Reviewer's report
Title:Epidemiology and outcome of cervical cancer in National Institute of
Oncology of Morocco
Version:12Date:11 January 2016
Reviewer: Alejandra Castanon
Reviewer's report:
1. Is the question posed by the authors well defined?
The authors aim to assess whether the outcomes of cervical cancer were
improved since 2005. And they conclude that the outcomes have improved in the
last paragraph of the manuscript. However no data is presented on what the
outcomes of a diagnosis of cervical cancer were, in Morocco, before 2005. May I
suggest that the aim is changed to assessing the current outcomes after a
diagnosis of cervical cancer since 2005 when campaigns to improve prevention
and treatment were launched? - Major Compulsory Revisions
In the results there are two sections (Toxicities and Response to treatment)
where tables are referenced but no text accompanies their description. I think
some text needs to be added. In particular table 4 needs footnotes to define the
following abbreviations: ORR, CR, PR, PD. - Minor essential
2. Are the methods appropriate and well described?
I am satisfied that the changed the authors made to the methods now make the
manuscript clear.
The data is sound and the figures appear to be genuine. The authors have now
formatted the manuscript according to STROBE which has made it easier to
follow.
3. Are the discussion and conclusions well balanced and adequately supported
by the data?
There are three statements in the discussion which I feel are not supported by
the data presented in the results:
1) Last sentence of the first paragraph in the discussion “After RT, patients with
clinical CR had a higher rate of PFS (54% vs 26%, p=0.018). I couldn’t find
mention of this in the results.
2) Paragraph that begging with “In our study, among patients with stage 1B1
disease (n=63)……” The authors go on to state conclusions on the equivalence
between surgery and RT. I don’t think their results support such a statement. It
also appears that they are basing this statement on the 18 references (15-33)
they use to support this. The discussion should be used to highlight the data in
this paper not to discuss other findings in the literature.
3) Last sentence in the discussion: “Clinical stage is clearly the most powerful
determinant of outcome in most scientific papers, and represents the only
significant variable influencing 5year OS, PFS and LRRFS(10)”. Surely if this is a
result of this study reference number 10 is not needed. Perhaps they should also
mention RT influences OS and PFS even if it doesn’t LRRFS.
In the conclusions the following statement should be removed as it is not
supported by the results: “The prognosis of patient has been improved mainly by
using CCRT as a standard treatment at advanced stages.”
All these comments are Major Compulsory Revisions
4. Are limitations of the work clearly stated?
I disagree that the proportion of women (14.6%) for whom no treatment
outcomes were available is a big limitation of the study. The limitation is that
those 96 that were lost to follow-up before management started may have had
the worst prognosis/most advanced cancers. The inclusion of these women may
have affected the overall survival from cervical cancer. As the authors say they
are likely to be the very poor. This is the limitation not that the loss to follow-up
was high, this is not an intervention study. The sample size was still large with
the remaining women. - Minor essential
5. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished?
Yes they do, but I feel they have selected too many references and there is still
scope to shorten the number quoted in order to make the discussion more
targeted. - Discretionary
Instead of reference 14 for survival in England which is quite old I would suggest
using the following reference: Trent Cancer Registry. Profile of Cervical Cancer
in England: incidence, mortality and survival. Sheffield: 2012.
Five year relative survival in England between 2003-2005 was 69.8%.
6. Do the title and abstract accurately convey what has been found?
Yes the abstract does a very good job at summarising the main points of the
study.
7. Is the writing acceptable?
The manuscript would benefit from editorial help to improve language and to
remove duplications in the text, allowing the manuscript to be shorter and more
concise. In particular I still feel that the authors have used to many references in
the discussion.
Level of interest: An article of importance in its field
Quality of written English: Needs some language corrections before being
published
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