Title: Dynamic Changes in Liver Stiffness Measurement by 2D Shear-wave Elastography
Predict Hepatocellular Carcinoma in Patients with Chronic Hepatitis B and Well-controlled
Viremia: A Retrospective Study
Version: 2 Date: 22 Apr 2025
Reviewer:  Suzan Hamed
Reviewer's report:
In this article the authors studied the capability of using dynamic changes in liver stiffness
measurements for chronic HBV patients with sustained controlled Viremia in predicting HCC
development.
This is a good study.
However, I have few comments.
1-The authors mentioned at the methods section line 140 that "Cirrhosis was clinically diagnosed
in patients who met the following criteria: (a) ultrasound findings suggestive of cirrhosis, (b)
serum albumin < 35 g/L, PLT < 100 × 109/L, international normalized ratio (INR) > 1.3 or
prolonged prothrombin time, and AST-to-PLT ratio index > 2 (meeting 2 or more of the above
criteria), and (c) evidence of portal hypertension."
They also mentioned that the number of cirrhotic patients was only 45.
They need to expand the definition of cirrhosis to include all F4 patients and also need to add to
them all patients with advanced fibrosis (F3) as all these patients have increased risk for HCC
development.
2- The authors need to clarify if all the patients were followed up for the same period of time or
there was significant difference in the duration of follow up for different patients, as the more
prolonged infection may be a confounding factor for the development of HCC.
3-The authors mentioned that they developed nomogram model for HCC prediction and
Comparison of the performance of the new model and previous models and compared the
performance of their new model with that of other models like SAGE-B, HCC-RESCUE and
REACH-B II.  I think the authors need to validate these results on a larger sample size.
Title: Dynamic Changes in Liver Stiffness Measurement by 2D Shear-wave Elastography
Predict Hepatocellular Carcinoma in Patients with Chronic Hepatitis B and Well-controlled
Viremia: A Retrospective Study
Version: 2 Date: 22 Apr 2025
Reviewer:  Suzan Hamed
Reviewer's report:
In this article the authors studied the capability of using dynamic changes in liver stiffness
measurements for chronic HBV patients with sustained controlled Viremia in predicting HCC
development.
This is a good study.
However, I have few comments.
1-The authors mentioned at the methods section line 140 that "Cirrhosis was clinically diagnosed
in patients who met the following criteria: (a) ultrasound findings suggestive of cirrhosis, (b)
serum albumin < 35 g/L, PLT < 100 × 109/L, international normalized ratio (INR) > 1.3 or
prolonged prothrombin time, and AST-to-PLT ratio index > 2 (meeting 2 or more of the above
criteria), and (c) evidence of portal hypertension."
They also mentioned that the number of cirrhotic patients was only 45.
They need to expand the definition of cirrhosis to include all F4 patients and also need to add to
them all patients with advanced fibrosis (F3) as all these patients have increased risk for HCC
development.
2- The authors need to clarify if all the patients were followed up for the same period of time or
there was significant difference in the duration of follow up for different patients, as the more
prolonged infection may be a confounding factor for the development of HCC.
3-The authors mentioned that they developed nomogram model for HCC prediction and
Comparison of the performance of the new model and previous models and compared the
performance of their new model with that of other models like SAGE-B, HCC-RESCUE and
REACH-B II.  I think the authors need to validate these results on a larger sample size.
Please review this paper.
user
Title: Dynamic Changes in Liver Stiffness Measurement by 2D Shear-wave Elastography
Predict Hepatocellular Carcinoma in Patients with Chronic Hepatitis B and Well-controlled
Viremia: A Retrospective Study
Version: 2 Date: 22 Apr 2025
Reviewer:  Suzan Hamed
Reviewer's report:
In this article the authors studied the capability of using dynamic changes in liver stiffness
measurements for chronic HBV patients with sustained controlled Viremia in predicting HCC
development.
This is a good study.
However, I have few comments.
1-The authors mentioned at the methods section line 140 that "Cirrhosis was clinically diagnosed
in patients who met the following criteria: (a) ultrasound findings suggestive of cirrhosis, (b)
serum albumin < 35 g/L, PLT < 100 × 109/L, international normalized ratio (INR) > 1.3 or
prolonged prothrombin time, and AST-to-PLT ratio index > 2 (meeting 2 or more of the above
criteria), and (c) evidence of portal hypertension."
They also mentioned that the number of cirrhotic patients was only 45.
They need to expand the definition of cirrhosis to include all F4 patients and also need to add to
them all patients with advanced fibrosis (F3) as all these patients have increased risk for HCC
development.
2- The authors need to clarify if all the patients were followed up for the same period of time or
there was significant difference in the duration of follow up for different patients, as the more
prolonged infection may be a confounding factor for the development of HCC.
3-The authors mentioned that they developed nomogram model for HCC prediction and
Comparison of the performance of the new model and previous models and compared the
performance of their new model with that of other models like SAGE-B, HCC-RESCUE and
REACH-B II.  I think the authors need to validate these results on a larger sample size.
assistant