Obesity Epidemic—The Underestimated Risk of Endometrial Cancer

Round 1

Reviewer 1 Report

In this manuscript, Kiesel et al. discussed the relationship between adiposity and endometrial cancers. They further discussed the pathophysiological mechanisms linking adiposity to ECs, which include the fundamental role of hyperglycemia, insulin resistance, and hyper-estrogenemia as well as interactions with a chronic pro-inflammatory microenvironment. Finally, the authors exhibit certain therapeutic options in preventing the disease. Overall, this manuscript is well-written and meaningful to the field of adiposity and ECs. There are a few minimal comments on this review paper.

1. The insert positions of “Figure 1” in line 86 and “Figure 2” in line 127 are not suitable for their contents.

2. In line 124, the “Asghari et al.” should be romoved.

3. It will be better to include one summary or prospection paragraph in the end of the manuscript.

Author Response

We thank the reviewer for the helful comments and recommendations:

1. The position of the figures have been re-aranged.
2. in l. 124 "the Ashgari et." has been removed.
3. A conclusion has been added at the end of the manuscript.

Reviewer 2 Report

Dear authors,

dear editor

thank you for allowing me to review your manuscript/commentary "Obesity epidemic - the underestimated risk of endometrial cancer". I enjoyed reading your commentary, and ,indeed, I strongly suggest acceptance of this manuscript, as it addresses the both preclinically and clinically important topic of obesity in the context of both endometrial cancerogenesis and management. In my opinion, this issues has been addressed and discussed far too little in the recent literature, and the authors succeed in not only providing a comprehensive overview of obesity-associated mechanisms of tumor induction but also in providing their view on clinical complications and management strategies. The manuscript is well-written, the idiomatic knowledge of English appears convincing, and all formal requirements for editorial acceptance were met.

With all authors being surgical oncologists, they naturally focus on obesity-related surgical morbidities and complications. However, with chemotherapy and radiotherapy being main pillars in the multidisciplinary reatment of endometrial cancer, I strongly suggest to add two (brief) paragraphs on obesity-related complications during both chemotherapy and radiation treatments, which surely exist. This might require including two additional authors from the respective departments.

Also, the potential benefit of weight loss once the tumor has originated (during or after treatment) and its possible prognostic significance should be discussed.

In conclusion, I strongly recommend editorial acceptance - once these minor modifications have been made.

Author Response

We thank reviewer 2 for the helpful comments and recommendations:

We added  two chapters about the possible impact of obesity on chemotherapy and radiotherapy.

The potential impact of weight loss during therapy is discussed.

Reviewer 3 Report

Is this a revision? In the “introduction section” the authors affirm that it is a revision. Perhaps it should be modified.

The sections about treatments and conclusions should be expanded.

Author Response

We thank reviewer 3 for the helpful comments and recommedations.

In the introduction section it has been made clear that this is a "communication".

The sections about treatments and conclusion have been expanded.

Round 2

Reviewer 3 Report

This paper does not add more information to the scientific community, but as a commentary, it is well organized and written.