Title: Clinical features of uterine sarcomas presenting mainly with uterine masses: a
retrospective study
Version: 1 Date: 19 May 2023
Reviewer's report:
Dear Authors:
Thank you for the valuable manuscript you sent. Please pay attention to the following points
and make the necessary corrections as much as you can to make it more attractive to the readers
of the journal.
While the retrospective study provides valuable insights into the clinical and ultrasound features
of uterine sarcomas, there are several problems that can be identified:
1. Selection bias: The study only includes patients who underwent gynecological surgery for
uterine sarcoma at a single tertiary institute in Shanghai, China. This may not represent the entire
population of patients with uterine sarcomas, leading to a biased sample. The findings may not
be generalizable to other populations.
2. Limited sample size: The study includes 162 patients over a 5-year period, which is a relatively
small sample size. A larger sample size would provide more robust results and improve the
statistical power of the analysis.
3. Retrospective design: Being a retrospective study, it relies on the analysis of historical data.
This introduces the possibility of incomplete or missing data, as mentioned in the discussion
section. The absence of some records can limit the comparability of influencing factors and
potentially introduce bias.
4. Lack of control group: The study does not include a control group for comparison purposes. A
control group consisting of patients without uterine sarcomas or with other uterine pathologies
would provide a better context for evaluating the clinical and ultrasound features specific to
uterine sarcomas.
5. Lack of standardized imaging techniques: The study mentions that gynecologic ultrasound
and magnetic resonance imaging (MRI) were performed preoperatively, but it does not provide
details about the standardized imaging protocols used. The lack of standardized imaging
techniques may introduce variability in the interpretation of imaging findings.
6. Limited scope of analysis: The study focuses mainly on the clinical and ultrasound features
of uterine sarcomas. Other relevant factors, such as patient demographics, comorbidities, and
surgical outcomes, are not extensively analyzed. A more comprehensive analysis would provide
a broader understanding of uterine sarcomas and their management.
7. Absence of long-term follow-up: The study mentions a median follow-up length of 24
months but does not provide information on long-term outcomes, such as overall survival and
disease-free survival. Long-term follow-up data would be essential to assess the effectiveness
of preoperative identification and the impact on patient outcomes.
8. Lack of validation: The study does not mention an external validation of the findings.
Validation of the identified clinical and ultrasound features in an independent cohort would
strengthen the reliability and applicability of the results.
In conclusion, while the retrospective study provides valuable preliminary insights into the
clinical and ultrasound features of uterine sarcomas, its limitations should be considered. Further
prospective studies with larger sample sizes, standardized imaging techniques, longer follow-up
periods, and external validation are needed to enhance our understanding of uterine sarcomas
and improve preoperative identification and management strategies.