Title: Sarcopenia Is Associated with Prognosis in Patients with Esophageal Squamous Cell
Cancer after Radiotherapy or Chemoradiotherapy
Version: 0 Date: 07 Sep 2021
Reviewer's report:
Dear authors:
Congratulation for the comprehensive work.
There are some recommended revisions as below:
1. In Table 1, you may add the correlation between sarcopenia and alcohol use.  Chronic
use of alcohol may impact the function of hepatopancreatic and gastrointestinal systems and
metabolism, which may also lead to sarcopenia.
2. You may illustrate the different implications between hypoalbuminemia and sarcopenia in the
discussion. In this study, hypoalbuminemia is not correlated with sarcopenia and both factors
are independent prognostic factors for overall survival.
3. In table 1, in the rows of SATI, VATI, and TATI, "high" and " low" are missing.  The
definitions of "high" and "low" are needed.
4. In Table 1, what is the definition of obesity?
5. What is the edition of AJCC staging system in this study?
6. In the paragraph of "Sarcopenia and Prognosis of ESCC", 5-year PFS was compared between
sarcopenia and non-sarcopenia.  It is recommended that 3-year rather than 5-year PFS is
compared.  The 5-year PFS is too low to have meaningful comparison.
7. This study showed that sarcopenia may impact the survival of ESCC patients.  However,
sarcopenia may also impact survival of general population.  You may try to compare the
hazard ratio in ESCC patients with the hazard ratio in general population in order to reveal the
interactions of sarcopenia with the cancer and the treatment.
8. If you have the baseline PET scan data from these patients, you may consider to correlate
the SUV of esophageal tumor with sarcopenia.  Sarcopenia may be related to cancer biology,
and PET scan may reveal the level of metabolism of the cancer. And some studies showed that
higher SUV of esophageal tumor is associated with poor survival in ESCC.
9. In table 2 and 3, please unify the direction of hazard ratios of all the factors. (Factor A, low
vs high, does the hazard ratio stand for low/high or high/low?)
10. In Figure 5a, you may explain why stage I-II has inferior survival in the first year compared
to stage III-IV.
11. In the discussion, you mentioned that the patients received definitive CRT combined with
chemotherapy, immunotherapy, and targeted therapy.  You may need to clarify what kind of
immunotherapy and targeted therapy were given, and whether these therapies may influence the
analysis.
Title: Sarcopenia Is Associated with Prognosis in Patients with Esophageal Squamous Cell
Cancer after Radiotherapy or Chemoradiotherapy
Version: 0 Date: 07 Sep 2021
Reviewer's report:
Dear authors:
Congratulation for the comprehensive work.
There are some recommended revisions as below:
1. In Table 1, you may add the correlation between sarcopenia and alcohol use.  Chronic
use of alcohol may impact the function of hepatopancreatic and gastrointestinal systems and
metabolism, which may also lead to sarcopenia.
2. You may illustrate the different implications between hypoalbuminemia and sarcopenia in the
discussion. In this study, hypoalbuminemia is not correlated with sarcopenia and both factors
are independent prognostic factors for overall survival.
3. In table 1, in the rows of SATI, VATI, and TATI, "high" and " low" are missing.  The
definitions of "high" and "low" are needed.
4. In Table 1, what is the definition of obesity?
5. What is the edition of AJCC staging system in this study?
6. In the paragraph of "Sarcopenia and Prognosis of ESCC", 5-year PFS was compared between
sarcopenia and non-sarcopenia.  It is recommended that 3-year rather than 5-year PFS is
compared.  The 5-year PFS is too low to have meaningful comparison.
7. This study showed that sarcopenia may impact the survival of ESCC patients.  However,
sarcopenia may also impact survival of general population.  You may try to compare the
hazard ratio in ESCC patients with the hazard ratio in general population in order to reveal the
interactions of sarcopenia with the cancer and the treatment.
8. If you have the baseline PET scan data from these patients, you may consider to correlate
the SUV of esophageal tumor with sarcopenia.  Sarcopenia may be related to cancer biology,
and PET scan may reveal the level of metabolism of the cancer. And some studies showed that
higher SUV of esophageal tumor is associated with poor survival in ESCC.
9. In table 2 and 3, please unify the direction of hazard ratios of all the factors. (Factor A, low
vs high, does the hazard ratio stand for low/high or high/low?)
10. In Figure 5a, you may explain why stage I-II has inferior survival in the first year compared
to stage III-IV.
11. In the discussion, you mentioned that the patients received definitive CRT combined with
chemotherapy, immunotherapy, and targeted therapy.  You may need to clarify what kind of
immunotherapy and targeted therapy were given, and whether these therapies may influence the
analysis.
Please review this paper.
user
Title: Sarcopenia Is Associated with Prognosis in Patients with Esophageal Squamous Cell
Cancer after Radiotherapy or Chemoradiotherapy
Version: 0 Date: 07 Sep 2021
Reviewer's report:
Dear authors:
Congratulation for the comprehensive work.
There are some recommended revisions as below:
1. In Table 1, you may add the correlation between sarcopenia and alcohol use.  Chronic
use of alcohol may impact the function of hepatopancreatic and gastrointestinal systems and
metabolism, which may also lead to sarcopenia.
2. You may illustrate the different implications between hypoalbuminemia and sarcopenia in the
discussion. In this study, hypoalbuminemia is not correlated with sarcopenia and both factors
are independent prognostic factors for overall survival.
3. In table 1, in the rows of SATI, VATI, and TATI, "high" and " low" are missing.  The
definitions of "high" and "low" are needed.
4. In Table 1, what is the definition of obesity?
5. What is the edition of AJCC staging system in this study?
6. In the paragraph of "Sarcopenia and Prognosis of ESCC", 5-year PFS was compared between
sarcopenia and non-sarcopenia.  It is recommended that 3-year rather than 5-year PFS is
compared.  The 5-year PFS is too low to have meaningful comparison.
7. This study showed that sarcopenia may impact the survival of ESCC patients.  However,
sarcopenia may also impact survival of general population.  You may try to compare the
hazard ratio in ESCC patients with the hazard ratio in general population in order to reveal the
interactions of sarcopenia with the cancer and the treatment.
8. If you have the baseline PET scan data from these patients, you may consider to correlate
the SUV of esophageal tumor with sarcopenia.  Sarcopenia may be related to cancer biology,
and PET scan may reveal the level of metabolism of the cancer. And some studies showed that
higher SUV of esophageal tumor is associated with poor survival in ESCC.
9. In table 2 and 3, please unify the direction of hazard ratios of all the factors. (Factor A, low
vs high, does the hazard ratio stand for low/high or high/low?)
10. In Figure 5a, you may explain why stage I-II has inferior survival in the first year compared
to stage III-IV.
11. In the discussion, you mentioned that the patients received definitive CRT combined with
chemotherapy, immunotherapy, and targeted therapy.  You may need to clarify what kind of
immunotherapy and targeted therapy were given, and whether these therapies may influence the
analysis.
assistant