Review Reports

Round 1

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

While the manuscript is improved, it still isn't complete.

The author should be commended on providing a methodology and for the other corrections.

The author should include a CONSORT diagram of the studies, indicating the number initially, how many were rejected, and the reasons for rejection. There are studies in this field that are not included but still meet the inclusion criteria.

Other concerns have been addressed.

Author Response

C1:The author should be commended on providing a methodology and for the other corrections.

R1: We thank the reviewers for their thoughtful comments to improve this review.

C2. The author should include a CONSORT diagram of the studies, indicating the number initially, how many were rejected, and the reasons for rejection. There are studies in this field that are not included but still meet the inclusion criteria.

R2: We thank the reviewer for this thoughtful suggestion. The present manuscript was designed as a structured narrative review rather than a systematic review or meta-analysis, and therefore a CONSORT flow diagram—which is intended for randomized clinical trials—is not applicable to this type of article.  To improve transparency regarding study identification and selection, we have expanded the Materials and Methods section to clearly describe the literature search strategy, databases queried (PubMed/MEDLINE, Embase, Scopus, and Web of Science), time frame (2000–2025), search terms, and inclusion and exclusion criteria, as well as the general approach used for screening titles, abstracts, and full texts. Because the objective of this review is to provide a conceptual synthesis of the evolving literature on myosteatosis in oncology, studies were selected to illustrate key findings across tumor types, methodological approaches, and biological mechanisms rather than to provide an exhaustive systematic enumeration. Table 1 summarizes representative clinical studies demonstrating the association between myosteatosis and adverse oncologic outcomes across multiple cancers.  We have clarified this approach in the revised Methods section to ensure transparency regarding the scope and methodology of the review.

C3. Other concerns have been addressed.

R3. Again, we thank the reviewers for their valuable critiques.

Reviewer 2 Report (Previous Reviewer 2)

Comments and Suggestions for Authors

Revised manuscript has addressed the raised concerns and fit for acceptance

Author Response

C1. Revised manuscript has addressed the raised concerns and fit for acceptance.

R1. We thank the reviewers for their valuable critique that has enhanced the quality of our manuscript.

Sincerely,

Round 2

Reviewer 1 Report (Previous Reviewer 1)

Comments and Suggestions for Authors

Thank you for your responses. 

The author has addressed my concerns. I commend her for submitting as the sole author; the work involved must have been intense. Kudos on a job well done. I look forward to their future work in this field. 

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This manuscript addresses an important topic: the role of myosteatosis (MYO) as an early, biologically distinct, and clinically meaningful biomarker in oncology. The author provides a review spanning definitions, biological mechanisms, measurement considerations, and prognostic implications of MYO across cancer populations. The manuscript synthesizes an extensive body of retrospective studies and argues for MYO as an under-recognized target for intervention.

However, several key issues require clarification and strengthening before publication. These include greater methodological transparency in the literature review process, improved integration of evidence, more precise terminology, elimination of redundancies, and better articulation of the manuscript’s conceptual contributions. 

A methodology is required. The manuscript states that a review of the evidence was conducted, but it provides no reproducible methodology.

There is no search strategy (databases, search terms, date limits), no inclusion/exclusion criteria, no description of how evidence was selected, appraised, or synthesized, and it is unclear whether this is a narrative review or a scoping review.

Provide at a minimum a transparent methodological description consistent with a narrative review, including: databases searched, search terms, dates covered, rationale for inclusion, and whether studies were evaluated for quality. Even if not a systematic review, minimal transparency is essential.

The descriptions of imaging modalities do not adequately evaluate them. Nor does it address potential drawbacks or adjustments needed (such as comparing imaging done with or without contrast). Is there an advantage to L3 over cervical or thoracic vertebrae levels? What are the tradeoffs between CT, MRI, PET, and biopsy? Is there a clinical significance between IMAT and SMD? 

The section on prevalence meanders from prevalence to associated outcomes, then back to prevalence.

The discussion could be expanded to indicate how this review advances the field, the author's recommendations, and the author's next steps.

 

 

Comments on the Quality of English Language

The paper requires editing to remove unnecessary spaces, double numbering, grammatical errors, unnecessary capitalization, and other issues.

Reviewer 2 Report

Comments and Suggestions for Authors

The review addresses a clinically meaningful and emerging topic with strong potential impact. However, methodological clarity, structural refinement, deeper synthesis, and improved organization are missing which is needed before publication in a high-impact oncology journal. It seems unacceptable in its present state. Following are some comments which should be addressed in future to improve the quality and readability of the article.

1. Clarify whether this is a narrative or systematic review. If narrative, explicitly state this and describe how literature was selected. If systematic, provide structured methodology (databases, time range, screening process, inclusion criteria).
2. The methodology is insufficiently described.
3. Include a comparative table summarizing tumor type, measures quantifying MYO, key outcomes, reference citations, etc.
4. Incorporate a new figure illustrating signaling pathways encompassing the biological mechanisms primarily involved in myosteatosis.