Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

Name: Kaimen Rigor review — Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.
Item: Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.
Rating: 59
Author: Alpha1

Kunkler IH, Russell NS, Anderson N, Sainsbury R, Dixon JM, Cameron D, Loncaster J, Hatton M, Westenberg H, Clarke J, McCarty H, Evans R, Geropantas K, Wolstenholme V, Alhasso A, Woodings P, Barraclough L, Bayman N, Welch R, Muturi F, McEleney T, Burns J, Riddle K, Macdonald E, Dunlop J, Sergenson N, van Tienhoven G, Taylor KJ, Bartlett JMS, Piper T, Velikova G, Aird E, Chua B, Hurkmans C, Venables K, Williams LJ, Thomas JS, Hanby AM, Maclennan M, Cleator S, Verghese ET, Li Y, Wang S, Canney P, SUPREMO Trial Investigators, Sunil

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Kaimen Rigor review — 2.25★ (Weak), 0 critical, 7 high issues for “Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.”

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Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 10, 2026

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Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

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DOI

10.1056/NEJMoa2412225

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Issued Aug 10, 2026Engine 7.29.0

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Kaimen Rigor reviewed

Rigor-Reviewed Manuscript

Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

Paper source

Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

Read full text (PMC)

Embed this Rigor badge

Links back to this Kaimen Rigor review.

Alpha1 Editorial

This rigor review was examined and confirmed by Alpha1 Editorial · August 10, 2026

Kaimen Rigor review

Kaimen Rigor reviewed

2.25 / 5

Weak — serious problems found

Interventional Study

Critical

High-priority

How this rating was calculated▸

Started at 5★ — deductions

IntegrityIntegrity concern ×2−1★
ReportingBiological variables not met−0.5★
ReportingKey resources not met−0.5★
ReportingData & code availability not met−0.5★
StatisticsPrinted percentage does not match its own count (capped)−0.25★

Model-reported confidence: moderateReviewer agreement: moderateEngine: 7.29.0Source: full text

Biggest issues

01Biological variables not reported
highDisclosurereviewer-assessedFull detail
The paper reports age and sex (women), but does not provide justification for the single-sex design, nor report weight, health status, race/ethnicity, or comorbidities.
“Eligible women had undergone a mastectomy for unilateral stage II intermediate-risk breast cancer”
MethodsFind in source
02Key resources not identified
highDisclosurereviewer-assessedFull detail
The investigational product (chest wall irradiation) is described by dose but not by equipment manufacturer or source, and no statistical software is identified, leaving all applicable sub-criteria inadequate.
“Patients randomized to CWI received doses ranging from 40 Gy in 15 fractions to 50 Gy in 25 fractions.”
MethodsFind in source
03Data and code not shared
highDisclosurereviewer-assessedFull detail
The paper does not include a data availability statement. Trial registration is provided, but no information on how to access the data is given.
“ISRCTN registration is 61145589.”
MethodsFind in source
04Printed percentage does not match its own count
mediumArithmeticrecomputedFull detail
65.8% does not match the reported count 195/295
“Most deaths (195/295, 65.8%) were due to breast cancer (S3.2)”
Most deaths (195/295, 65.8%) were due t…Find in source
05Internal contradictions in the reported numbers
mediumArithmeticreviewer-assessedFull detail
In the distant metastasis-free survival sentence, the reported event count (176) is inconsistent with the reported percentage (23.8%): 176/808 = 21.8%, whereas 23.8% of 808 = 192. The 23.8% value matches the disease-free survival event count (192/808), suggesting a transcription error.
“For distant metastasis-free survival we observed 176 metastatic events including death with irradiation (23.8%) and 166 events (20.8%) without irradiation”
ResultsFind in source

Findings by category

201ArithmeticNumerical inconsistencies 102OverreachOverstated conclusions 03AuthenticityNone found 304DisclosureReporting gaps 05AvailabilityNone found 106CopyeditCopyediting

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.

The SUPREMO trial is a methodologically sound, well-reported randomized phase 3 study with a clear scientific premise, rigorous randomization, an a priori power calculation, and adequate ethics documentation. Its main weaknesses are the absence of a data availability statement, a demonstrable internal inconsistency in a secondary-endpoint percentage (176 events reported as 23.8% instead of 21.8%), and minor transparency gaps (no explicit CONSORT citation, no COI statement, no statistical software named, incomplete demographic reporting).

Three independent reviewer runs of the same model were synthesized; they agreed on most dimensions but diverged on biological variables (fail/pass/warn → warn) and key resources (fail/not applicable/not applicable → not applicable). The statistical analysis dimension was downgraded from pass to warn based on the independently flagged internal contradiction (176/808 ≠ 23.8%), which the reviewers missed. Statistics verification covered only 2 recomputable tests; the rest were not machine-verified. Citation check found 0 retracted and 0 not-found references among 38 checked.

Numerical inconsistencies

2 findings · worst medium

Values 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
Printed percentage does not match its own countRecomputed

Recomputed 1 test: 1 consistent, 0 inconsistent; 1 via agent-written checks. 1 printed percentage that does not match its own count.

Overstated conclusions

1 finding · worst low

Conclusions 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

12 major claims checked against the paper's own evidence: all adequately supported.

Data authenticity concerns

None found

An 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

3 findings · worst high

Required detail the manuscript never states — study design, biological variables, ethics approval and consent, key resources, statistical reporting, data and code availability, and overall transparency.

Biological variables not reportedAssessed
Data and code not sharedAssessed
Key resources not identifiedAssessed

Eight Dimensions5 pass · 3 fail

The introduction cites the Danish and Canadian trials, the EBCTCG meta-analysis, and notes that the evidence base may not be applicable due to improvements in systemic therapy. The limitations of prior research are acknowledged. The hypothesis follows logically from the cited evidence.

Sub-criteria

prior work citedADEQUATE

premise rationaleADEQUATE

limitations addressedADEQUATE

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 95% conf

The paper clearly establishes the scientific premise by citing landmark trials and meta-analyses, and explains the rationale for the study given the uncertainty in current practice.

Evidence

paraphrase[Introduction, paragraph 2]

“Landmark Danish and Canadian randomized controlled trials (RCTs) reported in 1997-99 showed that post-mastectomy radiotherapy for stages II and III reduced the risk of locoregional recurrence and improved 10-year survival in women with nodal metastases. (...) Adjuvant systemic therapy in these trials is now considered sub-optimal.”

paraphrase[Introduction, paragraph 3]

“Hence, the role of post-mastectomy radiotherapy in patients with 1-3 involved axillary nodes is uncertain as reflected in differing guidelines (...) and practice.”

paraphrase[Introduction, paragraph 3 & Discussion]

“The paper notes that the evidence base from older studies is inapplicable to current practice due to improvements in systemic therapy, and that SUPREMO provides a more contemporary picture.”

PASSReviewer 2· 90% conf

The premise is well established: historical Danish/Canadian RCTs and the EBCTCG meta-analysis are cited as the basis, and the authors argue convincingly that outdated systemic therapy in those trials undermines their applicability to current practice.

Evidence

Introduction ¶2Find in source

“Hence, the role of post-mastectomy radiotherapy in patients with 1-3 involved axillary nodes is uncertain as reflected in differing guidelines”

IntroductionFind in source

“Adjuvant systemic therapy in these trials is now considered sub-optimal.”

IntroductionFind in source

PASSReviewer 3· 95% conf

The paper clearly establishes the scientific premise by citing landmark trials and meta-analyses, explains the rationale for the study given improvements in systemic therapy, and addresses limitations of prior research.

Evidence

Introduction ¶2Find in source

“Subsequently, major improvements in systemic therapy and reductions in breast cancer mortality () challenge the applicability of the evidence base for post-mastectomy radiotherapy to current practice.”

Introduction ¶3Find in source

“Adjuvant systemic therapy in these trials is now considered sub-optimal.”

Introduction ¶3Find in source

Randomization used permuted blocks with varying block length and center stratification. The unit of randomization is the individual patient. Inclusion and exclusion criteria are well-defined. A priori power analysis was performed and revised. The analysis is ITT. However, blinding is not mentioned; given the nature of the intervention, an open-label design is implied but not stated as a rationale.

Sub-criteria

controlsN/A

power analysisADEQUATE

blinding levelsNOT REPORTED

outlier handlingADEQUATE

randomization unitADEQUATE

inclusion exclusionADEQUATE

randomization methodADEQUATE

replicate distinctionN/A

independent replicationN/A

Per reviewer (3) — the votes behind the verdict

PASSReviewer 1· 85% conf

The study design is a well-conducted randomized phase 3 trial with permuted block randomization, pre-specified sample size calculation, and detailed eligibility criteria.

Evidence

“Patients were randomized 1:1 by permuted blocks with block length varied to minimize the effects of entry bias, with stratification by treating center.”

Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

Ten-Year Survival after Postmastectomy Chest-Wall Irradiation in Breast Cancer.

Numerical inconsistencies

Overstated conclusions

Data authenticity concerns

Reporting gaps

Broken references and links

Copyediting

Numerical inconsistencies

Overstated conclusions

Data authenticity concerns

Reporting gaps

Broken references and links

Copyediting