Reviewer’s report
Title: 
Prediction of distant metastatic recurrence by tumor-infiltrating lymphocytes in hormone receptor-
positive breast cancer
Version: 
0 
Date: 
30 Dec 2020
Reviewer's report:
In this manuscript, the authors conducted morphological assessment of tumor-infiltrating lymphocytes
(TILs) in order to reveal a potential association between TIL density and recurrence site in hormone
receptor-positive and HER2-negative breast cancer (HR+HER2-BC). It is demonstrated that patients with
no TILs density presented less local recurrence while distant metastases were significantly higher in
comparison with patients with TILs density concluding that TILs might be able to predict distant
metastatic recurrence. 
* In the abstract, although the authors conclude that TILs may be able to predict distant metastatic
recurrence in stages I- II of HR+HER2-BC, there are no findings that specifically support this conclusion
decreasing the reliability of the study.
* The total number of patients included in this study should be stated.
* In the background, the hypothesis and the aim of the study are clearly stated. However, the authors
should give greater emphasis on the distant metastatic recurrence in HR+HER2-BC patients.
Several points should also improved in the discussion section.
* The results of the study are not adequately discussed. For example, in the 2nd and 3rd paragraph they
report previous studies without discussing their findings in this content. 
* Given the important limitations of this study such as the small number of cases with recurrence, the
authors should explain how these constraints could be overcome.
* Most importantly, the authors conclude that ''This study suggested TILs to possibly be predictors of
distant metastatic recurrence in stages I-II HR+HER2-BC''; however, this conclusion is not clearly
supported by the results.
Finally, both the figure legends should be written more explicitly.
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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?
2
Are the methods sufficiently described to allow the study to be repeated?
1
Is the use of statistics and treatment of uncertainties appropriate?
1
Is the presentation of the work clear?
1
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
1