Reviewer ’s report  
 
Title: The Alpha -fetoprotein Serum is still Reliable as a Bi omarker for the Surveillance of 
Hepatocellular Carcinoma in Indonesia  
 
Version: 0 Date: 08 Mar 2020  
 
Reviewer's report:  
 
I read with interest the paper: The Alpha -fetoprotein Serum is still Reliable as a Biomarker for 
the Surveillance of Hepatocellular Carcino ma in Indonesia by Alessa Fahira et al., however I 
have some major concerns an clearly mor clinical information is needed.  
 
The fact that the median survival of HCC patients is less than 3 month is alarming and needs to 
be addressed more deeply as that wou ld denote that more of less every Patient is diagnosed in 
BCLC stage D?? in Indonesia  
 
I agree with the authors, that AFP &gt;10ng is seen quite frequently  - however in how many 
patients with elevated AFP the HCC was not seen on Ultrasound? - roughly 20% of HCC where 
AFP negative  
 
How many patients with a nodule on ultrasound should normal AFP levels  
 
What happened to patients with pos - AFP and neg. Ultrasound - in other words how many CT 
scans or MRI scans are necessary to detect one additional HCC.  
 
As t he authors stated correctly that early detection is crucial but only about 17% in their 
collective have potentially resectable tumour sizes ( &lt;5 cm) in cirrhotic patients.  
 
I truly agree that AFP ads diagnostic accuracy, but the authors must focus more o n the false 
positive and false negative cohort   as those two groups both ad significantly to the diagnostic 
costs and moreover might even inherited adverse events for the patients.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the wo rk include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able t o assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, co nsidering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review  policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as con fidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Reviewer ’s report  
 
Title: The Alpha -fetoprotein Serum is still Reliable as a Bi omarker for the Surveillance of 
Hepatocellular Carcinoma in Indonesia  
 
Version: 0 Date: 08 Mar 2020  
 
Reviewer's report:  
 
I read with interest the paper: The Alpha -fetoprotein Serum is still Reliable as a Biomarker for 
the Surveillance of Hepatocellular Carcino ma in Indonesia by Alessa Fahira et al., however I 
have some major concerns an clearly mor clinical information is needed.  
 
The fact that the median survival of HCC patients is less than 3 month is alarming and needs to 
be addressed more deeply as that wou ld denote that more of less every Patient is diagnosed in 
BCLC stage D?? in Indonesia  
 
I agree with the authors, that AFP &gt;10ng is seen quite frequently  - however in how many 
patients with elevated AFP the HCC was not seen on Ultrasound? - roughly 20% of HCC where 
AFP negative  
 
How many patients with a nodule on ultrasound should normal AFP levels  
 
What happened to patients with pos - AFP and neg. Ultrasound - in other words how many CT 
scans or MRI scans are necessary to detect one additional HCC.  
 
As t he authors stated correctly that early detection is crucial but only about 17% in their 
collective have potentially resectable tumour sizes ( &lt;5 cm) in cirrhotic patients.  
 
I truly agree that AFP ads diagnostic accuracy, but the authors must focus more o n the false 
positive and false negative cohort   as those two groups both ad significantly to the diagnostic 
costs and moreover might even inherited adverse events for the patients.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the wo rk include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able t o assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, co nsidering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review  policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as con fidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
Please review this paper.
user
Reviewer ’s report  
 
Title: The Alpha -fetoprotein Serum is still Reliable as a Bi omarker for the Surveillance of 
Hepatocellular Carcinoma in Indonesia  
 
Version: 0 Date: 08 Mar 2020  
 
Reviewer's report:  
 
I read with interest the paper: The Alpha -fetoprotein Serum is still Reliable as a Biomarker for 
the Surveillance of Hepatocellular Carcino ma in Indonesia by Alessa Fahira et al., however I 
have some major concerns an clearly mor clinical information is needed.  
 
The fact that the median survival of HCC patients is less than 3 month is alarming and needs to 
be addressed more deeply as that wou ld denote that more of less every Patient is diagnosed in 
BCLC stage D?? in Indonesia  
 
I agree with the authors, that AFP &gt;10ng is seen quite frequently  - however in how many 
patients with elevated AFP the HCC was not seen on Ultrasound? - roughly 20% of HCC where 
AFP negative  
 
How many patients with a nodule on ultrasound should normal AFP levels  
 
What happened to patients with pos - AFP and neg. Ultrasound - in other words how many CT 
scans or MRI scans are necessary to detect one additional HCC.  
 
As t he authors stated correctly that early detection is crucial but only about 17% in their 
collective have potentially resectable tumour sizes ( &lt;5 cm) in cirrhotic patients.  
 
I truly agree that AFP ads diagnostic accuracy, but the authors must focus more o n the false 
positive and false negative cohort   as those two groups both ad significantly to the diagnostic 
costs and moreover might even inherited adverse events for the patients.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
Does the wo rk include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able t o assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Needs some language corrections before being published  
 
Declaration of competing interests  
Please complete a declaration of competing interests, co nsidering the following questions:  
 
1.  Have you in the past five years received reimbursements, f ees, funding, or salary 
from an organisation that may in any way gain or lose financial ly from the 
publication of this manuscript, either now or in the future?  
 
2.  Do you hold any stocks or shares in an organisation t hat may in any way gain or 
lose financially from the publication of this manuscript, either now or in the 
future?  
 
3.  Do you hold or are you currently applying for any patents relating to the content 
of the manuscript?  
 
4.  Have you received reimbursements, fees, funding, or salary from an organization 
that holds or has applied for patents relating to the content of the manuscript?  
 
5.  Do you have any other financial competing interests?  
 
6.  Do you have any  non-financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
none  
 
I agree to the open peer review  policy of the journal. I understan d that my name will be included 
on my report to the authors and, if the manuscript is accepted f or publication, my named report 
including any attachments I upload will be posted on the website along with the authors' 
responses. I agree for my report to be made available under an Open Access Creative Commons 
CC-BY license ( http://creativecommons.org/licenses/by/4.0/ ). I understand that any comments 
which I do not wish to be included in my named report can be included as con fidential comments  
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal  
assistant