PONE-D-20-33755

Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass

PLOS ONE

Dear Dr. Trussardi Fayh,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands.  Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process by the expert Reviewers.

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Stephen E Alway, Ph.D.

Academic Editor

PLOS ONE

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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: Yes

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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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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: ‘Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass’ is a research article that is a pioneer study evaluating the accuracy of sarcopenia-based CC, compared to CT images.

This study is very valuable because it highlights the fact that calf circumference measurement can be used to muscle mass assessment for sarcopenia diagnosis in cancer patients, instead of computed tomography (CT). Calf circumference measurement is a simple, easy and cheap procedure, in opposite to CT, which is costly method and requiring specialized staff to operate it. The paper reads well.

I would only recommend to widen the description of the use of the SARC-CalF questionnaire in research on sarcopenia around the world, because interest in this tool has grown significantly in recent years (lines 256-258).

Please refer to the following articles:

1) Yang M, Hu X, Xie L, et al. Screening sarcopenia in community-dwelling older adults: SARC-F vs SARC-F combined with calf circumference (SARC-CalF). J Am Med Dir Assoc. 2018;19(3):277.e1-277.e8. doi:10.1016/j.jamda.2017.12.016

2) Krzymińska-Siemaszko R, Deskur-Śmielecka E, Kaluźniak-Szymanowska A, Lewandowicz M, Wieczorowska-Tobis K. Comparison of Diagnostic Performance of SARC-F and Its Two Modified Versions (SARC-CalF and SARC-F+EBM) in Community-Dwelling Older Adults from Poland. Clin Interv Aging. 2020; 15: 583–594.

3) Mo Y, Dong X, Wang XH. Screening accuracy of SARC-F combined with calf circumference for sarcopenia in older adults: a diagnostic meta-analysis. J Am Med Dir Assoc. 2020;21(2):288–289. doi:10.1016/j.jamda.2019.09.002

Reviewer #2: This manuscript reports the comparison of sarcopenia in cancer patients using computed tomography and calf circumference. Overall the study is important and it will certainly add to the current evidence on the potential of using a simpler method to measure muscle mass in cancer patients. However, I have some minor comments on the manuscript, which are outlined below,

Abstract

• Please write L3 in full when it's first mentioned in the text, i.e. "third lumbar vertebra".

• Mean ± “standard deviation” age of 70.6 ± 7.4 years?

Materials and Methods

• Was this trial registered in clinical trials registration? If so, please include this information in the Methods section.

Design and subjects

• Lines 83-84: Please include the institution of the ethics board.

Anthropometric evaluation

• Lines 96-99: How many measurements were taken for the calf circumference, e.g. once or twice?

Muscle strength assessment

• Lines 104-105: Is there any reason why the handgrip strength of the non-dominant hand was captured as well?

Results

• Table 1: Please include the definition for each of the BMI categories.

• Line 161: Should this read "Chi-square test"?

• Line 180: Please write the abbreviations in full when first mentioned.

• Table 2: It will be good to include the prevalence of low handgrip strength, low MM, and low CC in this table. Thank you.

• Line 183: Please change “according” to "according to".

• Table 2 header: Please include the denominator for all the "No" and "Yes" categories, e.g. Sarcopenia by low MM, Yes: "26 of 108 patients = 24.1%".

• Line 194: Should this read "moderate"?

• Table 3: Are all the kappa p-values referring to "p<0.001"?

Discussion

• Lines 250-251: Suggest using another term for 'patients at risk of death'.

• Line 256: Should this read 'researchers"?

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Reviewer #1: No

Reviewer #2: No

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PONE-D-20-33755R1

Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass

PLOS ONE

Dear Dr. Trussardi Fayh,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

This paper has only a few minor things to address. All of the major issues have been resolved so i am confident that the next revision can be done quickly.

Please submit your revised manuscript by Aug 05 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Stephen E Alway, Ph.D.

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #3: 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 #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: I Don't Know

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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 #3: No

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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 #1: Yes

Reviewer #3: 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 considering my comments. I recommend publishing this revised version of manuscript titled Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass.

Reviewer #3: Overall, I think the authors have done a good job at addressing the previous round of revisions. Below are a few thoughts and minor suggestions for improvement.

General Comments:

Double check all abbreviations are used consistently in paper. E.g. “Muscle mass” has frequently been abbreviated to MM. However, in some cases it still remains written in full.

Abstract:

Please introduce European 56 Work Group on Sarcopenia in Older People (EWGSOP) in abstract before referring to abbreviation.

Line with “prevalence of sarcopenia by the EWGSOP2” – suggest revising to “according to the EWGSOP2 criteria.”

Line with “evaluate the accuracy of sarcopenia using low CC considering MM assessment by computed tomography (CT)…” – suggest revising to “evaluate the accuracy of sarcopenia using low CC relative to MM assessment…”

Line “Data included sociodemographic, clinical and anthropometric variables.” – suggest deleting from abstract if you need to reduce word count. I don’t think this is necessary.

Suggest adding one additional statement at the end of the abstract or slightly revise the current last statement of the abstract. What is the key takeaway message from this study, i.e. what is the primary reason people will cite this paper? E.g. Measuring CC and HGS may serve as a useful alternative to identify sarcopenia in people with cancer relative to relying on CT imaging to diagnose low MM.

Introduction:

Line 60: remove capitalisation of sarcopenia.

Methods:

Line 90: This needs further clarification. How were patients approached for the study? Was there a set time period for recruitment, e.g. mm-yy to mm-yy?

Line 101: Was the calf measurement performed by the same researcher?

Line 103: After three measures of CC were taken, was the average then calculated across both legs or was it the maximum value that was used? This needs to be clearly articulated to allow for study replication or translation into practice.

Results:

Line 152: Was there a primary reason patients were unable to have their calf assessed? A little further detail might be helpful here.

Line 160: I would not refer to this as a nutritional evaluation, as that would require a more comprehensive assessment beyond BMI alone. Suggest revising this to: According to BMI categories, 47.2% of patients were classified as having a normal body weight and 30.6% were considered overweight.”

Line 202-207: This is a very long sentence. Suggest condensing or breaking into two or more statements for clarity. Please also double check use of brackets. One seems to be missing before “all p-value <0.001.”

Discussion:

Line 228: This sentence is a bit difficult to follow. Try to be very clear here. E.g. “The main finding of the present study is that CC can be used to diagnose sarcopenia in elderly patients with cancer and has similar accuracy to assessing MM using CT imaging.”

Line 230: Remove “In fact”

The utility of measuring CC versus relying on sophisticated and costly imaging techniques to identify low MM should be highlighted. One of the most important findings of this study is that a relatively quick, cost-effective and easy measurement can help identify sarcopenia. I suggest highlighting this more in the discussion.

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Reviewer #1: Yes: Roma Krzymińska-Siemaszko

Reviewer #3: No

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Comparison of revised EWGSOP2 criteria of sarcopenia in patients with cancer using different parameters of muscle mass

PONE-D-20-33755R2

Dear Dr. Trussardi Fayh,

The expert Reviewers who reviewed your manuscript are satisfied that the concerns have been addressed in this revision and I agree. Therefore 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 meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Congratulations on a great paper, and kind regards,

Stephen E Alway, Ph.D.

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 #3: All comments have been addressed

**********

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 #3: Yes

**********

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

Reviewer #3: 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 #3: 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 #3: 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 #3: The authors have carefully gone through the suggested comments and revised the manuscript accordingly. I feel the manuscript is improved and have no further comments.

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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 #3: No