Review for 10.1186/s12876-022-02419-2 (2022)

Reviewer’s report
Title: 
A dynamic predictive nomogram of long-term survival in primary gastric
lymphoma: a retrospective study
Version: 
0 
Date: 
26 Mar 2022
Reviewer's report:
This study aims to construct a nomogram in primary gastric lymphomas. In this
regard, the authors take into consideration two databases from which they select
two cohorts, referring to different time frames: SEER from 1975-2018 for a total
of 8898 patients and the Chinese one from 2015 to 2021 for a total of 127
patients. The work is well written, has logical sequence but there are some points
that need clarification:
1) Since the discovery of Helicobacter pylori dates back to 1984 and Isaacson's
first reports of MALT lymphoma date back to 1986, it would be interesting to
know how the data in the SEER database were extrapolated in the time ranging
from 1975 to early 1990.
2) From the text it is not possible to detect the magnitude of the population
studied for both cohorts and consequently the percentage of incidence of PGL.
3) The Ann Arbor staging system, as reported in the AJCC 7th edition of cancer
staging manual, was developed as a staging system to "photograph" the
developmental stage of lymphomas. In this intent, it does not consider other
variables such as marital status, age and race (Lines from 194 to 196 page 9) as
well as other staging systems do for other neoplasms, Lugano classification, for
instance, a more recent modification of Ann Arbor Staging System. However, for
DLBCL several additional factors are recommended for clinical care (page 943,
AJCC Cancer staging manual, 8th edition): International Prognostic Index (IPI)
and Related Indices, Cell of Origin (COO), Double-hit and Double expressor
DLBCL.
4) As correctly noted in the limitations of the study, the selection bias, the
absence of important parameters such as surgical details, HP status and
eventually its molecular status studied with RT-PCR and or FISH regarding
possible antibiotic resistance, family history, but also HIV, EBV status, gastric
microbiota analysis and any associated gastric pathologies that could possibly
interfere with therapeutic strategies were not considered. This is a severe
limitation on the impact of the study on patients' management. Despite this, I
believe that the study brings some clarifications in the therapeutic management
of PGL's patients that could be useful in association with the aforementioned
parameters.
5) Finally, it should be noted that the authors refer to the seventh edition of the
Cancer staging manual of the AJCC even if the eighth edition is currently in use,
with some differences listed above.
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Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
Yes
Are the methods sufficiently described to allow the study to be repeated?
Yes
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Yes
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Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes