PONE-D-19-21225

A lower psoas muscle volume was associated with a higher rate of recurrence in male clear cell renal cell carcinoma

PLOS ONE

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #1: I commend the authors on attempting to elucidate the prognostic value of sarcopenia (with a psoas muscle index) in male patients with clear cell renal cell cancer. This is a retrospective cohort study of 316 patients undergoing curative intent surgery for ccRCC. I have appended a few minor suggestions for improving this paper prior to submission below:

Methods

1. Primary outcome and exposure variable needs to be clearly stated in the methods section as per the STROBE statement for reporting observational studies

2. Method of determining correlation between PMV and PMI, including number of patients in this sub-cohort, requires further description in the methods section

3. The authors should attempt to compare the baseline clinical and oncologic metrics of patients with and without recurrent disease. The average PMI appears to be lower in patients with a recurrence, however, it is important to first determine whether this is a result of more advanced disease in this group.

Discussion

1. The authors must be cautious not be overstate their findings. The findings of this retrospective cohort study, with a limited sample size of patients with a clinical recurrence, suggests a correlation between PMI and RFS and is good first step in determining the prognostic value of sarcopenia in RCC. These findings however, require prospective validation.

Reviewer #2: ONE-D-19-21225

This is a retrospective cohort study of men with localized Clear Cell RCC undergoing surgical resection wherein the authors sought to determine the association between sarcopenia and recurrence. The authors utilized psoas muscle index (PMI) as the exposure variable, and showed low PMI was associated with a higher risk of recurrence.

Methods:

1. It does not make sense to exclude Female patients because the rates of recurrence was low or because the psoas muscle index was low. What the was even rate in women? Analysis could be considered separately in women with a different cut off of PMI.

2. The authors need to include the following covariates in the multivariable model: Margin Status, sarcomatoid/rhabdoid histology, receipt of adjuvant therapy (e.g. sunitinib)

3. Please explain why the analysis was restricted to clear cell histology only.

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Reviewer #1: Yes: Dr. Dhruvin Hirpara

Reviewer #2: No

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A lower psoas muscle volume was associated with a higher rate of recurrence in male clear cell renal cell carcinoma

PONE-D-19-21225R1

Dear Dr. Kawahara,

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

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With kind regards,

Biniam Kidane

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. 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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. 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

Reviewer #2: Yes

**********

5. 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

Reviewer #2: Yes

**********

6. 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: Thank you for your revisions. The manuscript has been appropriately amended and is acceptable for publication.

Reviewer #2: (No Response)

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Reviewer #1: No

Reviewer #2: No