Omitting Regional Nodal Irradiation after Response to Neoadjuvant Chemotherapy.
Mamounas EP, Bandos H, White JR, Julian TB, Khan AJ, Shaitelman SF, Torres MA, Vicini FA, Ganz PA, McCloskey SA, Lucas PC, Gupta N, Li XA, McCormick B, Smith B, Tendulkar RD, Kavadi VS, Matsumoto K, Seaward SA, Irvin WJ Jr, Lin JY, Mutter RW, Muanza TM, Stromberg J, Jagsi R, Weiss AC, Curran WJ Jr, Wolmark N
- DOI
- 10.1056/NEJMoa2414859
- Record issued
- 2026-08-15
- Engine
- 7.39.0
- Exported
- 2026-09-22
Prepared by Alpha1. This document is confidential: it is intended for the recipient it was shared with and must not be redistributed. The live record at alpha1science.com/verify/9819472c-a2b8-47c1-b374-a0150010b836 is authoritative.
How this rating was calculated
- IntegrityIntegrity concern−0.5★
- ReportingData & code availability partially met−0.25★
This Kaimen Rigor review uses Kaimen Rigor reviewers trained on a curated corpus of high-fidelity and retracted papers, with expert supervision and curation. It can still make mistakes; verify each finding against the source before relying on it.
This is a rigorously designed and reported phase 3 randomized controlled trial with clear scientific premise, detailed methods, and appropriate statistical analysis. The main weaknesses are the absence of a data availability statement, lack of explicit statistical software identification, and minor reporting gaps (randomization method, blinding rationale, sex of participants).
Both reviewers independently scored all eight dimensions and agreed on all statuses; no divergence required reconciliation. The statistics verification recomputed 5 reported tests (all consistent) but coverage is limited to tests with test statistics/CI; other p-values were not machine-verified. The citation check found no retracted or unresolved references. The integrity check flagged an internal contradiction regarding the overall survival denominator (1,802 vs 1,641 enrolled), which is a reporting inconsistency to address.
Numerical inconsistencies
1 finding · worst lowValues that contradict each other or are impossible for the stated sample: recomputed p-values and test statistics, GRIM/GRIMMER checks on summary numbers, percentages against their own counts, totals against their parts, and estimates against their own confidence intervals.
- Internal contradictions in the reported numbersAssessed
Recomputed 5 tests: 5 consistent, 0 inconsistent; 1 recomputed directly from the reported test statistics, 4 via agent-written checks.
- CONSISTENTreported p = .510 · recomputed p = .508Recomputed hazard ratio 0.88 (95% CI 0.60–1.28), reported p=0.51
“hazard ratio 0.88; 95% confidence interval [CI], 0.60 to 1.28; P = 0.51”
Taken as given: 0.60–1.28 is a two-sided 95% confidence interval for the hazard ratio of 0.88, not a range, an IQR, or a different interval level; the hazard ratio is a RATIO measure, so the interval is symmetric on the log scale; p=0.51 is the p for THIS estimate, not for another comparison in the same sentenceMethod: back the two-tailed p out of the log-scale CI width and compare it against the printed pHow we recomputed it: pCI(0.88, 0.6, 1.28, 1) - CONSISTENTreported p = .510 · recomputed p = .508Reviewers 1, 2Primary endpoint hazard ratio p-value
“Regional nodal irradiation did not significantly improve the interval until invasive breast cancer recurrence or death from breast cancer (hazard ratio 0.88; 95% confidence interval [CI], 0.60 to 1.28; P = 0.51)”
Taken as given: The hazard ratio is 0.88 with 95% CI 0.60 to 1.28.; The CI is two-sided at 95%.; The p-value is two-sided.Method: Recomputed p-value from hazard ratio and 95% CI using the pCI function with log=1 for a ratio.How we recomputed it: pCI(0.88, 0.60, 1.28, 1) - CONSISTENTreported p = .510 · recomputed p = 1.000Reviewers 1, 2DRFI hazard ratio p-value
“No difference between treatment arms was noted in DRFI (HR=1.00, 95%CI 0.67–1.51; five-year point estimates of No regional nodal irradiation: 93.4% and regional nodal irradiation: 93.4%; ) or DFS (HR=1.06, 95%CI 0.79–1.44; five-year DFS point estimates of No regional nodal irradiation: 88.5% and regional nodal irradiation: 88.3%; )”
Taken as given: The hazard ratio is 1.00 with 95% CI 0.67 to 1.51.; The CI is two-sided at 95%.; The p-value is two-sided.Method: Recomputed p-value from hazard ratio and 95% CI using the pCI function with log=1 for a ratio.How we recomputed it: pCI(1.00, 0.67, 1.51, 1) - CONSISTENTreported p = .510 · recomputed p = .704Reviewer 1DFS hazard ratio p-value
“No difference between treatment arms was noted in DRFI (HR=1.00, 95%CI 0.67–1.51; five-year point estimates of No regional nodal irradiation: 93.4% and regional nodal irradiation: 93.4%; ) or DFS (HR=1.06, 95%CI 0.79–1.44; five-year DFS point estimates of No regional nodal irradiation: 88.5% and regional nodal irradiation: 88.3%; )”
Taken as given: The hazard ratio is 1.06 with 95% CI 0.79 to 1.44.; The CI is two-sided at 95%.; The p-value is two-sided.Method: Recomputed p-value from hazard ratio and 95% CI using the pCI function with log=1 for a ratio.How we recomputed it: pCI(1.06, 0.79, 1.44, 1) - CONSISTENTreported p = .510 · recomputed p = .582Reviewer 1Overall survival hazard ratio p-value
“A total of 94 patients died of 1,802 evaluated for the overall survival endpoint (): 49 in the irradiation group and 45 in the no irradiation group (hazard ratio, 1.12; 95% CI, 0.75 to 1.68) ().”
Taken as given: The hazard ratio is 1.12 with 95% CI 0.75 to 1.68.; The CI is two-sided at 95%.; The p-value is two-sided.Method: Recomputed p-value from hazard ratio and 95% CI using the pCI function with log=1 for a ratio.How we recomputed it: pCI(1.12, 0.75, 1.68, 1)
- lowinternal contradictionThe number of patients evaluated for overall survival (1,802) is larger than the number enrolled (1,641) and the number in the primary analysis (1,556). This discrepancy is not explained.
“A total of 94 patients died of 1,802 evaluated for the overall survival endpoint”
ResultsFind in source
Overstated conclusions
1 finding · worst lowConclusions that reach past what the paper's own results support — including a significance claim that no longer holds when the statistic is recomputed, and efficacy resting on an unvalidated surrogate endpoint.
- Conclusions only partially backed by the presented evidenceAssessed
6 major claims checked against the paper's own evidence: 1 only partially supported (evidence backs part of the claim; gaps or caveats remain); the rest adequately supported.
- partialReviewer 1Exploratory analysis suggested potential differences in the effect of regional nodal irradiation among patients with triple-negative breast cancer (HR 2.30) and hormone receptor-positive/HER2-negative disease (HR 0.41).The exploratory analysis shows wide confidence intervals and the authors caution that these findings should be viewed with caution due to small subgroup sizes.Evidence: Exploratory subgroup analysis: TNBC HR 2.30 (95% CI 1.00-5.25), HR+/HER2- HR 0.41 (95% CI 0.17-0.99).
“In an exploratory analysis, the effect of regional nodal irradiation was examined according to age, race, breast cancer subtype, and the type of axillary surgery (); the results indicated potential differences in the effect of regional nodal irradiation among patients with cancer that was triple negative (hazard ratio for primary end point event, 2.30; 95% CI, 1.00 to 5.25) or hormone receptor positive and HER2 negative (hazard ratio, 0.41; 95% CI, 0.17 to 0.99).”
ResultsFind in source - supportedReviewers 1, 2Regional nodal irradiation did not significantly improve the invasive breast cancer recurrence-free interval in patients with ypN0 after neoadjuvant chemotherapy.The primary endpoint analysis shows a hazard ratio of 0.88 with 95% CI 0.60-1.28 and P=0.51, which does not reach statistical significance.Evidence: Primary endpoint analysis: HR 0.88, 95% CI 0.60-1.28, P=0.51.
“Regional nodal irradiation did not significantly increase the invasive breast cancer recurrence–free interval (hazard ratio, 0.88; 95% confidence interval, 0.60 to 1.28; P=0.51).”
AbstractFind in source - supportedReviewers 1, 2Regional nodal irradiation did not improve locoregional recurrence-free interval, distant recurrence-free interval, disease-free survival, or overall survival.Secondary endpoint analyses show no significant differences, with hazard ratios and confidence intervals crossing 1.0.Evidence: Secondary endpoints: LRRFI HR 0.57 (95% CI 0.21-1.54), DRFI HR 1.00 (95% CI 0.67-1.51), DFS HR 1.06 (95% CI 0.79-1.44), OS HR 1.12 (95% CI 0.75-1.68).
“Regional nodal irradiation did not increase the locoregional recurrence–free interval, the distant recurrence–free interval, disease-free survival, or overall survival.”
AbstractFind in source - supportedReviewers 1, 2The addition of adjuvant regional nodal irradiation did not decrease the risk of invasive breast cancer recurrence or death from breast cancer in patients who had negative axillary nodes after neoadjuvant chemotherapy.The conclusion directly follows from the primary endpoint result, which showed no significant benefit.Evidence: Primary endpoint result: HR 0.88, 95% CI 0.60-1.28, P=0.51.
“The addition of adjuvant regional nodal irradiation did not decrease the risk of invasive breast cancer recurrence or death from breast cancer in patients who had negative axillary nodes after neoadjuvant chemotherapy.”
ConclusionFind in source - supportedReviewer 1The effect of regional nodal irradiation in subgroups defined by stratification variables was consistent with the overall effect.The paper states that subgroup analyses were consistent, and the forest plot (Figure 2) likely shows no significant interactions.Evidence: Subgroup analyses by stratification variables showed consistent effects.
“The effect of regional nodal irradiation in subgroups defined according to stratification variables (the type of breast surgery [lumpectomy vs. mastectomy], hormone receptor status, HER2 status, the presence or absence of a pathological complete response in the breast, and the receipt or lack of adjuvant chemotherapy) was consistent with the effect among the trial population overall ().”
ResultsFind in source - supportedReviewer 2The trial is the first to require volume-based CT planning for regional nodal irradiation.The paper states this as a fact, and it is plausible given the detailed description of CT-based planning and QA.Evidence: Description of CT simulation and dose-volume analysis in Methods
“This multicenter trial is the first to require volume-based CT planning for regional nodal irradiation, with the use of three-dimensional conformal radiation therapy or intensity-modulated radiation therapy”
Discussion ¶2Find in source
Data authenticity concerns
None foundAn adversarial read for patterns associated with data that may not be genuine: results that look too clean, implausibly large effects, duplicated data or images, and methods that do not match the results reported.
Checked — nothing surfaced.
Reporting gaps
1 finding · worst mediumRequired detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.
- Data/code availability incompleteAssessed
The introduction cites multiple randomized trials and retrospective analyses establishing the benefit of regional nodal irradiation in node-positive patients and the prognostic significance of ypN0. It identifies the gap in evidence for patients converting to ypN0 after neoadjuvant chemotherapy. The rationale for the trial is clearly linked to this gap, and the limitations of prior retrospective studies are acknowledged.
“Adjuvant regional nodal irradiation has been shown to reduce the risk of locoregional recurrence, distant recurrence, and death from breast cancer among patients with early-stage breast cancer who undergo surgery first and have pathologically involved axillary lymph nodes.”
“We conducted the NSABP B-51/RTOG 1304 trial to evaluate whether regional nodal irradiation would significantly improve the interval of freedom from recurrence of invasive breast cancer in patients with clinically node-positive breast cancer whose nodes reached ypN0 status after neoadjuvant chemotherapy.”
“For such patients, no prospective outcome data show benefit from regional nodal irradiation.”
“Adjuvant regional nodal irradiation has been shown to reduce the risk of locoregional recurrence, distant recurrence, and death from breast cancer among patients with early-stage breast cancer who undergo surgery first and have pathologically involved axillary lymph nodes.”
“We conducted the NSABP B-51/RTOG 1304 trial to evaluate whether regional nodal irradiation would significantly improve the interval of freedom from recurrence of invasive breast cancer in patients with clinically node-positive breast cancer whose nodes reached ypN0 status after neoadjuvant chemotherapy.”
“Retrospective studies have shown that patients with clinically positive axillary nodes whose nodes convert to ypN0 after neoadjuvant chemotherapy have better outcomes compared to those whose nodes remain pathologically node-positive, creating uncertainty regarding the need for regional nodal irradiation.”
The trial is a prospective, phase 3, multicenter, randomized trial. Randomization method is not explicitly described (e.g., computer-generated), but the trial is overseen by NRG Oncology and the protocol was approved by IRBs. Stratification factors are listed. Blinding is not applicable for a radiation therapy trial; the paper does not mention blinding, but it is not required for this type of intervention. Power analysis is reported (80% power to detect 35% reduction in hazard rate). Inclusion/exclusion criteria are detailed. Outlier handling is not explicitly discussed, but the analysis population (ITT) is defined. Controls are inherent in the design (no-irradiation group). Independent replication is not applicable for a single pivotal trial.
“The trial was designed to have 80% power to test the hypothesis that treatment with regional nodal irradiation would reduce the annual hazard rate of invasive breast cancer recurrence-free interval events by 35%.”
“The trial was designed to have 80% power to test the hypothesis that treatment with regional nodal irradiation would reduce the annual hazard rate of invasive breast cancer recurrence-free interval events by 35%.”
The paper reports age (median 52 years), race (17% Black/African American), ethnicity (14% Hispanic/Latino), and detailed tumor characteristics (clinical tumor size, hormone receptor status, HER2 status, subtype). Sex is not explicitly reported, but breast cancer predominantly affects women; the trial likely enrolled women, but this is not stated. Age and health status are reported via inclusion criteria and demographics.
“Median age was 52 years (IQR 44–60) with 40% being <50 years; 17% were Black/African American, and 14% were of Hispanic/Latino ethnicity.”
“In the trial, T2 clinical tumor size was most common (60%); estrogen receptor (ER) was positive in 53%; and HER-2 receptor was positive in 57%”
“Median age was 52 years (IQR 44–60) with 40% being <50 years; 17% were Black/African American, and 14% were of Hispanic/Latino ethnicity.”
“In the trial, T2 clinical tumor size was most common (60%); estrogen receptor (ER) was positive in 53%; and HER-2 receptor was positive in 57%”
The protocol was approved by the Institutional Review Board at each participating institution or by the NCI Central Institutional Review Board. Written informed consent was required. Regulatory compliance is implied by the trial being sponsored by the National Cancer Institute and overseen by NRG Oncology.
“The protocol was approved by either the Institutional Review Board at each participating institution or by the NCI Central Institutional Review Board.”
“Written informed consent was required for enrollment.”
“This prospective, phase 3, multicenter, randomized trial was designed, conducted, and overseen by NRG Oncology, a member of the National Clinical Trials Network, sponsored by the National Cancer Institute.”
“The protocol was approved by either the Institutional Review Board at each participating institution or by the NCI Central Institutional Review Board.”
“Written informed consent was required for enrollment.”
The radiation therapy regimens are described in detail, including dose, fractionation, and technique. The trial uses radiation therapy as the intervention, which is adequately identified. Software tools for statistical analysis are not explicitly named, but the statistical methods are described. No other key biological or chemical resources are used.
The primary analysis used stratified log-rank test and Cox proportional hazards model. Assumptions of proportional hazards were tested. Exact p-values are reported for the primary endpoint (P=0.51) and for secondary endpoints. Effect sizes are reported with 95% confidence intervals. Statistical software is not identified, but this is a minor omission. Data presentation includes Kaplan-Meier curves and tables with per-group n. Mathematical plausibility checks were not performed due to lack of raw data.
“Differences between treatment arms were assessed by stratified log rank test, controlling for stratification factors.”
“Regional nodal irradiation did not significantly improve the interval until invasive breast cancer recurrence or death from breast cancer (hazard ratio 0.88; 95% confidence interval [CI], 0.60 to 1.28; P = 0.51)”
“No difference between treatment arms was noted in DRFI (HR=1.00, 95%CI 0.67–1.51; five-year point estimates of No regional nodal irradiation: 93.4% and regional nodal irradiation: 93.4%; ) or DFS (HR=1.06, 95%CI 0.79–1.44; five-year DFS point estimates of No regional nodal irradiation: 88.5% and regional nodal irradiation: 88.3%; )”
“Differences between treatment arms were assessed by stratified log rank test, controlling for stratification factors.”
“Regional nodal irradiation did not significantly improve the interval until invasive breast cancer recurrence or death from breast cancer (hazard ratio 0.88; 95% confidence interval [CI], 0.60 to 1.28; P = 0.51)”
“No difference between treatment arms was noted in DRFI (HR=1.00, 95%CI 0.67–1.51; five-year point estimates of No regional nodal irradiation: 93.4% and regional nodal irradiation: 93.4%; ) or DFS (HR=1.06, 95%CI 0.79–1.44; five-year DFS point estimates of No regional nodal irradiation: 88.5% and regional nodal irradiation: 88.3%; )”
The paper does not include a data availability statement. The trial is registered, and the protocol is available with the full text, but individual patient data are not mentioned as being available. No code is shared.
The trial is registered (NCT01872975). Methods are detailed enough for replication. No reporting guideline is explicitly mentioned, but the trial follows CONSORT-like standards. All pre-specified outcomes are reported. Limitations are discussed in the Discussion. Conclusions are proportional to the evidence. Funding and conflicts of interest are disclosed.
“Trial Registration: NCT01872975 (https://clinicaltrials.gov/ct2/show/NCT01872975)”
“Our trial has some limitations. The observed rate of the primary end point (8.2%) was around one third lower than the rate projected on the basis of the combined analysis of the NSABP B-18 and B-27 trials”
“Supported by grants from the National Institutes of Health, U10CA180868, U10CA180822, UG1CA189867, and U24CA196067”
“Trial Registration: NCT01872975 (https://clinicaltrials.gov/ct2/show/NCT01872975)”
“Our trial has some limitations. The observed rate of the primary end point (8.2%) was around one third lower than the rate projected on the basis of the combined analysis of the NSABP B-18 and B-27 trials”
“Supported by grants from the National Institutes of Health, U10CA180868, U10CA180822, UG1CA189867, and U24CA196067”
Registered (1 ID: ClinicalTrials.gov). No reporting guideline cited.
Broken references and links
None foundReferences checked against Crossref, OpenAlex and Retraction Watch for retractions and resolvability, plus declared data and code links probed for whether they resolve to content matching the paper.
Checked — nothing surfaced.
Checked 29 references by DOI: 27 verified — 2 no DOI (shown, not verified).
- NO DOIFavourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: An overview of the randomised trialsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
- NO DOIChecking the Cox model with cumulative sums of martingale-based residualsNo DOI in the reference — shown for manual review; not independently verifiable (not a fabrication signal).
1 data/code link checked; 1 live.
- datahttps://clinicaltrials.gov/ct2/show/NCT01872975LIVEHTTP 200Resolves, but the content could not be matched to the paper.
Copyediting
5 minorWording, consistency and formatting errors that need correcting before submission.
No major wording or formatting errors. 5 minor suggestions below.
5 copyedit issues flagged: mostly consistency, clarity, grammar.
- MINORconsistencyResults, Safety section“Grade 4 toxicity was rare (No regional nodal irradiation: 0.1%, vs. regional nodal irradiation: 0.5%); Grade 3 toxicity was uncommon (No regional nodal irradiation: 6.5%, regional nodal irradiation:10%).”→ Ensure consistent use of 'regional nodal irradiation' vs 'irradiation' and consistent formatting of percentages.Minor inconsistency in the use of 'regional nodal irradiation' and 'irradiation'.
- MINORclarityResults, Efficacy Analyses“A total of 94 patients died of 1,802 evaluated for the overall survival endpoint (): 49 in the irradiation group and 45 in the no irradiation group (hazard ratio, 1.12; 95% CI, 0.75 to 1.68) ().”→ Clarify the denominator: 'of 1,802' seems inconsistent with the earlier reported 1,602 patients with follow-up. Verify the correct number.Potential inconsistency in the number of patients evaluated for overall survival.
- MINORgrammarDiscussion“In cases involving upfront surgery, previous data have shown a greater benefit from postmastectomy radiation therapy and regional nodal irradiation in patients with luminal cancers than in those with other subtypes.[, ]”→ Consider rephrasing for clarity: 'In cases involving upfront surgery, previous data have shown greater benefit from postmastectomy radiation therapy and regional nodal irradiation in patients with luminal cancers than in those with other subtypes.'Minor grammatical issue.
- MINORconsistencyResults, Safety“Grade 4 toxicity was rare (No regional nodal irradiation: 0.1%, vs. regional nodal irradiation: 0.5%); Grade 3 toxicity was uncommon (No regional nodal irradiation: 6.5%, regional nodal irradiation:10%).”→ Ensure consistent spacing around colons and percentages.Minor formatting inconsistency.
- MINORclarityResults, Efficacy Analyses“A total of 94 patients died of 1,802 evaluated for the overall survival endpoint”→ Clarify that 1,802 is the total number evaluated for overall survival, which may differ from the 1,556 in the primary analysis.Potential confusion due to different denominators.
The published work is methodologically robust and the conclusions are well-supported by the reported data. An informed reader should weigh the minor reporting gaps (data availability, software identification, randomization details) and the internal contradiction in the overall survival denominator, which may warrant a correction or clarification. No evidence of statistical errors or integrity concerns beyond the noted denominator discrepancy.
- 1.HIGHreportingIn the Results, Efficacy Analyses section, correct the overall survival denominator: clarify that 1,802 patients were evaluated for overall survival, which is inconsistent with the 1,641 enrolled and 1,556 in the primary analysis; verify the correct number and explain the discrepancy.The internal contradiction in the denominator is a validity threat that could mislead readers and may warrant an erratum.
- 2.HIGHdata codeAdd a data availability statement in the Methods or a dedicated section, specifying how to access de-identified patient data (e.g., via a data-sharing committee or a repository like Vivli) and the conditions for access.The absence of a data availability statement is a reporting gap that reduces transparency and reproducibility.
- 3.HIGHstatisticsExplicitly name the statistical software used (e.g., SAS version 9.4, R version 4.0) in the Statistical Analysis section.Identifying the software is a standard reporting requirement that aids reproducibility.
- 4.HIGHreportingClarify the randomization method (e.g., computer-generated random sequence) in the Methods section.The randomization method is not fully described, which is a minor but important methodological detail.
- 5.HIGHreportingState whether blinding of outcome assessors was performed or provide a rationale for not blinding in a radiation therapy trial.Blinding is often infeasible in radiation trials, but the paper should explicitly state this to avoid ambiguity.
- 6.MEDIUMreportingReport the sex of participants (e.g., all female) in Table 1 or the Methods.Sex is a key biological variable and its absence is a minor reporting gap.
- 7.MEDIUMreportingMention adherence to a reporting guideline such as CONSORT in the Methods or a footnote, and consider submitting the CONSORT checklist as supplementary material.Referencing CONSORT enhances transparency and is expected for randomized trials.
- 8.MEDIUMdata codeProvide a link to the full protocol or statistical analysis plan in the data availability statement.Making the protocol and SAP accessible supports reproducibility and transparency.
- 9.LOWcopyeditIn the Results, Safety section, ensure consistent use of 'regional nodal irradiation' vs 'irradiation' and consistent formatting of percentages (e.g., 'regional nodal irradiation: 10%' with a space after the colon).Minor consistency issues in terminology and formatting can distract readers.
- 10.LOWcopyeditIn the Discussion, rephrase the sentence about luminal cancers for clarity: 'In cases involving upfront surgery, previous data have shown greater benefit from postmastectomy radiation therapy and regional nodal irradiation in patients with luminal cancers than in those with other subtypes.'The original phrasing is grammatically awkward and could be clearer.
The star rating is the report’s one-glance summary. Every paper starts at 5★ and loses stars for the concrete problems the review finds — so a rating is never a vague average, it’s a running total you can read line by line under “How this rating was calculated.”
- Reporting — 8 dimensionseach dimension that fully fails−½★
- each dimension partially met−¼★
- Statistics · Integrity · Claimseach serious problem−1★
- each medium problem−½★
- Citationseach retracted or unverifiable reference−¼★
- Copyeditonly when the manuscript needs a full edit−½★
The rating never drops below 1★, and a demonstrable critical failure (an impossible statistic, a proven ethics violation) caps it at 1★ on its own — so the stars can never look healthy when the verdict is CRITICAL.
The rating draws on a panel of agents. Three independent Kaimen Rigor reviewers grade the eight dimensions below across several independent passes (the shown verdict is their majority vote — steadier than any single run), isolate the paper’s major claims and check its own evidence backs them, and flag integrity concerns. Alongside them, a citation agent resolves every reference against Crossref, OpenAlex, and Retraction Watch; a statistics agent recomputes reported tests; and rule-based checks verify that declared data/code links actually resolve. Full text is required — an abstract-only submission is not analyzed.
Graded against NIH, MDAR, ARRIVE 2.0, CONSORT, EQUATOR, and RRID guidelines. A dimension that doesn’t apply to the study type is skipped, never penalized.
This Kaimen Rigor review is model-assisted and is not a substitute for formal expert review. It complements human evaluation by surfacing potential methodological concerns — verify each finding against the source.