Title: Evaluation of patients treated with direct-acting anti-viral therapy for chronic hepatitis C
and their risk of hepatocellular carcinoma in Hong Kong
Version: 3 Date: 13 Nov 2023
Reviewer's report:
This study on the treatment of patients with HCV has certain clinical value.
I have the following suggestions and questions.
1#While direct antivirals have been widely used to treat patients with HCV infection, they have
been shown to reduce all-cause mortality. However, the results are affected by many factors, so
it is necessary to study the influence of single factors in the later stage. For example: age, sex,
body mass index, geographical origin, route of infection, fibrosis score, alcohol consumption,
diabetes, etc. For follow-up studies, I recommend focusing on assessing how diabetes, weight
change, and alcohol consumption affect liver cancer risk, and extending follow-up, preferably
to more than seven years. Do you have any follow-up plans?
2#The follow-up time was insufficient. Although HCC risk decreased after a sustained
virological response to direct-acting antivirals, follow-up was not long enough to determine
whether cancer risk continued to decline to a level sufficient to forgo screening. Although the
authors also stated in the limitations, I recommend extending the follow-up time. The current
results are acceptable, will you continue to follow up in the later study?
3#METHODS---“Definitions”
“The diagnosis of cirrhosis would be established if at least one of the following was present:
i) liver histology showing stage 4 fibrosis (METAVIR score); ii) liver stiffness measurement
(LSM) greater than 12.5 kPa at transient elastography (FibroScan, Echosens, Paris, France) (33);
iii) signs of cirrhosis on imaging of the abdomen (34); iv) evidence of portal hypertension at
Oesophago-gastro-duodenoscopy (OGD).”
i, ii, iv can be determined. But number two: "liver stiffness measurement (LSM) greater than
12.5 kPa at transient elastography", LSM is a relatively new non-invasive quantitative evaluation
method of liver stiffness. But the latest is the SWE liver elasticity measure. There is still some
controversy about the repeatability and accuracy of the two ultrasound methods. If the authors
are to consider LSM as one of the diagnostic methods, it is necessary to add references to LSM
to support the article.Suggest added relevant references about the LSM.
Title: Evaluation of patients treated with direct-acting anti-viral therapy for chronic hepatitis C
and their risk of hepatocellular carcinoma in Hong Kong
Version: 3 Date: 13 Nov 2023
Reviewer's report:
This study on the treatment of patients with HCV has certain clinical value.
I have the following suggestions and questions.
1#While direct antivirals have been widely used to treat patients with HCV infection, they have
been shown to reduce all-cause mortality. However, the results are affected by many factors, so
it is necessary to study the influence of single factors in the later stage. For example: age, sex,
body mass index, geographical origin, route of infection, fibrosis score, alcohol consumption,
diabetes, etc. For follow-up studies, I recommend focusing on assessing how diabetes, weight
change, and alcohol consumption affect liver cancer risk, and extending follow-up, preferably
to more than seven years. Do you have any follow-up plans?
2#The follow-up time was insufficient. Although HCC risk decreased after a sustained
virological response to direct-acting antivirals, follow-up was not long enough to determine
whether cancer risk continued to decline to a level sufficient to forgo screening. Although the
authors also stated in the limitations, I recommend extending the follow-up time. The current
results are acceptable, will you continue to follow up in the later study?
3#METHODS---“Definitions”
“The diagnosis of cirrhosis would be established if at least one of the following was present:
i) liver histology showing stage 4 fibrosis (METAVIR score); ii) liver stiffness measurement
(LSM) greater than 12.5 kPa at transient elastography (FibroScan, Echosens, Paris, France) (33);
iii) signs of cirrhosis on imaging of the abdomen (34); iv) evidence of portal hypertension at
Oesophago-gastro-duodenoscopy (OGD).”
i, ii, iv can be determined. But number two: "liver stiffness measurement (LSM) greater than
12.5 kPa at transient elastography", LSM is a relatively new non-invasive quantitative evaluation
method of liver stiffness. But the latest is the SWE liver elasticity measure. There is still some
controversy about the repeatability and accuracy of the two ultrasound methods. If the authors
are to consider LSM as one of the diagnostic methods, it is necessary to add references to LSM
to support the article.Suggest added relevant references about the LSM.
Please review this paper.
user
Title: Evaluation of patients treated with direct-acting anti-viral therapy for chronic hepatitis C
and their risk of hepatocellular carcinoma in Hong Kong
Version: 3 Date: 13 Nov 2023
Reviewer's report:
This study on the treatment of patients with HCV has certain clinical value.
I have the following suggestions and questions.
1#While direct antivirals have been widely used to treat patients with HCV infection, they have
been shown to reduce all-cause mortality. However, the results are affected by many factors, so
it is necessary to study the influence of single factors in the later stage. For example: age, sex,
body mass index, geographical origin, route of infection, fibrosis score, alcohol consumption,
diabetes, etc. For follow-up studies, I recommend focusing on assessing how diabetes, weight
change, and alcohol consumption affect liver cancer risk, and extending follow-up, preferably
to more than seven years. Do you have any follow-up plans?
2#The follow-up time was insufficient. Although HCC risk decreased after a sustained
virological response to direct-acting antivirals, follow-up was not long enough to determine
whether cancer risk continued to decline to a level sufficient to forgo screening. Although the
authors also stated in the limitations, I recommend extending the follow-up time. The current
results are acceptable, will you continue to follow up in the later study?
3#METHODS---“Definitions”
“The diagnosis of cirrhosis would be established if at least one of the following was present:
i) liver histology showing stage 4 fibrosis (METAVIR score); ii) liver stiffness measurement
(LSM) greater than 12.5 kPa at transient elastography (FibroScan, Echosens, Paris, France) (33);
iii) signs of cirrhosis on imaging of the abdomen (34); iv) evidence of portal hypertension at
Oesophago-gastro-duodenoscopy (OGD).”
i, ii, iv can be determined. But number two: "liver stiffness measurement (LSM) greater than
12.5 kPa at transient elastography", LSM is a relatively new non-invasive quantitative evaluation
method of liver stiffness. But the latest is the SWE liver elasticity measure. There is still some
controversy about the repeatability and accuracy of the two ultrasound methods. If the authors
are to consider LSM as one of the diagnostic methods, it is necessary to add references to LSM
to support the article.Suggest added relevant references about the LSM.
assistant