PONE-D-20-08174

Sarcopenia as a predictor of survival in patients undergoing bland transarterial embolization for unresectable Hepatocellular Carcinoma

PLOS ONE

Dear Dr. Ezio Lanza,

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Gianfranco D. Alpini

Academic Editor

PLOS ONE

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3. One of the noted authors is a group or consortium "Humanitas HCC Multidisciplinary Group" In addition to naming the author group, please list the individual authors and affiliations within this group in the acknowledgments section of your manuscript. Please also indicate clearly a lead author for this group along with a contact email address.

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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: Yes

Reviewer #2: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

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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

Reviewer #2: 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

Reviewer #2: Yes

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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 manuscript is a mono-centric study by the Humanitas HCC Multidisciplinary Group in Milan (Italy). It is a retrospective study aiming to evaluate the prognostic significance of sarcopenia in patients affected by HCC who received bland transarterial embolization (TAE) therapy. The manuscript is interesting and well-written. I have only few minor points.

- In table 1, authors could include also alcohol abuse and NAFLD diagnosis as variables.

- Line 179. Authors stated “No specific liver disease was associated with sarcopenia (Table 4); non-NASH liver disease showed the highest incidence (p < 0.01)”. However, table 4 reports variables tested in the multivariate analysis.

Reviewer #2: The authors provide insight on an important factor determining HCC TAE outcome, however there are some issues that must be addressed prior to publication:

1. Ranges must be included along with the mean in the various tables provided with this manuscript. Additionally, subcategories of underlying diseases of sarcopenic and non-sarcopenic patients must be added in additional rows in the appropriate table.

2. There must a table with the TAE data that was listed in the manuscript.

3. Results should be rewritten for a more cohesive presentation of the data collected.

4. Correlation analysis should be performed between sarcopenia and the following:

a. Previous treatment and HCC nodule #

b. TAE complication and TAE #

5. Additionally, there should be analysis that separates the OS of sarcopenic/non-sarcopenic patients for the various stages. This data will likely be weaker due to the lower N, but it will help lend evidence to the idea that sarcopenia may influence OS and early intervention will help depending on HCC stage.

6. The authors should discuss the lower OS in non-sarcopenic patients in years 3 and 4 compared to sarcopenic patients.

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Reviewer #1: No

Reviewer #2: No

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Sarcopenia as a predictor of survival in patients undergoing bland transarterial embolization for unresectable Hepatocellular Carcinoma

PONE-D-20-08174R1

Dear Dr. Ezio Lanza,

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.

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication.

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With kind regards,

Gianfranco D. Alpini

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 #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 #2: Yes

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

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 #2: Yes

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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 #2: Yes

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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 #2: The authors have either addressed the reviewer critiques or explained as to why text should not be changed. There are no further comments or recommendations.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No