Sarcopenia and Pleural Mesothelioma: The Current Knowledge

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

 

 

The study is a review to present the current state of association between pleural mesothelioma and sarcopenia.

 

Introduction:

 

The paragraphs describing PM, has a lot of histo-pathological description followed by clinical symptoms, risk factors and treatment. I would rather describe the prevalence of the disease, magnitude of the problem with its clinical significance, risk factors, symptoms, method(s) of diagnosis, complications, treatment, and its relation to sarcopenia.

 

Line 62: BAP1 – use the gene symbol after naming it with its abbreviation.

Line 85: where sarcopenia is considered as probable when low muscle strength is present [11]- need rephrasing, using the word probable cannot describe a diagnostic criterion.

 

Line 91: the paragraph starting with Various tests and tools – you did not mention any tools.

Line 96 - SARC-F questionnaire where it what SARC-F means ‘Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire’.

 

Line 111: assessment is cheap – maybe describe it as less expensive or economical.

 

The association between sarcopenia and PM is missing in the introduction!

 

Line 154: In this literature review article – In our review and do not forget adding (,) after it.

 

Line 158: through different mechanisms including oxidative stress and inflammation, even though more research is needed [29,30]. First time to mention the possible mechanisms involved at the end of the introduction but without further details!!!

 

Methods:

 

As the four included studies used different scoring system to evaluate sarcopenia could you briefly explain those systems, advantage and limitation for each.

 

Out of the four studies included, two are for the same group with same authors, I am afraid that this leads to bias in the observed outcomes and results!

 

Table 1: The statistical tools presented in table 1 for each of the four included studies is different form mean to median. P value or p value and correlation (r) results – I would rather present comparable data.

 

 

Comments on the Quality of English Language

Some sentences need rephrasing for easier understanding.

Author Response

Dear Editor of MUSCLES,

We wish to thank you for considering our review article for publication in Muscles and for allowing us to resubmit a revised version of our manuscript.  In addition, we would like to thank the reviewers for their insightful comments and suggestions, which have been helpful in order to improve and strengthen our manuscript. We have carefully revised our manuscript, according to the comments made by the reviewers and please find below the changes that we have made, using the green color in MS Word, to our initial submission.

 

RESPONSE TO THE REFEREES

# Reviewer 1

The study is a review to present the current state of association between pleural mesothelioma and sarcopenia.

 

Introduction:

The paragraphs describing PM, has a lot of histo-pathological description followed by clinical symptoms, risk factors and treatment. I would rather describe the prevalence of the disease, magnitude of the problem with its clinical significance, risk factors, symptoms, method(s) of diagnosis, complications, treatment, and its relation to sarcopenia.

Response: Thank you for this insightful comment. We have added the appropriate parts in the introduction of our manuscript trying to keep the structure of the manuscript solid.

 

Line 62: BAP1 – use the gene symbol after naming it with its abbreviation.

Response: Thank you for this comment. We have made the appropriate change.

 

Line 85: where sarcopenia is considered as probable when low muscle strength is present [11]- need rephrasing, using the word probable cannot describe a diagnostic criterion.

Response: Thank you for this significant comment. We have made the appropriate change. We have added the word “potential” because it is known that muscle strength solely might be indicative of sarcopenia but not conclusive, two more criteria are needed according to EWGSOP2.

 

 

Line 91: the paragraph starting with Various tests and tools – you did not mention any tools.

Response: Thank you for this comment. We have made the appropriate alterations.

 

Line 96 - SARC-F questionnaire where it what SARC-F means ‘Strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F) questionnaire’.

Response:  Thank you for this comment. We have added the appropriate change.

 

Line 111: assessment is cheap – maybe describe it as less expensive or economical.

Response:  Thank you for this kind comment. We have added the suggested alteration.

 

The association between sarcopenia and PM is missing in the introduction!

Response: Thank you for this kind comment. This article tried to investigate any potential role between these two entities based on existing studies. The main idea that fueled our study is mentioned at the last paragraph of introduction, “sarcopenia and cancer might be present simultaneously and have an impact on each other, while in lung cancer subjects sarcopenia might be related to lung cancer progno-sis through different mechanisms including oxidative stress and inflammation, even though more studies are required”. We try to raise the awareness for further scientific investigation.

 

Line 154: In this literature review article – In our review and do not forget adding (,) after it.

Response:  Thank you for this comment. We have added this alteration.

 

Line 158: through different mechanisms including oxidative stress and inflammation, even though more research is needed [29,30]. First time to mention the possible mechanisms involved at the end of the introduction but without further details!!!

Response: Thank you for this kind comment. As we have mentioned above, this article tried to investigate any potential role between these two entities based on existing studies. The main idea that fueled our study is mentioned at the last paragraph of introduction, “sarcopenia and cancer might be present simultaneously and have an impact on each other, while in lung cancer subjects sarcopenia might be related to lung cancer progno-sis through different mechanisms including oxidative stress and inflammation, even though more studies are required”. We try to raise the awareness for further scientific investigation.

 

Methods:

As the four included studies used different scoring system to evaluate sarcopenia could you briefly explain those systems, advantage and limitation for each.

Response: Thank you for your insightful comment. The methods and limitations concerning DXA and CT are briefly explained into the manuscript (introduction), but we don’t prefer to further mention them because the purpose of this article is different and these methods are well known.

 

Out of the four studies included, two are for the same group with same authors, I am afraid that this leads to bias in the observed outcomes and results!

Response: Thank you for your insightful comment. Our study is a non-systematic review and not a systematic review. We have mentioned all the studies relevant with the under investigation topic as shown by current literature. Of course, a non-systematic especially with small number of studies might be prone to bias. As for the two studies from the same group, it is mentioned in our manuscript that the second study is a secondary data analysis of the first. Moreover, this two studies have different scope of research. The first one studied and determined the prevalence of pre-sarcopenia and malnutrition in malignant pleural mesothelioma (MPM) and investigated if there was any difference in activity levels and QoL in accordance with nutritional status and body composition, while the second which was a secondary data analysis of the first, examined MPM subjects potential alterations in body composition over time and its association with activity levels, dietary intake and survival, without discriminating subjects as pre-sarcopenic.

 

Table 1: The statistical tools presented in table 1 for each of the four included studies is different form mean to median. P value or p value and correlation (r) results – I would rather present comparable data.

Response: Thank you for your kind comment. The appropriate alterations have been made.

 

Some sentences need rephrasing for easier understanding.

Response:  Thank you for your kind comment. Appropriate alterations have been made.

 

Reviewer 2 Report

Comments and Suggestions for Authors

There is an extensive literature base on cancer-induced muscle loss – which is better termed as cachexia. This review provides a comprehensive discussion of Pleural mesothelioma (PM) in the context of sarcopenia. The manuscript could benefit from defining the differences between cachexia and sarcopenia in their review. It was less clear to me if really, they were discussing cachexia or if indeed it is sarcopenia (as an aged related muscle mass loss) that accompanies or is also related to PM. However, it is important to distinguish between cachexia and sarcopenia. Cachexia, a systemic wasting condition, is typically considered a late-stage manifestation of chronic diseases, such as cancer, organ failure, or infections (Ferrer, M., Anthony, T. G., Ayres, J. S., Biffi, G., Brown, J. C., Caan, B. J., Cespedes Feliciano, E. M., Coll, A. P., Dunne, R. F., Goncalves, M. D., Grethlein, J., Heymsfield, S. B., Hui, S., Jamal- Hanjani, M., Lam, J. M., Lewis, D. Y., McCandlish, D., Mustian, K. M., O'Rahilly, S., ... Janowitz, T. (2023). Cachexia: A systemic consequence of progressive, unresolved disease[J]. Cell, 186(9), 1824–1845).

 

Only three studies were described (Table 1) and two of them were from the same research group. Thus, there appears to be very little data from which to conduct a non systematic review. This seems more like a preliminary assessment of the association between PM and muscle wasting and a call for more research to be done in this area. I think the paper could benefit by such a reformatting and particularly addressing the needs for follow-up studies to address gaps in the scientific literature on PM and muscle wasting (which was done somewhat in the discussion but this could be a separate area in the body of the paper and I think this would also increase the citablity of the manuscript as other work is conducted).

There were a number of grammatical errors that should be corrected with a careful read through. Although I would have preferred more integration of the findings of the studies rather than reporting the outcome study by study, the information that is needed to assess sarcopenia in PM was presented in good detail. There was a good assessment of the methods used to measure overall muscle mass (DEXA, CT scan etc.) but there was not as much attention paid to assessing different measures of muscle strength assessment or obtaining muscle biopsies to directly assess muscle fiber size. Additional functional data and assessments would strengthen the paper if this information is available for PM patients.

 

Comments on the Quality of English Language

 

There were a number of grammatical errors that should be corrected with a careful read through.

 

Author Response

Dear Editor of MUSCLES,

We wish to thank you for considering our review article for publication in Muscles and for allowing us to resubmit a revised version of our manuscript.  In addition, we would like to thank the reviewers for their insightful comments and suggestions, which have been helpful in order to improve and strengthen our manuscript. We have carefully revised our manuscript, according to the comments made by the reviewers and please find below the changes that we have made, using the green color in MS Word, to our initial submission.

 

RESPONSE TO THE REFEREES

 

#Reviewer 2

There is an extensive literature base on cancer-induced muscle loss – which is better termed as cachexia. This review provides a comprehensive discussion of Pleural mesothelioma (PM) in the context of sarcopenia. The manuscript could benefit from defining the differences between cachexia and sarcopenia in their review. It was less clear to me if really, they were discussing cachexia or if indeed it is sarcopenia (as an aged related muscle mass loss) that accompanies or is also related to PM. However, it is important to distinguish between cachexia and sarcopenia. Cachexia, a systemic wasting condition, is typically considered a late-stage manifestation of chronic diseases, such as cancer, organ failure, or infections (Ferrer, M., Anthony, T. G., Ayres, J. S., Biffi, G., Brown, J. C., Caan, B. J., Cespedes Feliciano, E. M., Coll, A. P., Dunne, R. F., Goncalves, M. D., Grethlein, J., Heymsfield, S. B., Hui, S., Jamal- Hanjani, M., Lam, J. M., Lewis, D. Y., McCandlish, D., Mustian, K. M., O'Rahilly, S., ... Janowitz, T. (2023). Cachexia: A systemic consequence of progressive, unresolved disease[J]. Cell, 186(9), 1824–1845).

Response: Thank you for your useful comment. The appropriate alteration has been made.

 

Only three studies were described (Table 1) and two of them were from the same research group. Thus, there appears to be very little data from which to conduct a non-systematic review. This seems more like a preliminary assessment of the association between PM and muscle wasting and a call for more research to be done in this area. I think the paper could benefit by such a reformatting and particularly addressing the needs for follow-up studies to address gaps in the scientific literature on PM and muscle wasting (which was done somewhat in the discussion but this could be a separate area in the body of the paper and I think this would also increase the citablity of the manuscript as other work is conducted).

Response: Thank you for your kind comment. We agree with your insightful comment and we think that discussion clearly demonstrates the needs for further investigation. We really hope to raise the awareness.

 

There were a number of grammatical errors that should be corrected with a careful read through. Although I would have preferred more integration of the findings of the studies rather than reporting the outcome study by study, the information that is needed to assess sarcopenia in PM was presented in good detail. There was a good assessment of the methods used to measure overall muscle mass (DEXA, CT scan etc.) but there was not as much attention paid to assessing different measures of muscle strength assessment or obtaining muscle biopsies to directly assess muscle fiber size. Additional functional data and assessments would strengthen the paper if this information is available for PM patients.

Response:  Thank you for your kind comment. Appropriate alterations have been made.

 

There were a number of grammatical errors that should be corrected with a careful read through.

Response:  Thank you for your kind comment. Appropriate changes have been made.

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I am accepting it in the current form. Thanks!

Comments on the Quality of English Language

Good job, thanks!

Reviewer 2 Report

Comments and Suggestions for Authors

The authors are to be commended for their revision and addressing the prior concerns.

I have no other concerns.

Comments on the Quality of English Language

The English was fine overall. I only found a couple of small grammatical issues but these were very minor.