Title: Impact of Nutrition Risk Index, Prognostic Nutritional Index and Skeletal Muscle Index
on early myelosuppression of first-line chemotherapy in stage IV gastric cancer patients
Version: 2 Date: 29 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is a very interesting and well conducted study designed to
evaluate the relationship between several parameters of nutritional index (including Nutrition
Risk Index, Low prognostic nutritional index and skeletal muscle index) before chemotherapy
and early myelosuppression in stage IV gastric cancer in patients treated with first-line
chemotherapy. One hundred and two patients were evaluated between July 2012 and December
2021. They report that those patients that had low values for those nutritional indexes that were
measured had higher incidence of grade > or equal to 2 myelosuppression. They also found that
a high level of prognostic nutrition nutritional index was associated with higher completion rate
of chemotherapy.  Thus, one can conclude that malnutrition before chemotherapy can exacerbate
chemotherapy toxicity enhancing chemotherapy intolerance and affect outcomes.
Overall, this is a strong study. I do have some comments about minor English mistakes and the
presentation of Tables and Figures that I think will greatly improve the clarity of this study. I
will address them in the next part of this evaluation
REQUESTED REVISIONS:
These are my comments. As I mentioned early is more about style than substance, but I believe
they should be done to improve clarity.
Abstract
1. line 22. The main measurable outcome was the incidence.....
Background
2. Authors should start the paragraph defining gastric cancer rather than just write GC
Line 61. significantly shortened  (?) there is a word missing.
Methods
3. I know that this might be out of the scope of this study but did authors analyze dietary records.
Knowing what individuals normally eat does help in understanding better the low levels of
hemoglobin, the presence of sarcopenia and other low nutritional indexes.
Tables. I have comment on all tables
Table 1. All the abbreviations need to be defined in all Tables since Tables stand separately from
the main body of the manuscript. In Table 1, please define ECOG.
4. Table 2. I think a better title for the Table would be Baseline anthropometrics, Nutrional
indexes, hemoglobin, albumin and NRS (please define, I am not even sure what this is).
Nutritional characteristics does not seem to be the appropriate term. One tends to think of
nutrients not of nutritional indexes.
5. line 149 chemotherapy "and" was higher.....
6. Tables 3, 4 and 5 you need to define all the abbreviations, they can be as a footnote in the Table
but it is very difficult to go back and forth trying to remember what those abbreviations stand for
7. Line 172; there were (not are). use past tense.
8. Please give a better explanation for figure 1 in the figure. Something like 27% of the patients
had the three nutritional indexes low.
9 Tables 6, 7 and 8. Make sure that you define all abbreviations.
10. Although there is a list of abbreviations, they still need to be defined the first time. for
example OS on line 205 or QOL on line 240.
Discussion
11. One of the limitations is that there is no knowledge on the type of foods that subjects are
consuming before chemotherapy
ADDITIONAL REQUESTS/SUGGESTIONS:
I advise authors strongly to define all abbreviations, the first time that they are used and always
in the tables.
Title: Impact of Nutrition Risk Index, Prognostic Nutritional Index and Skeletal Muscle Index
on early myelosuppression of first-line chemotherapy in stage IV gastric cancer patients
Version: 2 Date: 29 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is a very interesting and well conducted study designed to
evaluate the relationship between several parameters of nutritional index (including Nutrition
Risk Index, Low prognostic nutritional index and skeletal muscle index) before chemotherapy
and early myelosuppression in stage IV gastric cancer in patients treated with first-line
chemotherapy. One hundred and two patients were evaluated between July 2012 and December
2021. They report that those patients that had low values for those nutritional indexes that were
measured had higher incidence of grade > or equal to 2 myelosuppression. They also found that
a high level of prognostic nutrition nutritional index was associated with higher completion rate
of chemotherapy.  Thus, one can conclude that malnutrition before chemotherapy can exacerbate
chemotherapy toxicity enhancing chemotherapy intolerance and affect outcomes.
Overall, this is a strong study. I do have some comments about minor English mistakes and the
presentation of Tables and Figures that I think will greatly improve the clarity of this study. I
will address them in the next part of this evaluation
REQUESTED REVISIONS:
These are my comments. As I mentioned early is more about style than substance, but I believe
they should be done to improve clarity.
Abstract
1. line 22. The main measurable outcome was the incidence.....
Background
2. Authors should start the paragraph defining gastric cancer rather than just write GC
Line 61. significantly shortened  (?) there is a word missing.
Methods
3. I know that this might be out of the scope of this study but did authors analyze dietary records.
Knowing what individuals normally eat does help in understanding better the low levels of
hemoglobin, the presence of sarcopenia and other low nutritional indexes.
Tables. I have comment on all tables
Table 1. All the abbreviations need to be defined in all Tables since Tables stand separately from
the main body of the manuscript. In Table 1, please define ECOG.
4. Table 2. I think a better title for the Table would be Baseline anthropometrics, Nutrional
indexes, hemoglobin, albumin and NRS (please define, I am not even sure what this is).
Nutritional characteristics does not seem to be the appropriate term. One tends to think of
nutrients not of nutritional indexes.
5. line 149 chemotherapy "and" was higher.....
6. Tables 3, 4 and 5 you need to define all the abbreviations, they can be as a footnote in the Table
but it is very difficult to go back and forth trying to remember what those abbreviations stand for
7. Line 172; there were (not are). use past tense.
8. Please give a better explanation for figure 1 in the figure. Something like 27% of the patients
had the three nutritional indexes low.
9 Tables 6, 7 and 8. Make sure that you define all abbreviations.
10. Although there is a list of abbreviations, they still need to be defined the first time. for
example OS on line 205 or QOL on line 240.
Discussion
11. One of the limitations is that there is no knowledge on the type of foods that subjects are
consuming before chemotherapy
ADDITIONAL REQUESTS/SUGGESTIONS:
I advise authors strongly to define all abbreviations, the first time that they are used and always
in the tables.
Please review this paper.
user
Title: Impact of Nutrition Risk Index, Prognostic Nutritional Index and Skeletal Muscle Index
on early myelosuppression of first-line chemotherapy in stage IV gastric cancer patients
Version: 2 Date: 29 Oct 2024
Reviewer's report:
PEER REVIEWER ASSESSMENTS:
OBJECTIVE - Full research articles: is there a clear objective that addresses a testable research
question(s) (brief or other article types: is there a clear objective)?
No - there are minor issues
DESIGN - Is the current approach (including controls and analysis protocols) appropriate for
the objective?
Yes - the approach is appropriate
EXECUTION - Are the experiments and analyses performed with technical rigor to allow
confidence in the results?
Yes - experiments and analyses were performed appropriately
STATISTICS - Is the use of statistics in the manuscript appropriate?
Yes - appropriate statistical analyses have been used in the study
INTERPRETATION - Is the current interpretation/discussion of the results reasonable and not
overstated?
Yes - the author's interpretation is reasonable
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work technically
sound? If not, can revisions be made to make the work technically sound?
Probably - with minor revisions
PEER REVIEWER COMMENTS:
GENERAL COMMENTS: This is a very interesting and well conducted study designed to
evaluate the relationship between several parameters of nutritional index (including Nutrition
Risk Index, Low prognostic nutritional index and skeletal muscle index) before chemotherapy
and early myelosuppression in stage IV gastric cancer in patients treated with first-line
chemotherapy. One hundred and two patients were evaluated between July 2012 and December
2021. They report that those patients that had low values for those nutritional indexes that were
measured had higher incidence of grade > or equal to 2 myelosuppression. They also found that
a high level of prognostic nutrition nutritional index was associated with higher completion rate
of chemotherapy.  Thus, one can conclude that malnutrition before chemotherapy can exacerbate
chemotherapy toxicity enhancing chemotherapy intolerance and affect outcomes.
Overall, this is a strong study. I do have some comments about minor English mistakes and the
presentation of Tables and Figures that I think will greatly improve the clarity of this study. I
will address them in the next part of this evaluation
REQUESTED REVISIONS:
These are my comments. As I mentioned early is more about style than substance, but I believe
they should be done to improve clarity.
Abstract
1. line 22. The main measurable outcome was the incidence.....
Background
2. Authors should start the paragraph defining gastric cancer rather than just write GC
Line 61. significantly shortened  (?) there is a word missing.
Methods
3. I know that this might be out of the scope of this study but did authors analyze dietary records.
Knowing what individuals normally eat does help in understanding better the low levels of
hemoglobin, the presence of sarcopenia and other low nutritional indexes.
Tables. I have comment on all tables
Table 1. All the abbreviations need to be defined in all Tables since Tables stand separately from
the main body of the manuscript. In Table 1, please define ECOG.
4. Table 2. I think a better title for the Table would be Baseline anthropometrics, Nutrional
indexes, hemoglobin, albumin and NRS (please define, I am not even sure what this is).
Nutritional characteristics does not seem to be the appropriate term. One tends to think of
nutrients not of nutritional indexes.
5. line 149 chemotherapy "and" was higher.....
6. Tables 3, 4 and 5 you need to define all the abbreviations, they can be as a footnote in the Table
but it is very difficult to go back and forth trying to remember what those abbreviations stand for
7. Line 172; there were (not are). use past tense.
8. Please give a better explanation for figure 1 in the figure. Something like 27% of the patients
had the three nutritional indexes low.
9 Tables 6, 7 and 8. Make sure that you define all abbreviations.
10. Although there is a list of abbreviations, they still need to be defined the first time. for
example OS on line 205 or QOL on line 240.
Discussion
11. One of the limitations is that there is no knowledge on the type of foods that subjects are
consuming before chemotherapy
ADDITIONAL REQUESTS/SUGGESTIONS:
I advise authors strongly to define all abbreviations, the first time that they are used and always
in the tables.
assistant