiological diagnoses had confirmatory pathology (either
by examination of surgically resected specimen or biopsy or cytology) the
conclusions are somewhat weakened.
3.In the discussion the term “elder” patients is used. Older is probably more
correct.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests