Title: Trends in incidence, survival and initial treatments of gynecological sarcoma: A
retrospective analysis of the United States subpopulation
Version: 2 Date: 22 Nov 2022
Reviewer's report:
Confidential comments to editors
Major Compulsory Revisions
1. Reword title to indicate this analysis is for a portion of the US population representing <20%.
“…a United States Subpopulation”
2. Significant grammar editing is needed throughout the manuscript text.
3. Abstract, line 40, sentence starting with “GS cases showed increased…” is confusing and
needs to be rewritten. It appears the author is referring to increases in the subsites except “Other
Sites”. The sentence also doesn’t seem to match results in Figure 1.
4. Indicate in the Introduction, line 64, that this analysis is for a subpopulation of the US
population representing <20%.
5. Methods, line 67, cite the exact SEER 9 dataset used. The most current SEER 9 dataset does
not include radiation or chemotherapy data due to known issues with under-reporting.
6. Methods, line 73, add citation.
7. Methods, line 84, describe adjustments made for stage groups over time. Three staging
systems (Summary Stage 1977, Summary Stage 2000, Collaborative Staging Data Collection
System) were in use at various times during the study period.
8. Results, lines 92-93, using each SEER 9 dataset available in SEER*Stat, this reviewer is
unable to reproduce the incidence rates stated in these lines, raising concerns on the validity of
all study results.
9. Results, lines 110-114 and 130-134, the known stage group changes over the study period
raises concerns with the reported stage group results.
10. Results, line 119, is Figure 2 really prevalence? Prevalence is presented as counts or
percentages. Figure 2 appears to be incidence rates.
11. Results, lines 136-146, if authors are not using the most current SEER 9 dataset, the reported
survival results could not be considered reliable.
12. Results, lines 147-162, reported treatment information is questionable especially as it relates
to the receipt of chemotherapy and radiation and surgery as the only treatment. There are known
issues with under-reporting chemotherapy and radiation treatment data, especially in the early
years when the primary focus was on data collection from hospitals. Due to under-reporting,
chemotherapy and radiation treatment data are no longer included in the more recent datasets.
13. Discussion, lines 164-165 and 236-237, this study is not population-based as it represents a
US subpopulation. Revise to clearly state this is a subpopulation.
14. Discussion, lines 209-212, increased availability of chemotherapy and radiation treatment
data is also related to improved access to and reporting mechanisms for treatment information
provided outside the hospital setting.
Minor Essential Revisions
Discretionary Revisions
Level of Interest
An article whose findings are important to those with closely related research interests.
I found this to be an interesting article describing gynecologic sarcoma in a US subpopulation.
Quality of Written English
Requires grammatical editing.
Quality of Figures
Acceptable
Statistical Review
No, the manuscript does not need to be seen by a statistician.
Declaration of Competing Interests
I declare that have no competing interests in relation to this paper.
Recommendation
Accept after significant study and manuscript revision.