Craniopharyngioma, Chronotypes and Metabolic Risk Profile

Round 1

Reviewer 1 Report

Thank you for addressing the reviewer comments.

Please consider including the Table on "Differences in study parameters between patients with craniopharyngioma treated with neurosurgery only and patients with craniopharyngioma treated with neurosurgery plus radiotherapy" from your reply to reviewers as a supplemental Table in the paper.

Author Response

See file attached

Author Response File: Author Response.docx

Reviewer 2 Report

GENERAL COMMENTS

Dear authors,

I appreciated the reading of your manuscript.

The manuscript evaluating chronotype in Craniopharyngioma appears as a novelty in order to solve the obesity problem in this pathology.

However, I have some concerns. The major one is that I do not understand what the authors try to demonstrate and what is the aim of the study. More specifically, also considering the statistical analysis, why did the authors include a control group? Which information does the control group add to the patients' group results? In literature, it is already known that the evening type is associate with higher obesity risk; thus, what is the novelty of your study? From the analysis and the results, you did not find if there is an association between the pathology and chronotype, but the association between eveningness and obesity has been found in both groups.

Please see later for the comments and suggestions.

TITLE

I have some doubts about using the words "score" and "new". You evaluated the chronotypes (categories) and not the continuous score. The association between obesity and eveningness is not new but has been already reported in the literature (De Amicis et al., 2020, doi: 10.3390/nu12030592).

ABSTRACT

In my opinion, the results should be abbreviated and only the essential ones should be reported.

INTRODUCTION

1. I wonder if all the information in lines 52-66 is essential or if some could be omitted.
2. In line 95, related to chronotype differences, I also suggest these articles: Montaruli et al., 2019, DOI: https://doi.org/10.1080/07420528.2019.1652831) and Mulè et al., 2020, DOI: 10.1007/s11332-019-00610-9.
3. Line 103:it is not clear the link between CP and the synchronization of the circadian rhythm.

SUBJECTS AND METHODS

1. Patients: the recruitment period is very long and in 20 years the surgical and medical treatments could have changed too much. Is it possible that treatment improvements in these years could have, in turn, improved the post-surgical obesity condition? In this way, the differences you found could also be traceable in changes in medical treatments.
2. In table 1, it is not clear what the number means.
3. Approbation of the ethics committee is missing.
4. In my opinion, one-way ANOVA is not the most appropriate method to analyze the data and accomplish the study's aim. Maybe, a two-way ANOVA is more appropriate. With two-way ANOVA analysis, you could evaluate chronotype and pathology/health effects and their interaction in your sample. From your analysis, it appears that eveningness is associated with obesity in both groups. In this way, what want the authors demonstrate? Furthermore, is a control group necessary considering that you did not compare the two groups with this kind of analysis?
5. If you decide to maintain the one-way ANOVA analysis, the way to report the results is incorrect. You should report the F analysis and parameters and the post-hoc test.
6. Given my previous comment, you should evaluate if the partial correlation analysis (adjuted by health/pathology) could be more appropriate.
7. You should evaluate to adjust the analysis by sex, because body composition is different between the two sexes.

DISCUSSION

1. Lots of concepts already introduced and explained in the introduction session are repeated in the discussion session without adding something more or inherent to the results. In my opinion, this section should be completely reviewed, avoiding repetition and commenting more on the results.
2. Line 299, with such a small sample, you cannot speak about the chronotype distribution in CP patients.
3. A real practical application of the present study is missing. The potential application named in line 303 is not elucidated.
4. Line 316: metabolic syndrome is not obesity; why do you introduce the metabolic syndrome?
5. With regards to circadian rhythms, I suggest reading: Montaruli et al., 2021, DOI: 10.3390/biom11040487;

Author Response

see attached file

Author Response File: Author Response.docx