Title: The impact of Karnofsky Performance Status on prognosis of patients with hepatocellular
carcinoma in liver transplantation
Version: 1 Date: 12 Aug 2023
Reviewer:  Deok Gie Kim
Reviewer's report:
The authors tried to investigate the association between pre-transplant KPS score and long-term
outcomes in HCC patients listed for liver transplantation. Association between KPS before LT
and waiting list and post-LT mortality have been well-explored whereas relation with HCC
outcome has not. The conclusion of authors was negative for HCC recurrence, but positive for
survival, which were not novel finding. However, I think their finding would be informative
enough to be published in the journal if they clarify the purpose of the study.
There are several points needing major revision.
Most important point : what is the main purpose of this study? As the title says, association
between KPS and HCC outcome after LT? Then authors should clarify the primary purpose with
corresponding changes of whole study flow.
#Abstract
1. In the method, primary and secondary end points should be clearly descripted. Primary end
point of this study is HCC recurrence after LT, not ITT survival or OS after LT, wasn’t it? If I’m
true, authors should re-check the direction of the study flow and major point of abstract. If the
association between KPS and HCC recurrence after LT is the key point of this study, I suggest
ITT survival for wait-listed patients should be removed or moved to supplement. In this case,
study population could be changed to including LT recipients only.
2. In the results, please mention 5y ITT survival (if it should be included), post-transplant
survival and HCC recurrence. Also, HR with 95% CI should be presented for the results of Cox
and competing risk regression.
3. Conclusion should be fitted to the main purpose of the study (current form is in line with
the title though)
#Background
Background is too long and redundant. Please reduce it to an half of current form.
#Method
1. Too many abbreviations have been used. Use abbreviations only where essential.
2. “The time-dependent effects of KPS for survival were investigated based on Schoenfeld’s
residuals”  => please reference for this method
#Results
1. Results also should be corrected according to adequate primary and secondary end point and
study inclusion as mentioned above.
2. 1 digits after decimal point would be adequate for presenting survival rates.
3. 2 digits after decimal point would be adequate for presenting HR and 95% CI
4. Table 2 and 3 are two redundant. They should be moved to supplement and make 1 or 2
tables showing multivariable analyses for outcomes only including variables included in the
multivariable models.
5. Survival curves should be presented with number at risk.
6. curve for dropout do not need to be in main results. Please move it to supplement.
7. Please rearrange curves in 1 figure with multiple panels.
8. Legend is missing in the supplement figure 1.
Title: The impact of Karnofsky Performance Status on prognosis of patients with hepatocellular
carcinoma in liver transplantation
Version: 1 Date: 12 Aug 2023
Reviewer:  Deok Gie Kim
Reviewer's report:
The authors tried to investigate the association between pre-transplant KPS score and long-term
outcomes in HCC patients listed for liver transplantation. Association between KPS before LT
and waiting list and post-LT mortality have been well-explored whereas relation with HCC
outcome has not. The conclusion of authors was negative for HCC recurrence, but positive for
survival, which were not novel finding. However, I think their finding would be informative
enough to be published in the journal if they clarify the purpose of the study.
There are several points needing major revision.
Most important point : what is the main purpose of this study? As the title says, association
between KPS and HCC outcome after LT? Then authors should clarify the primary purpose with
corresponding changes of whole study flow.
#Abstract
1. In the method, primary and secondary end points should be clearly descripted. Primary end
point of this study is HCC recurrence after LT, not ITT survival or OS after LT, wasn’t it? If I’m
true, authors should re-check the direction of the study flow and major point of abstract. If the
association between KPS and HCC recurrence after LT is the key point of this study, I suggest
ITT survival for wait-listed patients should be removed or moved to supplement. In this case,
study population could be changed to including LT recipients only.
2. In the results, please mention 5y ITT survival (if it should be included), post-transplant
survival and HCC recurrence. Also, HR with 95% CI should be presented for the results of Cox
and competing risk regression.
3. Conclusion should be fitted to the main purpose of the study (current form is in line with
the title though)
#Background
Background is too long and redundant. Please reduce it to an half of current form.
#Method
1. Too many abbreviations have been used. Use abbreviations only where essential.
2. “The time-dependent effects of KPS for survival were investigated based on Schoenfeld’s
residuals”  => please reference for this method
#Results
1. Results also should be corrected according to adequate primary and secondary end point and
study inclusion as mentioned above.
2. 1 digits after decimal point would be adequate for presenting survival rates.
3. 2 digits after decimal point would be adequate for presenting HR and 95% CI
4. Table 2 and 3 are two redundant. They should be moved to supplement and make 1 or 2
tables showing multivariable analyses for outcomes only including variables included in the
multivariable models.
5. Survival curves should be presented with number at risk.
6. curve for dropout do not need to be in main results. Please move it to supplement.
7. Please rearrange curves in 1 figure with multiple panels.
8. Legend is missing in the supplement figure 1.
Please review this paper.
user
Title: The impact of Karnofsky Performance Status on prognosis of patients with hepatocellular
carcinoma in liver transplantation
Version: 1 Date: 12 Aug 2023
Reviewer:  Deok Gie Kim
Reviewer's report:
The authors tried to investigate the association between pre-transplant KPS score and long-term
outcomes in HCC patients listed for liver transplantation. Association between KPS before LT
and waiting list and post-LT mortality have been well-explored whereas relation with HCC
outcome has not. The conclusion of authors was negative for HCC recurrence, but positive for
survival, which were not novel finding. However, I think their finding would be informative
enough to be published in the journal if they clarify the purpose of the study.
There are several points needing major revision.
Most important point : what is the main purpose of this study? As the title says, association
between KPS and HCC outcome after LT? Then authors should clarify the primary purpose with
corresponding changes of whole study flow.
#Abstract
1. In the method, primary and secondary end points should be clearly descripted. Primary end
point of this study is HCC recurrence after LT, not ITT survival or OS after LT, wasn’t it? If I’m
true, authors should re-check the direction of the study flow and major point of abstract. If the
association between KPS and HCC recurrence after LT is the key point of this study, I suggest
ITT survival for wait-listed patients should be removed or moved to supplement. In this case,
study population could be changed to including LT recipients only.
2. In the results, please mention 5y ITT survival (if it should be included), post-transplant
survival and HCC recurrence. Also, HR with 95% CI should be presented for the results of Cox
and competing risk regression.
3. Conclusion should be fitted to the main purpose of the study (current form is in line with
the title though)
#Background
Background is too long and redundant. Please reduce it to an half of current form.
#Method
1. Too many abbreviations have been used. Use abbreviations only where essential.
2. “The time-dependent effects of KPS for survival were investigated based on Schoenfeld’s
residuals”  => please reference for this method
#Results
1. Results also should be corrected according to adequate primary and secondary end point and
study inclusion as mentioned above.
2. 1 digits after decimal point would be adequate for presenting survival rates.
3. 2 digits after decimal point would be adequate for presenting HR and 95% CI
4. Table 2 and 3 are two redundant. They should be moved to supplement and make 1 or 2
tables showing multivariable analyses for outcomes only including variables included in the
multivariable models.
5. Survival curves should be presented with number at risk.
6. curve for dropout do not need to be in main results. Please move it to supplement.
7. Please rearrange curves in 1 figure with multiple panels.
8. Legend is missing in the supplement figure 1.
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