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The authors have thoroughly addressed all of the reviewers' comments. The manuscript may now be accepted in accordance with the journal's policy.
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The authors have made the necessary changes as suggested. The report is clear and unambiguous, with professional English used throughout. The literature references are appropriate, providing sufficient background and context for the field. The article follows a professional structure, including well-organized figures and tables. Raw data has been shared, which supports transparency and reproducibility. Overall, the manuscript is self-contained, presenting relevant results that address the hypotheses.
The authors have appropriately addressed the experimental design concerns. The research question is well-defined, relevant, and meaningful, addressing an identified knowledge gap. The methods are described with sufficient detail, allowing for replication. The study follows a rigorous investigation protocol, meeting high technical and ethical standards. Overall, the revisions made to the experimental design align with the required standards.
The authors have thoroughly validated their findings. The data provided are robust, statistically sound, and well-controlled. The conclusions are clearly stated, directly linked to the original research question, and appropriately limited to the supporting results. The revisions have effectively addressed the necessary standards for the validity of the findings.
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We have received reviews from the reviewers for your manuscript. This is a well-written article; however, some areas need improvements. Please include a paragraph in the Discussion section – with regard to the implications of the findings for clinical audiences.
No specification of the inclusion and exclusion criteria for the review.
Specify methods used to present and synthesize results.
No specification of the methods used to assess the risk of bias in the included studies.
A brief part about limitations is missing.
Registration of the review in the methods section is absent.
The quality of evidence assessment tool is not mentioned in the abstract.
For Ding et al, 2015 (Reference 27) while the RR (LL, UL) is correct, the number of cases should be 113 instead of 1076
These points need to be addressed to enhance the clarity and completeness of your systematic review and meta-analysis according to PRISMA guidelines.
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In the Limitation section mention reason why workplace, or exposure for more than two relatives of passive smoking difference has not been considered.
The manuscript “Passive Smoking and Risk of Pancreatic Cancer: An Updated Systematic Review and Meta-Analysis” significantly contributes to the existing literature by updating and synthesizing research on the association between passive smoking and pancreatic cancer. The study concludes that passive smoking is associated with a moderate increased risk of pancreatic cancer, particularly among current and non-current smokers and with exposure during both childhood and adulthood. Notably, regular or daily exposure significantly elevates risk, while occasional exposure does not. These findings underscore the importance of minimizing passive smoke exposure as a potential preventive measure against pancreatic cancer.
1) The manuscript should include a more detailed description of the search strategy, including specific databases searched, date ranges, and any filters or limits applied. This would increase transparency and reproducibility.
2) Clarify the process used for data extraction, including how many reviewers were involved and the method used to resolve disagreements. If possible, include a standardized form or a supplementary file detailing the data extraction template.
3) Instead of relying solely on the funnel plot to assess publication bias, consider incorporating a Doi plot and Luis Furuya-Kanamori (LFK) index. The Doi plot and LFK index are newer methods that provide a more nuanced assessment of asymmetry in meta-analyses and are particularly useful in detecting subtle forms of bias.
4) Provide a clearer rationale for chosen subgroup analyses. Explain why particular subgroups (geographic regions, types of exposure, etc.) were selected and discuss the biological or social rationale behind expecting different effects in these groups.
5) Provide prediction intervals of the estimates. Including a prediction interval alongside the standard 95% confidence intervals (CIs) and the random effects model offers a more realistic picture of the potential variability in effect sizes across different settings and populations. This is especially pertinent in meta-analyses dealing with epidemiological data where heterogeneity is expected.
6) Discuss how the quality of included studies affects the overall findings of the meta-analysis. This could involve a sensitivity analysis that only includes high-quality studies to see if the results differ significantly.
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Thank you for the opportunity to review this manuscript, which addresses the association between passive smoking and the risk of pancreatic cancer. This topic is highly relevant due to the public health implications of passive smoking and the severe prognosis typically associated with pancreatic cancer. The authors have conducted a systematic review and meta-analysis to update the evidence on this potentially critical association, aiming to fill gaps left by previous studies.
The authors aim to provide updated insights by incorporating recent studies that may have been excluded from earlier analyses, thereby potentially affecting public health guidelines and patient care strategies. However, several areas need major improvement.
Some sections could benefit from further clarification and detail to enhance the understanding of the methodologies and findings. The discussion could be expanded to better situate the study's findings within the broader context of tobacco control and cancer prevention research. It would be beneficial if the authors could provide more detailed information about the quality assessment of included studies and discuss the potential impact of study quality on the overall findings. Overall the grammar and writing can be improved.
Abstract:
1. Inclusion criteria should be briefly stated in the Methods section of the abstract.
Introduction:
2. The authors state that "Recently, more population-based studies were published," but no references are provided.
Methods:
3. The starting date of the literature search is not mentioned.
4. Inclusion and exclusion criteria are not clearly defined. They should be elaborated further. What study designs were included? I suggest presenting the inclusion criteria in PECO format. Table 1 should only be cited in the Results section, not in the Methods section.
5. The method of study selection was not explained. The Methods section is too brief. The process of record screening is missing from this section.
6. "Two researchers independently performed the data extraction (Xudong Wang and Xujie Wang), with discrepancies resolved by the senior author (Xujie Wang)." Initials of the authors' names can be used instead of stating the full names.
7. It is unclear which data were extracted and how it was extracted. Did the authors use any specialized software for data extraction? The data extraction section is also very brief. All steps should be detailed thoroughly. All variables and details extracted from studies should be mentioned.
8. A separate subheading should be given for certainty of evidence and statistical analysis; it should not be combined with data extraction.
9. Did the authors pool RR and OR together? How was publication bias assessed? I found that some studies reported HR. Ideally, OR, RR, and HR should not be combined together in a meta-analysis.
Results:
9. The results of the literature search should be further elaborated in the Results section.
10. In the PRISMA flow diagram, for "reports not retrieved," the exclusion reason should only be records that the authors could not retrieve or could not find the full text of the article. Exclusion reasons based on different types of articles or different inclusion criteria should either be excluded in the previous step or in the next step of full-text eligibility assessment. This should be corrected. Similarly, the reason "full article not available" is applicable in "report sought for retrieval," not in "report assessed for eligibility."
11. The caption of Figure 1 can be changed to "PRISMA flow diagram showing the study selection process."
12. The total sample size of each study can be mentioned in Table 1. For each study, it should be specified whether they used OR, HR, or RR. Some studies have reported HR, but the authors didn't specify.
13. The results of the quality assessment with the NOS are lacking. The authors can mention how many studies were of high quality, how many were of moderate quality, and so on.
14. The authors mentioned they evaluated the certainty of evidence using GRADE criteria with GRADEpro. However, the results are not mentioned in the Results section, only in the Discussion. If the authors are using GRADE, the details should be specified in the Results section, and how the authors attained low certainty of evidence. A summary of findings table from GRADEpro can be given for transparency.
15. Did the authors exclude non-English articles? This should be stated as a limitation.
The method section is lacking. Methods need to be elaborated further.
Thank you for the opportunity to review this manuscript, which addresses the association between passive smoking and the risk of pancreatic cancer. This topic is highly relevant due to the public health implications of passive smoking and the severe prognosis typically associated with pancreatic cancer. The authors have conducted a systematic review and meta-analysis to update the evidence on this potentially critical association, aiming to fill gaps left by previous studies.
The authors aim to provide updated insights by incorporating recent studies that may have been excluded from earlier analyses, thereby potentially affecting public health guidelines and patient care strategies. However, several areas need major improvement.
Some sections could benefit from further clarification and detail to enhance the understanding of the methodologies and findings. The discussion could be expanded to better situate the study's findings within the broader context of tobacco control and cancer prevention research. It would be beneficial if the authors could provide more detailed information about the quality assessment of included studies and discuss the potential impact of study quality on the overall findings. Overall the grammar and writing can be improved.
Abstract:
1. Inclusion criteria should be briefly stated in the Methods section of the abstract.
Introduction:
2. The authors state that "Recently, more population-based studies were published," but no references are provided.
Methods:
3. The starting date of the literature search is not mentioned.
4. Inclusion and exclusion criteria are not clearly defined. They should be elaborated further. What study designs were included? I suggest presenting the inclusion criteria in PECO format. Table 1 should only be cited in the Results section, not in the Methods section.
5. The method of study selection was not explained. The Methods section is too brief. The process of record screening is missing from this section.
6. "Two researchers independently performed the data extraction (Xudong Wang and Xujie Wang), with discrepancies resolved by the senior author (Xujie Wang)." Initials of the authors' names can be used instead of stating the full names.
7. It is unclear which data were extracted and how it was extracted. Did the authors use any specialized software for data extraction? The data extraction section is also very brief. All steps should be detailed thoroughly. All variables and details extracted from studies should be mentioned.
8. A separate subheading should be given for certainty of evidence and statistical analysis; it should not be combined with data extraction.
9. Did the authors pool RR and OR together? How was publication bias assessed? I found that some studies reported HR. Ideally, OR, RR, and HR should not be combined together in a meta-analysis.
Results:
9. The results of the literature search should be further elaborated in the Results section.
10. In the PRISMA flow diagram, for "reports not retrieved," the exclusion reason should only be records that the authors could not retrieve or could not find the full text of the article. Exclusion reasons based on different types of articles or different inclusion criteria should either be excluded in the previous step or in the next step of full-text eligibility assessment. This should be corrected. Similarly, the reason "full article not available" is applicable in "report sought for retrieval," not in "report assessed for eligibility."
11. The caption of Figure 1 can be changed to "PRISMA flow diagram showing the study selection process."
12. The total sample size of each study can be mentioned in Table 1. For each study, it should be specified whether they used OR, HR, or RR. Some studies have reported HR, but the authors didn't specify.
13. The results of the quality assessment with the NOS are lacking. The authors can mention how many studies were of high quality, how many were of moderate quality, and so on.
14. The authors mentioned they evaluated the certainty of evidence using GRADE criteria with GRADEpro. However, the results are not mentioned in the Results section, only in the Discussion. If the authors are using GRADE, the details should be specified in the Results section, and how the authors attained low certainty of evidence. A summary of findings table from GRADEpro can be given for transparency.
15. Did the authors exclude non-English articles? This should be stated as a limitation.
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