Reviewer’s report
Title: 
Frequency and Clinical Characteristics of HER2 over-expressed Breast
Cancer in Saudi Arabia: A Retrospective Study
Version: 
0 
Date: 
13 Sep 2020
Reviewer's report:
Zekri et al. present a multi-center retrospective study on HER-2 positive breast
cancer frequency in Saudi Arabian population between 2007 and 2013. Being a
multi-center study and ample clinical data are the strengths of this study,
however, I believe the methods used do not quite provide the answers to the
questions posed:
1. The authors state that the results of the study provide information on
prevalence of HER2+ BC, but we only know the frequency of HER2+ results in
newly diagnosed cases where the HER2+ testing was actually performed. To
make assumptions about prevalence authors should provide the numbers of
newly diagnosed and previously diagnosed BC cases between 2007-2013,
provide what proportion of those had HER2 testing and then make appropriate
calculation for prevalence per 100000 population.
2. Authors compare overall survival and progression free survival in HER2+
patients based on type of treatment administered. Where the survival curves
adjusted for TNM, age, and other relevant factors as that can directly influence
the difference in survival. If not adjustment was performed, authors should
provide information on how these groups differed in these factors, otherwise the
findings are of little value. Why median OS and PFS survival was not reached in
neoadjuvant/adjuvant therapy groups?
3. Figure 1: I believe there is a mistake for HER2+ frequency (listed as 20.9%).
4. For patients included for survival analysis, was availability of clinical data the
only inclusion/exclusion criterion or were some HER2+ patients excluded for
some other reasons?
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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?
No
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No
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No
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Yes
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from apparent manipulation?
Yes