PONE-D-22-33838Oral aspirin for preventing colorectal adenoma recurrence: a systematic review and network meta-analysis of randomized controlled trialsPLOS ONE

Dear Dr. Chen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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Tariq Jamal Siddiqi

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

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

Reviewer #1: Yes

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Reviewer #1: Yes

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Reviewer #1: Yes

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5. Review Comments to the Author

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Reviewer #1: The authors have conducted a comprehensive systematic review and network meta-analysis of RCTs to evaluate the prophylactic role of oral aspirin for colorectal adenoma recurrence. While commendable effort has been done for the extensive methodology outlined and explained in the article, and figures and tables are appropriately designed, there are some major points that the authors must consider for improvement.

1. The introduction of the article is unnecessarily long and filled with excessive jargon which is not really required. For instance, the details regarding the pathophysiology is not needed in the introduction and can be removed. The authors should cut down on the text of the introduction and make it as comprehensive and readable as possible. Consider the following sequence for a better introduction - first mention the known details with relevant statistics and what the current guidelines state about oral aspirin for colorectal adenoma recurrence, then mention the conflicts in literature and what is the basis for investigating this and finally develop strongly on the rationale of the meta-analysis and mention the main objective of the study.

2. Consider including a subheading for conclusion and mention the conclusive statements there.

3. The discussion does not elaborate upon the future directions for oral aspirin use for preventing colorectal adenoma recurrences. Kindly add a paragraph for it.

4. The authors state in the first paragraph of discussion, 'its efficacy was more statistically significant for long-term use than for short-term use.' Please rephrase this sentence. Just saying more statistically significant does not indicate any direction of the results.

5. The authors state 'These results are not easy to explain' in the discussion while mentioning the large trial by Baron et al. This is a very important study and given the fact that it is well-designed and robustly conducted, removing this study from the analysis should have a solid reason which must be stated in the text. Please also discuss why the risk of severe adverse events was significantly higher in the aspirin group in this study. While it may be hard to state definitive reasons, the authors can provide suggestive reasons as to why this was the case in this large trial.

6. The discussion lacks details about clinical implications of this meta-analysis. Kindly add a paragraph for it.

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Reviewer #1: No

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PONE-D-22-33838R1Oral aspirin for preventing colorectal adenoma recurrence: a systematic review and network meta-analysis of randomized controlled trialsPLOS ONE

Dear Dr. Chen,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Oct 21 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Rodney John Scott

Academic Editor

PLOS ONE

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1. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

The manuscript needs to be corrected for English language and poor grammatical construction. Once a revised manuscript is submitted that does not include grammatical errors, I will send it out for re-review.

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

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Oral aspirin for preventing colorectal adenoma recurrence: a systematic review and network meta-analysis of randomized controlled trials

PONE-D-22-33838R2

Dear Dr. Chen,

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

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Kind regards,

Rodney John Scott

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: