Gastric Cancer Treatments and Survival Trends in the United States
, Elizabeth J. Olecki 1, Matthew E. Dixon 1, June S. Peng 1, Madeline B. Torres 1, Niraj J. Gusani 1 and Chan Shen 1,2,*Round 1
Reviewer 1 Report
I think this is a very clear and well written paper that describes the care of Gastric Cancer in the US. I think it is clear and concise and descriptive. Although not practice changing it highlights the need to improve disparities of care for African American population as well as the need for better adherence to guidelines which may allow policy makers to address these issues and make changes in the system
Author Response
1) I think this is a very clear and well written paper that describes the care of Gastric Cancer in the US. I think it is clear and concise and descriptive. Although not practice changing it highlights the need to improve disparities of care for African American population as well as the need for better adherence to guidelines which may allow policy makers to address these issues and make changes in the system
R: We thank the reviewer for the positive comments and review of our manuscript.
Reviewer 2 Report
It is a very interesting article and gives a perspective on how gastric cancer is treated in the United States.
The authors must enrich the data, results and discussion regarding the quality of surgery, namely, surgical margins, quality of the lymphnode dissection (<15 nodes, 15 to 25 and> 25 nodes. The rate of minimally invasive surgery. It would also be important to address the rate of postoperative complications.
It would be interesting to better justify the reasons for systemic treatment in patients with early neoplasia and understand under what circumstances radiotherapy was used and its reasons.
In the discussion chapter the differences in treatment with asia and europe could be succinctly discussed.
Author Response
Thank you for reviewing our manuscript. Please see the attachment for our response.
Author Response File: 
Author Response.docx
Reviewer 3 Report
This is valuable large, multicenter study from US, evaluating time trends in the treatment of gastric cancer, and rarely seen evaluation of compliance to the national (NCCN) guidelines. Authors showed that regardless of stage, patients that received guideline concordant care had significantly improved 3-year OS compared to patients that did not receive guideline concordant care.
However, I’ve got one remark to comment on:
Authors stated (line 188 & 189) that “Patients with Stage I disease (Figure 3A) had a 3-year OS of 74% if they received guideline concordant care compared to a 20% 3-year OS rate if they did not receive guideline concordant care (P value <.0001).” This striking difference demands explanation – what kind of treatment received the 27% of patients for the Stage I gastric cancer that did not adhere to published guidelines?
Author Response
Thank you for reviewing our manuscript. Please see the attachment for our response.
Author Response File: Author Response.docx
