Peer Review History

Original SubmissionSeptember 18, 2019
Decision Letter - Giorgio Treglia, Editor

PONE-D-19-26087

Prognostic value of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of positron emission tomography/computed tomography in patients with breast cancer: A systematic review and meta-analysis

PLOS ONE

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Kind regards,

Giorgio Treglia, MD, MSc

Academic Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors investigated the prognostic value of SUVmax, MTV and TLG in patients with breast cancer through a systematic review and meta-analysis of previous studies.

The topic is interesting and the work is methodologically good, nevertheless few major concerns emerged.

1. I understand that MTV and TLG have not a significant correlation with PFS and OS in the meta-analysis, but authors did not clearly explain this data in the results and discussion section

2. Only SUVmax significantly correlate with PFS and OS, so authors should rewrite the paper according to this main significant result.

Reviewer #2: Dear editor,

Thank you for giving me the opportunity to review for your journal.

The article under review is a very well performed systematic review and meta-analyses on prognostic significance of FDG PET/CT parameters in breast cancer patients.

Systematic reviews of prognostic studies are very hard to perform and the authors should be commended in this regard.

The search strategy is OK, inclusion and exclusion criteria are appropriate.

The statistical analyses are appropriate.

The quality assessment is not appropriate. Actually the authors used the quality assessment tools for treatment studies. For prognostic studies, there are couple of quality assessment tools for example the following link can be used

https://www.cebm.net/wp-content/uploads/2018/11/Prognosis.pdf

In my opinion the study can be published with minor revision.

Best wishes,

Ramin Sadeghi ,MD

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Reviewer #1: No

Reviewer #2: Yes: Ramin Sadeghi, MD

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Revision 1

Response to the Reviewers

Point by point reply to the comments

Answer to Reviewer #1:

1. I understand that MTV and TLG have not a significant correlation with PFS and OS in the meta-analysis, but authors did not clearly explain this data in the results and discussion section

Answer: Thank you for your valuable advice. I have supplemented the data in the results section and the discussion section according to your requirements, It is also marked in red in the original text.

In the results section: The EFS was based on 3 studies including MTV. A fixed-effects model was used and the pooled HR was 1.31(95% CI 0.65-2.65, P=0.18; I2 = 42%, figure 3B). There was no significant heterogeneity, and so the results showed no statistically significant correlations. The OS was analyzed in 3 studies with TLG, and fixed effects model was used (HR =1.20; 95% CI = 0.65-2.23, P=0.45; I2 = 0%, figure 3F). No significant heterogeneity was observed, and so the results showed no statistically significant correlations.

In the discussion section: Our meta-analysis results did not reveal the prognostic value of MTV for EFS [HR=1.31(95% CI 0.65-2.65, P=0.18) , figure 3B] and TLG for OS[HR=1.20 (95% CI = 0.65-2.23, P=0.45), figure 3F].

2. Only SUVmax significantly correlate with PFS and OS, so authors should rewrite the paper according to this main significant result.

Answer: Thank you for your valuable advice. I have rewritten the discussion of MTV for EFS and TLG for OS according to your requirements. Additional discussion sections are as follows: Our meta-analysis results did not reveal the prognostic value of MTV for EFS [HR=1.31(95% CI 0.65-2.65, P=0.18) , figure 3B] and TLG for OS[HR=1.20 (95% CI = 0.65-2.23, P=0.45), figure 3F], as they are influenced by limited sample size, which in turn result in low statistical efficiency. This might be affected by insufficient statistical power, since there were only 3 studies analyzed EFS with MTV and 3 studies analyzed EFS with TLG. Further research should be conducted to investigate the prognostic value of MTV for EFS and TLG for OS in patients with BC.18 F-FDG-PET/CT can be used for risk stratification in disease control and survival. Future large-scale prospective studies are warranted to further validate our findings.

Answer to Reviewer #2:

Thanks for your valuable comments on my paper. I have benefited a lot. The following is the answer to your question: The quality assessment is not appropriate. Actually the authors used the quality assessment tools for treatment studies. For prognostic studies, there are couple of quality assessment tools for example the following link can be used

https://www.cebm.net/wp-content/uploads/2018/11/Prognosis.pdf

Answer: The following is what I modified and added according to your requirements and it is also marked in red in the original text. We also modified the quality evaluation chart. The rewrite is as follows: The quality of 20 studies was assessed according to CRITICAL APPRAISAL OF PROGNOSTICSTUDIES

(https://www.cebm.net/wp-content/uploads/2018/11/Prognosis.pdf)(figure2). Generally, the included studies were of high quality,In the domain of prognostic factor follow-up time measurements , there was a high risk of bias in 7 studies because follow-up data were missing Or the follow-up time was too short. 7 studies were judged to be at high or unclear risk of bias in the domain of defined representative sample measurements because few studies were non-blinded or non-randomized. Most of the studies were well described and monitored regarding adverse events by objective criteria.

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Giorgio Treglia, Editor

Prognostic value of maximum standard uptake value, metabolic tumor volume and total lesion glycolysis of positron emission tomography/computed tomography in patients with breast cancer: A systematic review and meta-analysis

PONE-D-19-26087R1

Dear Dr. Xu,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Giorgio Treglia, MD, MSc

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Authors changed the paper according to Reviewers' comments.

The manuscript clearly improved and could be now accepted.

Reviewer #2: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Ramin Sadeghi, MD Associate Professor of Nuclear Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Formally Accepted
Acceptance Letter - Giorgio Treglia, Editor

PONE-D-19-26087R1

Prognostic value of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of positron emission tomography/computed tomography in patients with breast cancer: A systematic review and meta-analysis

Dear Dr. Xu:

I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

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Thank you for submitting your work to PLOS ONE.

With kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Giorgio Treglia

Academic Editor

PLOS ONE

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