Income Disparities in Survival and Receipt of Neoadjuvant Chemotherapy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer
, Vincent E. Xu 1, Oluwafolajimi Adesanya 2, Arthur Drouaud 1, Noah Longton 3, Olivia Gordon 1, Kirolos Youssef 1, Jad Kfouri 1, Sarah Azari 1, Sean Tafuri 1, Briana Goddard 1 and Michael J. Whalen 1
Round 1
Reviewer 1 Report (Previous Reviewer 1)
Comments and Suggestions for Authors
The authors answered the queries satisfactorily
Reviewer 2 Report (Previous Reviewer 2)
Comments and Suggestions for Authors
The manuscript is overall well written and easy to follow, methodology is well performed, and results are clearly presented.
In respect to previous draft submitted, Authors properly replied to all my comments.
I endorse the publication of the manuscript in its present form. I only suggest minimal English language revision by the Editorial staff.
Comments on the Quality of English Language
Minor editing required.
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 authors used the NCDB to evaluate the impact of income as a factor for receipt of guideline-directed therapy in muscle invasive bladder cancer (MIBC). Results were telling, although not unexpected, in that low income patients suffer from non-standard of care and subsequently worse survival when compared to higher income patients . The manuscript adds interesting data and discussion of known social determinants of health for MIBC patients.
Minor comments
- In terms of trends for RC+NAC, although I agree it is underutilized , some clarification should be added in lines 221-226 that chemoradiation use could have impacted the overall utilization of surgery.
- In terms of extensive PLND discussion, I would suggest clarifying that extensive LND has actually not been found to be better than standard LND based on recent S1011 findings.
- Table 1 b : CCI zero score is missing for low income cohort.
Author Response
Please see attachment
Author Response File: 
Author Response.pdf
Reviewer 2 Report
Comments and Suggestions for Authors
In this manuscript Authors aimed to examine whether socioeconomic status could represent a predictor of neoadjuvant chemotherapy and pelvic lymph node dissection receipt in patients diagnosed with muscle invasive bladder cancer submitted to radical cystectomy in addition to test whether low income represents a determinant of adverse cancer control outcomes in these patients. Authors relied on a large population-based US databases and made several noteworthy observations.
I have only a couple of comments.
1. Why did you consider also clinically node positive patients? Neoadjuvant chemotherapy followed by radical cystectomy is recommended by international guidelines in patients with T2-4 N0 M0 bladder cancer.
2. Why did you choose overall survival instead of the more suitable cancer-specific survival as outcome of interest? If data on cancer-specific survival are not available within NCDB this limitation should be addressed in the “Discussion” section of the manuscript.
3. Please consider the following manuscript:
- “Effect of Neoadjuvant Chemotherapy on Complications, in-Hospital Mortality, Length of Stay and Total Hospital Costs in Bladder Cancer Patients Undergoing Radical Cystectomy” (PMID 35267529).
Comments on the Quality of English Language
None.
Author Response
Please see attachment
Author Response File: Author Response.pdf
