Title: Clinical features of uterine sarcomas presenting mainly with uterine masses: a
retrospective study
Version: 1 Date: 04 May 2023
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are major issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: I read carefully the article titled "Clinical features of uterine
sarcomas presenting mainly with uterine masses: a retrospective study". Despite I appreciate the
efforts of the authors in designing and performing this retrospective analysis, several elements
need to be clarified, especially from the methodological point of view, in order to allow a proper
data interpretation. In addition, I have serious doubts about the potential novelty of such kind of
investigation, since there are several published studies similar to this one.
REQUESTED REVISIONS:
I recommend to take into account the following suggestions:
- Introduction: the authors have correctly classified different subtypes of sarcomas.
Nevertheless, they should also discuss, at least briefly, the potential occurrence of botryoid
rhabdomyosarcoma, an aggressive subtype of embryonal rhabdomyosarcoma occurring mainly
in female infants and children (they may refer to: PMID: 36900067).
- Introduction: I would recommend to highlight the different molecular fingerprints of
leiomyomas and sarcomas, as well as potential target therapies based on these pathways (for a
comprehensive overview, the authors may refer to: PMID: 28531111).
- Introduction: the authors need to clarify what is the knowledge gap that they are trying to
cover with this study; conversely, the reader may have serious concern about the novelty of this
investigation.
- Methods: the authors should clarify the number of cases who underwent MRI as second level
diagnostics.
- Methods: does this study conform with the REportingof studies Conducted using Observational
Routinely-collected health Data (RECORD)Statement, validated by the Enhancing the QUAlity
and Transparency Of health Research (EQUATOR) Network? If the study does not conform
with this international guideline standard, the authors should explain why.
- Methods: the authors should clarify what they considered primary outcome, and what they
considered secondary outcomes.
- Methods: the authors should clarify in this section what they compared with statistical analyses.
- Method: what about sample size analysis? This calculation should have been performed on the
basis of primary outcome; conversely, it is not possible to check whether the study is powered
enough to detect significant differences for the investigated parameters.
- Results: the authors must report the overall number of investigated cases, out of which they
identified 277 cases of sarcomas. Conversely it is impossible to define the exact prevalence of
the disease.
- Discussion: authors should add further details about the risk of uterine/mass morcellation in
case of unsuspected malignancies, and the management of these conditions (they may refer to:
PMID: 36553227).
- Discussion: the authors should clarify the novelty of their investigation (if any!).
- Discussion: more details about the type of surgery, and especially specimen retrieval
techniques, would have been mandatory. Indeed, after laparoscopic myomectomy it is possible
to perform specimen retrieval by laparotomy, in-bag transvaginal extraction, or in-bag
morcellation. It would be interesting to discuss this point, for cases with final diagnosis of
sarcomas but unsuspected at surgery, with pros and cons for each retrieval technique (a possible
discussion could be based on: PMID: 36150421).