Title: The Predictive Value of PIV, PLR, LMR, NPR, and NLR for the Prognosis of
Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Combined with
Liver Cirrhosis
Version: 1 Date: 09 Feb 2025
Reviewer's report:
In this single-centre retrospective study, the authors aimed  to assess the prognostic
value of different inflammatory markers such as pan-immunological value (PIV), platelet-
lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), neutrophil-platelet ratio (NPR),
and neutrophil-lymphocyte ratio (NLR) in predicting outcomes in hepatocellular carcinoma
(HCC) patients with underlying cirrhosis undergoing transarterial chemoembolization (TACE).
Overall, 216 HCC patients underwent TACE were studied. According to the inclusion criteria,
patients' liver function had to be classified as Child-Pugh grade A and also B class.
Exclusion criteria included acute or chronic inflammatory diseases, evidence of infections,
ongoing medications like aspirin or clopidogrel, hematologic disorders or immunological
diseases. They found that patients in the poor prognosis group had significantly higher PIV,
PLR, NLR, and NPR, and lower LMR. After multivariate analysis, PIV and NPR showed the
strongest independent predictors of poor prognosis and ROC analysis demonstrated that PIV had
the greatest predictive accuracy (AUC = 0.803). The authors concluded that PIV, PLR, LMR,
NPR, and NLR are significant prognostic markers for cirrhotic patients with HCC receving
TACE .
Comments:
-To this referee is not clear the HCC stage of patients underwent TACE. To better analyze the
study design and results, the authors should report the HCC stage according to the more widely
used BCLC staging system. This would allow to better understand the tumor burden and other
important patients features such as liver function and performance status.
-Could the authors report in detail the TACE procedure ?
-How many HCC treatment(s) and type of treatment(s), if any, had received the enrolled
patients? This might impact the laboratory parameters, the residual liver function,  and thus the
study results.
-The authors should expand the literature data on previous studies assessing the prgnostic
markers and scores in HCC patients receiving TACE, such as TACE Predict (Hepatology 2019),
ASAR (BMC Cancer 2020). as well as post-TACE transient hypertrasanminasemia that showed
significant correlation withe radiological objective response, as recently demonstrated (J Pers
Med. 2021;11:1041. doi: 10.3390/jpm11101041. ). The authors could suggest how to combine
their prognostic markers with these previously reported laboratory prognostic markers.
Title: The Predictive Value of PIV, PLR, LMR, NPR, and NLR for the Prognosis of
Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Combined with
Liver Cirrhosis
Version: 1 Date: 09 Feb 2025
Reviewer's report:
In this single-centre retrospective study, the authors aimed  to assess the prognostic
value of different inflammatory markers such as pan-immunological value (PIV), platelet-
lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), neutrophil-platelet ratio (NPR),
and neutrophil-lymphocyte ratio (NLR) in predicting outcomes in hepatocellular carcinoma
(HCC) patients with underlying cirrhosis undergoing transarterial chemoembolization (TACE).
Overall, 216 HCC patients underwent TACE were studied. According to the inclusion criteria,
patients' liver function had to be classified as Child-Pugh grade A and also B class.
Exclusion criteria included acute or chronic inflammatory diseases, evidence of infections,
ongoing medications like aspirin or clopidogrel, hematologic disorders or immunological
diseases. They found that patients in the poor prognosis group had significantly higher PIV,
PLR, NLR, and NPR, and lower LMR. After multivariate analysis, PIV and NPR showed the
strongest independent predictors of poor prognosis and ROC analysis demonstrated that PIV had
the greatest predictive accuracy (AUC = 0.803). The authors concluded that PIV, PLR, LMR,
NPR, and NLR are significant prognostic markers for cirrhotic patients with HCC receving
TACE .
Comments:
-To this referee is not clear the HCC stage of patients underwent TACE. To better analyze the
study design and results, the authors should report the HCC stage according to the more widely
used BCLC staging system. This would allow to better understand the tumor burden and other
important patients features such as liver function and performance status.
-Could the authors report in detail the TACE procedure ?
-How many HCC treatment(s) and type of treatment(s), if any, had received the enrolled
patients? This might impact the laboratory parameters, the residual liver function,  and thus the
study results.
-The authors should expand the literature data on previous studies assessing the prgnostic
markers and scores in HCC patients receiving TACE, such as TACE Predict (Hepatology 2019),
ASAR (BMC Cancer 2020). as well as post-TACE transient hypertrasanminasemia that showed
significant correlation withe radiological objective response, as recently demonstrated (J Pers
Med. 2021;11:1041. doi: 10.3390/jpm11101041. ). The authors could suggest how to combine
their prognostic markers with these previously reported laboratory prognostic markers.
Please review this paper.
user
Title: The Predictive Value of PIV, PLR, LMR, NPR, and NLR for the Prognosis of
Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Combined with
Liver Cirrhosis
Version: 1 Date: 09 Feb 2025
Reviewer's report:
In this single-centre retrospective study, the authors aimed  to assess the prognostic
value of different inflammatory markers such as pan-immunological value (PIV), platelet-
lymphocyte ratio (PLR), lymphocyte-monocyte ratio (LMR), neutrophil-platelet ratio (NPR),
and neutrophil-lymphocyte ratio (NLR) in predicting outcomes in hepatocellular carcinoma
(HCC) patients with underlying cirrhosis undergoing transarterial chemoembolization (TACE).
Overall, 216 HCC patients underwent TACE were studied. According to the inclusion criteria,
patients' liver function had to be classified as Child-Pugh grade A and also B class.
Exclusion criteria included acute or chronic inflammatory diseases, evidence of infections,
ongoing medications like aspirin or clopidogrel, hematologic disorders or immunological
diseases. They found that patients in the poor prognosis group had significantly higher PIV,
PLR, NLR, and NPR, and lower LMR. After multivariate analysis, PIV and NPR showed the
strongest independent predictors of poor prognosis and ROC analysis demonstrated that PIV had
the greatest predictive accuracy (AUC = 0.803). The authors concluded that PIV, PLR, LMR,
NPR, and NLR are significant prognostic markers for cirrhotic patients with HCC receving
TACE .
Comments:
-To this referee is not clear the HCC stage of patients underwent TACE. To better analyze the
study design and results, the authors should report the HCC stage according to the more widely
used BCLC staging system. This would allow to better understand the tumor burden and other
important patients features such as liver function and performance status.
-Could the authors report in detail the TACE procedure ?
-How many HCC treatment(s) and type of treatment(s), if any, had received the enrolled
patients? This might impact the laboratory parameters, the residual liver function,  and thus the
study results.
-The authors should expand the literature data on previous studies assessing the prgnostic
markers and scores in HCC patients receiving TACE, such as TACE Predict (Hepatology 2019),
ASAR (BMC Cancer 2020). as well as post-TACE transient hypertrasanminasemia that showed
significant correlation withe radiological objective response, as recently demonstrated (J Pers
Med. 2021;11:1041. doi: 10.3390/jpm11101041. ). The authors could suggest how to combine
their prognostic markers with these previously reported laboratory prognostic markers.
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