Low Serum Alanine Aminotransferase Blood Activity Is Associated with Shortened Survival of Renal Cell Cancer Patients and Survivors: Retrospective Analysis of 1830 Patients

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

It is an interesting study concerning the correlation between low ALT levels and frailty and shorter survival time in patients suffering from RCC. I would like to congratulate the authors for the very deep analysis of the date and the large sample size that is capable of extracting clear conclusions. The results are well interpreted and the tables very helpful and comprehensive. Although I have some concerns.

Comment 1: Did the sample include all the patients who were examined and treated for RCC at your hospital or there is a specific duration? Please clarify.

Comment 2: You performed a stratification in patients who underwent surgery and not in materials and methods. On the other hand, the low ALT levels were not investigated in each subgroup separately. In addition, the history of surgery does affect the prognosis of patients with low ALT levels?

Comment 3: The discussion section is too limited. The use of ALT as a predictor of frailty and worse prognosis in other cancer types should also be added. Commentation on the results may also be added.

Comments on the Quality of English Language

As mentioned above

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

 

- Why was 17 IU/L taken as the limit value for ALL if it is known that most reference laboratories accept a value of up to 34 IU/L - explain with a reference!

- Multivariate regression analysis did not register known predictors of mortality such as glycemia, hypoalbuminemia and age, which is necessary to discuss in detail with known data!

- No data for ferritin, which is important considering polytransfusions in these sarcopenic patients?

- Add ferritin and glycemia to Cox analysis!

- Was it graded during CT diagnostics that was done to assess the progression of RCC?

- It is necessary to expand the discussion in accordance with the supplementary statistics!

Author Response

Please see the attachment

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Overall, the manuscript is ameliorated. On the other hand, I support that the results for the subgroups should also be included.

Author Response

REVIEWER 1

COMMENT 1

Overall, the manuscript is ameliorated. On the other hand, I support that the results for the subgroups should also be included.

ANSWER BY AUTHORS

We thank you for confirming our answers and changes regarding the changes we made in this manuscript. The current research did not intend and was not designed for subgroup analysis. We do intend to follow this recommendation in our future studies. We added a comment in this regard to the discussion section of the manuscript in lines 277 – 278.

Reviewer 2 Report

Comments and Suggestions for Authors

No

Author Response

We thank you for reviewing our manuscript.