Review Reports

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

The authors have made substantial revisions in response to the reviewers' comments, and the manuscript is now deemed acceptable for publication.

Reviewer 2 Report (New Reviewer)

Comments and Suggestions for Authors

The authors resubmitted a comprehensive and carefully revised manuscript. The editor's and reviewers' comments were thoroughly considered. The authors methodically completed all revision stages and constructed a more comprehensive text, with clear and unambiguous messages about the methodology and technical resources applied. The figures, photos, and tables are well-constructed and understandable. The discussion was also improved with the introduction of the study's limitations. The authors introduced new and pertinent references.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The manuscript titled “A Real-World Study on 148 cases of Uterine Sarcoma in the Chinese Population” has been subject to a comprehensive evaluation, which has revealed the necessity for several detailed analyses prior to its readiness for submission to peer review.

To enhance the introduction, it is imperative to provide a more extensive overview of

 Uterine Sarcoma statistics. This should include specific regional data that provide critical context and underscore the research's significance within the broader landscape of uterine leiomyosarcoma (uLMS), undifferentiated uterine sarcoma(UUS), and adenosarcoma.

Furthermore, the manuscript would benefit substantially from the inclusion of a detailed flow diagram that effectively illustrates the research methodology. This diagram should clearly define each stage of the patient selection process and explicitly outline the inclusion and exclusion criteria applied. Such a visual representation will significantly enhance the study's transparency, allowing readers to gain a more thorough understanding of the research approach and the methodological steps undertaken throughout the investigation.

Regarding the statistical methods employed, the manuscript requires a comprehensive overview of the analytical techniques used in the research. Each statistical test must be appropriately justified, as this clarity will enhance the study's credibility and help readers understand the data analysis process.

The conclusions presented in the manuscript are somewhat concise and require further expansion. A more detailed examination of how these findings relate to the existing body of research would enrich the conclusions drawn.

Moreover, the manuscript's reference list is notably limited. The authors are strongly encouraged to broaden their literature review by incorporating a wider range of scholarly sources. Expanding this reference list will not only enhance the credibility of the research but also position the findings within the broader context of the existing literature on Sarcoma.

The manuscript should present a comprehensive list of all abbreviations used throughout the text, accompanied by clear definitions at their first occurrence. This practice will improve the overall readability and comprehension, ensuring that the intended messages are accessible to the audience.

Figure 1A and 5B: bar scale should be included in the Figure and caption.

As the authors studied 148 patients, they must include the strengths and limitations of the study.

Lastly, the manuscript exhibits a similarity index of 28%. To adhere to publication standards, this index must be reduced to below 20%. This reduction is critical to ensuring the originality and integrity of the research.

Reviewer 2 Report

Comments and Suggestions for Authors

Dear Authors,

Thank you for the opportunity to read the manuscript „A Real-World Study on 148 cases of Uterine Sarcoma in Chinese Population”.  The topic of endometrial sarcomas is very important. Due to uterine sarcoma rarity, diagnosis, surgical and systemic treatment of this tumors type are challenging. The fact is that available evidence is insufficient, and in clinical practice, irrespective of a multidisciplinary tumor board we often rely on case series or a few clinical trials. 

Below are some suggestions and questions that,  I hope may be helpful

Introduction:

I propose to supplement the introduction with a short commentary on the diagnostic difficulties in differentiating benign leiomyomas from uterine sarcomas, which means that the final diagnosis is often reached after assessment of a surgical specimen.

I also suggest supplementing the introduction with a commentary on lymph node dissection and adnexectomy in uterine sarcoma, especially since these aspects of the surgical procedure are being analyzed. In my opinion, given the rarity of sarcomas, this will enhance the educational value of the manuscript.

Results:

What does the "Other tumor" parameter in Table 1 mean? Any previous cancers? Coexisting tumors?

Figure 1c - "typo" - plevis instead of pelvis.

3.2. Prognostic analysis of uterine sarcoma:

I suggest you to include the meaning of the abbreviations used in Table 2 below, which will make it easier to understand the data. For example: what does Transabdominal mean? (Open abdominal surgery?), N-based chemotherapy?

3.3. Association of ER/PR with subtypes and prognosis of uterine sarcoma

I suggest including the proliferation index in the title of this section, as the discussion of the expression of this marker is part of it (or adding an additional section with an appropriate title)

Discussion

Lines 331-336: „  In our cohort of 148 patients, 80 received adjuvant chemotherapy postoperatively, including 51 (63.7%) with stage I disease, 12 (15%) with stage II, 9 (11.2%) with stage III, and 8 (10%) with stage IV. Chemotherapy was associated with an increased risk of recurrence (P < 0.001) and was an independent adverse prognostic factor for overall survival (HR = 5.97, P = 0.005)” – Table 2 shows that risk factors for relapse were analyzed for 91 pts, of which 80 received chemotherapy. Does the mentioned HR= 5.97, P=0.005 refer to 148 pts or 91?

 

Reviewer 3 Report

Comments and Suggestions for Authors

Dear Authors,

Please find my comments in the PDF file of your article. There is a lot of work to be done to render this paper complete. So far you have 2 different analyses which have nothing to do with each other, except the fact that the disease is the same. There is no integration, no complementarity.

Thank you for submitting. Best o luck in continuing this project.

Comments for author File: Comments.pdf

Comments on the Quality of English Language

minor issues.