PONE-D-24-33122Development and Validation of a Predictive Nomogram for Vascular Crises in Oral and Maxillofacial Cancer Patients Undergoing Free Flap SurgeryPLOS ONE

Dear Dr. Bi,

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Academic Editor

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Additional Editor Comments:

Dear Authors,

submitted manuscript "Development and Validation of a Predictive Nomogram for Vascular Crises in Oral and Maxillofacial Cancer Patients Undergoing Free Flap Surgery" PONE-D-24-33122, noode some major revisions. Please find the following comments:

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

2.This interesting paper shows a large study about a very wide series of free-flaps performed for face reconstruction after cancer, with an interesting "prospectiv in the past" pattern

In my opinion, some major comments can be addressed :

1) description of the cohort is incomplete. Data such as radiation therapy, type of free flap per patient should be provided

2) these data should be used in the comparison between training and validation cohorts

3) it isn't clear whether the biological data are pre or post operative ones, therefore if patients can be classified in "high risk" and "low risk" groups PRE operatively, which would be at greater value

4) association between vascular crisis and year of surgery is not clear : is it supposed to depend on surgeon's experience ?

5) the nomogram, which is the major result of this sudy, has to be publicly available

6) I think that a specific statistical reviewing is mandatory, to validate this intersting tool

As minor comment, the autors should specify which package of R software they used

As a general impression, an interesting tool, a huge cohort, but specifications of the cohort and discussion both need more precision

with compliments

Stanisław Wroński

Academic Editor

[Note: HTML markup is below. Please do not edit.]

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: Partly

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

Reviewer #1: I Don't Know

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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

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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

**********

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: This interesting paper shows a large study about a very wide series of free-flaps performed for face reconstruction after cancer, with an interesting "prospectiv in the past" pattern

In my opinion, some major comments can be addressed :

1) description of the cohort is incomplete. Data such as radiation therapy, type of free flap per patient should be provided

2) these data should be used in the comparison between training and validation cohorts

3) it isn't clear whether the biological data are pre or post operative ones, therefore if patients can be classified in "high risk" and "low risk" groups PRE operatively, which would be at greater value

4) association between vascular crisis and year of surgery is not clear : is it supposed to depend on surgeon's experience ?

5) the nomogram, which is the major result of this sudy, has to be publicly available

6) I think that a specific statistical reviewing is mandatory, to validate this intersting tool

As minor comment, the autors should specify which package of R software they used

As a general impression, an interesting tool, a huge cohort, but specifications of the cohort and discussion both need more precision

**********

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Reviewer #1: No

**********

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Development and Validation of a Predictive Nomogram for Vascular Crises in Oral and Maxillofacial Cancer Patients Undergoing Free Flap Surgery

PONE-D-24-33122R1

Dear Dr. Xiaoqin Bi

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.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Stanisław Jacek Wroński, M.D., Ph.D, FEBU

Academic Editor

PLOS ONE

Additional Editor Comments

Dear Authors,

after careful consideration of revised version and the reviewer's opinion, I conclude that in its present form the article can be approved for publication in POLS ONE.

The authors have effectively addressed all concerns raised, resulting in a significantly improved manuscript.

With compliments

Stanisław Wroński

Academic Editor

Reviewers' comments:

Reviewer #1: All comments have been addressed. Thank you for your precise answers to my questions

Impressive series indeed ! the case mix, with a majority of ALT, is quite uncommon for max-fac, as we genrally use FFF and ABF as main flaps in facial reconstruction