Title: Incremental High Power Radiofrequency Ablation with Multi-electrodes for Small
Hepatocellular Carcinoma: A Prospective Study
Version: 1 Date: 17 Jul 2024
Reviewer's report:
Thank you for inviting me to review the article 'Incremental High Power Radiofrequency
Ablation with Multi-electrodes for Small Hepatocellular Carcinoma: A Prospective Study'
submitted to BMC Gastroenterology. The authors reported the outcomes regarding high-power
RFA which is considered to be a new technique to reduce local recurrence of HCC in patients
suitable for ablative therapy.
While the authors reported impressively high technical success and low rate of local tumor
progression, there are some questions and suggestions regarding this article as follows:
Major points:
1. What is the primary objective of the study? On page 6, the authors stated that the primary
endpoint was cumulative 3-year LTP whereas on page 7, the authors wrote that the key outcome
is the creation of ideal safety margin >5 mm around the treated tumor. Sample size should be
calculated based on the primary objective of the study. This should be clarified.
2. The major drawback of the current study is that there is no control group. The authors
hypothesized that the high power RFA technique would create a larger ablation zone and reduce
the incidence of local recurrence. If there is a control group for comparisons between this new
technique and conventional RFA technique, it would be much helpful and increase the validity of
the current study. I noticed that the study design was not an RCT, but the historical control of the
patients underwent conventional RFA at the same institute might be the suitable control group.
3. Regarding comment #2, the statement in the discussion part written that high-power RFA is
superior to conventional RFA seems to be overclaimed, as the study was not designed in that
manner, please refrain to make that assumption. There might be other variables influences the
different in LTP between different studies other than the technique itself.
Minor points:
4.  Please check for the typo errors for an entire manuscript, as well as the tense used in the
method part.
5. There are some discrepancies in numbers e.g., on page 7 the authors stated that they included
105 patients, whereas it was 110 patients on the results part and in the figure of study flow.
Additionally, why the authors excluded 7 patients who had follow up time of less than 12 months,
this was not stated in the exclusion criteria and should be elaborated more.
6. Regarding comment #5, the calculated sample size was 124, why the authors included only
110 (or 105?) patients in this study? This should be explained and mentioned somewhere in the
manuscript.
7.  in Table 1, Tumor size (cm) = 5 (16.7%) seems to be incorrect. Please check, and tumor
number should be present in this table as well.
Title: Incremental High Power Radiofrequency Ablation with Multi-electrodes for Small
Hepatocellular Carcinoma: A Prospective Study
Version: 1 Date: 17 Jul 2024
Reviewer's report:
Thank you for inviting me to review the article 'Incremental High Power Radiofrequency
Ablation with Multi-electrodes for Small Hepatocellular Carcinoma: A Prospective Study'
submitted to BMC Gastroenterology. The authors reported the outcomes regarding high-power
RFA which is considered to be a new technique to reduce local recurrence of HCC in patients
suitable for ablative therapy.
While the authors reported impressively high technical success and low rate of local tumor
progression, there are some questions and suggestions regarding this article as follows:
Major points:
1. What is the primary objective of the study? On page 6, the authors stated that the primary
endpoint was cumulative 3-year LTP whereas on page 7, the authors wrote that the key outcome
is the creation of ideal safety margin >5 mm around the treated tumor. Sample size should be
calculated based on the primary objective of the study. This should be clarified.
2. The major drawback of the current study is that there is no control group. The authors
hypothesized that the high power RFA technique would create a larger ablation zone and reduce
the incidence of local recurrence. If there is a control group for comparisons between this new
technique and conventional RFA technique, it would be much helpful and increase the validity of
the current study. I noticed that the study design was not an RCT, but the historical control of the
patients underwent conventional RFA at the same institute might be the suitable control group.
3. Regarding comment #2, the statement in the discussion part written that high-power RFA is
superior to conventional RFA seems to be overclaimed, as the study was not designed in that
manner, please refrain to make that assumption. There might be other variables influences the
different in LTP between different studies other than the technique itself.
Minor points:
4.  Please check for the typo errors for an entire manuscript, as well as the tense used in the
method part.
5. There are some discrepancies in numbers e.g., on page 7 the authors stated that they included
105 patients, whereas it was 110 patients on the results part and in the figure of study flow.
Additionally, why the authors excluded 7 patients who had follow up time of less than 12 months,
this was not stated in the exclusion criteria and should be elaborated more.
6. Regarding comment #5, the calculated sample size was 124, why the authors included only
110 (or 105?) patients in this study? This should be explained and mentioned somewhere in the
manuscript.
7.  in Table 1, Tumor size (cm) = 5 (16.7%) seems to be incorrect. Please check, and tumor
number should be present in this table as well.
Please review this paper.
user
Title: Incremental High Power Radiofrequency Ablation with Multi-electrodes for Small
Hepatocellular Carcinoma: A Prospective Study
Version: 1 Date: 17 Jul 2024
Reviewer's report:
Thank you for inviting me to review the article 'Incremental High Power Radiofrequency
Ablation with Multi-electrodes for Small Hepatocellular Carcinoma: A Prospective Study'
submitted to BMC Gastroenterology. The authors reported the outcomes regarding high-power
RFA which is considered to be a new technique to reduce local recurrence of HCC in patients
suitable for ablative therapy.
While the authors reported impressively high technical success and low rate of local tumor
progression, there are some questions and suggestions regarding this article as follows:
Major points:
1. What is the primary objective of the study? On page 6, the authors stated that the primary
endpoint was cumulative 3-year LTP whereas on page 7, the authors wrote that the key outcome
is the creation of ideal safety margin >5 mm around the treated tumor. Sample size should be
calculated based on the primary objective of the study. This should be clarified.
2. The major drawback of the current study is that there is no control group. The authors
hypothesized that the high power RFA technique would create a larger ablation zone and reduce
the incidence of local recurrence. If there is a control group for comparisons between this new
technique and conventional RFA technique, it would be much helpful and increase the validity of
the current study. I noticed that the study design was not an RCT, but the historical control of the
patients underwent conventional RFA at the same institute might be the suitable control group.
3. Regarding comment #2, the statement in the discussion part written that high-power RFA is
superior to conventional RFA seems to be overclaimed, as the study was not designed in that
manner, please refrain to make that assumption. There might be other variables influences the
different in LTP between different studies other than the technique itself.
Minor points:
4.  Please check for the typo errors for an entire manuscript, as well as the tense used in the
method part.
5. There are some discrepancies in numbers e.g., on page 7 the authors stated that they included
105 patients, whereas it was 110 patients on the results part and in the figure of study flow.
Additionally, why the authors excluded 7 patients who had follow up time of less than 12 months,
this was not stated in the exclusion criteria and should be elaborated more.
6. Regarding comment #5, the calculated sample size was 124, why the authors included only
110 (or 105?) patients in this study? This should be explained and mentioned somewhere in the
manuscript.
7.  in Table 1, Tumor size (cm) = 5 (16.7%) seems to be incorrect. Please check, and tumor
number should be present in this table as well.
assistant