Title: Construction and validation of a novel nomogram for prediction of lymph node metastasis
in HER2-positive breast cancer: based on the optimal number of examined lymph nodes for
accurate nodal staging
Version: 1 Date: 07 Jan 2025
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses one or several
testable research questions? (Brief or other article types: is there a clear objective?)
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with sufficient technical rigor to
allow confidence in the results?
No - there are minor 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 minor issues
OVERALL MANUSCRIPT POTENTIAL - Has the author addressed your concerns sufficiently
for you to now recommend the work as a technically sound contribution? If not, can further
revisions be made to make the work technically sound?
Maybe - with major revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: I appreciate the authors' comprehensive response to my previous
concerns. While most of my earlier points have been addressed, there are still some issues that
require further clarification to enhance the transparency and reproducibility of the study. Below,
I provide my detailed comments.
REQUESTED REVISIONS:
1. The authors state that samples or features with more than 20% missing values, as well as those
with missing survival information, were removed. However, the manuscript does not specify
how many patients were excluded for these reasons. It is crucial to investigate and report how
this exclusion may have impacted the final model's performance and generalizability.
2. While baseline characteristics are described, there is no clear comparison between the training
and validation cohorts to assess potential significant differences. Such a comparison is essential
to ensure the cohorts are representative and to validate the robustness of the model.
3. Although overfitting is mentioned, it is not thoroughly addressed. The manuscript lacks a
discussion on strategies to prevent overfitting, such as the use of regularization techniques (e.g.,
LASSO, Ridge regression) or cross-validation.
4. The manuscript does not compare the proposed nomogram to other existing models for
predicting lymph node metastasis in HER2-positive breast cancer. Including such a comparison
would provide valuable context and highlight the nomogram’s relative advantages or limitations.
5. The 95% confidence intervals for the performance metrics presented in Table 3 are missing.
Providing these intervals is essential to assess the precision and reliability of the reported results.
6. Although the results are discussed, the manuscript does not sufficiently compare its findings
to those of similar studies or existing evidence. This comparison would help to position the
model within the broader research landscape and validate its clinical relevance.
7. The manuscript should provide the formula underlying the nomogram to ensure transparency
and enable reproducibility.
8. No supplementary resources, such as a web calculator, dataset, or code, are provided. These
resources would greatly enhance the practical usability and reproducibility of the model.