Reviewer ’s report  
 
Title:  The association of liver function and quality of life of patients with liver cancer  
 
Version: 0 Date: 12 Dec 2018 
 
Reviewer:  Research  Square  
 
Reviewer’s report:  
 
"STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the research question (considering whether the analyzed 
population accurately reflects the design  and whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
No - there are minor issues  
 
 
Are methodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are major issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whether figures and tables are well labeled and described)?  
 
No - there are major issues  
 
 
Does the interpretation accurately reflect the analyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
No - there are major issues  
 
 
Could an appropriately REVISE D version of this work represent a statistically sound 
contribution?  
 
Maybe - with major revisions  
 
 
STATISTICAL REVIEWER COMMENTS:  
 
The manuscript entitled "The association of liver function and quality of life of patients with 
liver cancer" presents corre lation analyses between a few quality -of-life (QOL) parameters and a 
few liver functions in the patients having Hapatocellular carcinoma (HCC), a common type of 
liver cancer. The authors briefly describe the QOL parameters and the liver function parameters  
in tables. They also briefly describe the association studies done elsewhere and the importance of 
such relationship in the overall survival of the patients with HCC. After the study, the authors 
were able to observe some association/correlation between t he QOL and liver functions. Strength 
of the manuscript is the large number of subjects in the study and weaknesses are the statistical 
analysis and English write -up. Appropriately revised manuscript can be interesting to some 
people working in the area of HCC.  
 
 
REQUESTED REVISIONS:  
 
1. The statistical analysis part of the manuscript is very weak. The authors have wrongly 
mentioned that T -test was used to assess the correlation. T test does not measure the 
correlation. T -test is used to assess the differenc e in mean scores between the two groups. 
The way it is presented in the manuscript, it looks like a few liver functions were 
dichotomized and the two sample T -test was used to assess the difference in the QOL 
scores between the two groups of liver function s. However, the rationale of such 
dichotomization should be presented. For example, why child class was groups as A vs 
B+C, ALBI grade was grouped as G1 vs G2+3 etc. Alternatively, the comparison of the 
QOL scores can be done for more than two groups using  One-way ANOVA or Kruskall 
Wallis test.  
 
2. Next, a large number of pairwise comparisons were done and presented in the 
manuscript. However, no multiple testing adjustments are done. The type I error 
increases as number of comparisons increase and therefor e appropriate adjustments are 
required before drawing any interpretations. There are several methods to do that e.g. 
Bonferroni method, Benzamini and Hochberg's FDR method etc. This will help in 
controlling false positives.  
 
3. The authors talk about overa ll survival (OS) but there is no analysis or discussion 
presented in the manuscript about any survival analysis. Perhaps, survival analysis is out 
of scope of this manuscript.  
 
4. In the results section, authors have simply described the large number of cor relations in 
words. It would be helpful to the readers if the authors present the selected important 
results in the form of figures and diagrams. For example, the comparison across the 
groups can be presented with boxplots, and comparison of the continuous  variables with 
scatter plots with trend lines on them.   
 
5. There are several grammatical errors throughout the manuscript. At some places, it is 
very hard to understand what the authors mean. Professional English language edit is 
required to improve the manuscript.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
NA" 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to  the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comm ents to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 -financi al 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer ha s 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the websi te 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 confidential 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 association of liver function and quality of life of patients with liver cancer  
 
Version: 0 Date: 12 Dec 2018 
 
Reviewer:  Research  Square  
 
Reviewer’s report:  
 
"STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the research question (considering whether the analyzed 
population accurately reflects the design  and whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
No - there are minor issues  
 
 
Are methodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are major issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whether figures and tables are well labeled and described)?  
 
No - there are major issues  
 
 
Does the interpretation accurately reflect the analyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
No - there are major issues  
 
 
Could an appropriately REVISE D version of this work represent a statistically sound 
contribution?  
 
Maybe - with major revisions  
 
 
STATISTICAL REVIEWER COMMENTS:  
 
The manuscript entitled "The association of liver function and quality of life of patients with 
liver cancer" presents corre lation analyses between a few quality -of-life (QOL) parameters and a 
few liver functions in the patients having Hapatocellular carcinoma (HCC), a common type of 
liver cancer. The authors briefly describe the QOL parameters and the liver function parameters  
in tables. They also briefly describe the association studies done elsewhere and the importance of 
such relationship in the overall survival of the patients with HCC. After the study, the authors 
were able to observe some association/correlation between t he QOL and liver functions. Strength 
of the manuscript is the large number of subjects in the study and weaknesses are the statistical 
analysis and English write -up. Appropriately revised manuscript can be interesting to some 
people working in the area of HCC.  
 
 
REQUESTED REVISIONS:  
 
1. The statistical analysis part of the manuscript is very weak. The authors have wrongly 
mentioned that T -test was used to assess the correlation. T test does not measure the 
correlation. T -test is used to assess the differenc e in mean scores between the two groups. 
The way it is presented in the manuscript, it looks like a few liver functions were 
dichotomized and the two sample T -test was used to assess the difference in the QOL 
scores between the two groups of liver function s. However, the rationale of such 
dichotomization should be presented. For example, why child class was groups as A vs 
B+C, ALBI grade was grouped as G1 vs G2+3 etc. Alternatively, the comparison of the 
QOL scores can be done for more than two groups using  One-way ANOVA or Kruskall 
Wallis test.  
 
2. Next, a large number of pairwise comparisons were done and presented in the 
manuscript. However, no multiple testing adjustments are done. The type I error 
increases as number of comparisons increase and therefor e appropriate adjustments are 
required before drawing any interpretations. There are several methods to do that e.g. 
Bonferroni method, Benzamini and Hochberg's FDR method etc. This will help in 
controlling false positives.  
 
3. The authors talk about overa ll survival (OS) but there is no analysis or discussion 
presented in the manuscript about any survival analysis. Perhaps, survival analysis is out 
of scope of this manuscript.  
 
4. In the results section, authors have simply described the large number of cor relations in 
words. It would be helpful to the readers if the authors present the selected important 
results in the form of figures and diagrams. For example, the comparison across the 
groups can be presented with boxplots, and comparison of the continuous  variables with 
scatter plots with trend lines on them.   
 
5. There are several grammatical errors throughout the manuscript. At some places, it is 
very hard to understand what the authors mean. Professional English language edit is 
required to improve the manuscript.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
NA" 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to  the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comm ents to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 -financi al 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer ha s 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the websi te 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 confidential 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 association of liver function and quality of life of patients with liver cancer  
 
Version: 0 Date: 12 Dec 2018 
 
Reviewer:  Research  Square  
 
Reviewer’s report:  
 
"STATISTICAL REVIEWER ASSESSMENT:  
 
Is the study design appropriate for the research question (considering whether the analyzed 
population accurately reflects the design  and whether you see any problems with 
control/comparison groups, e.g., likely confounders)?  
 
No - there are minor issues  
 
 
Are methodologies adequate and well implemented (considering whether assumptions are 
addressed and whether analyses are robust)?  
 
No - there are major issues  
 
 
Are the analyses adequately communicated (considering whether reporting details are adequate 
and whether figures and tables are well labeled and described)?  
 
No - there are major issues  
 
 
Does the interpretation accurately reflect the analyses without overstatement (considering 
whether limitations/bias are acknowledged and whether accurate descriptors, e.g., 'significant', 
are used?  
 
No - there are major issues  
 
 
Could an appropriately REVISE D version of this work represent a statistically sound 
contribution?  
 
Maybe - with major revisions  
 
 
STATISTICAL REVIEWER COMMENTS:  
 
The manuscript entitled "The association of liver function and quality of life of patients with 
liver cancer" presents corre lation analyses between a few quality -of-life (QOL) parameters and a 
few liver functions in the patients having Hapatocellular carcinoma (HCC), a common type of 
liver cancer. The authors briefly describe the QOL parameters and the liver function parameters  
in tables. They also briefly describe the association studies done elsewhere and the importance of 
such relationship in the overall survival of the patients with HCC. After the study, the authors 
were able to observe some association/correlation between t he QOL and liver functions. Strength 
of the manuscript is the large number of subjects in the study and weaknesses are the statistical 
analysis and English write -up. Appropriately revised manuscript can be interesting to some 
people working in the area of HCC.  
 
 
REQUESTED REVISIONS:  
 
1. The statistical analysis part of the manuscript is very weak. The authors have wrongly 
mentioned that T -test was used to assess the correlation. T test does not measure the 
correlation. T -test is used to assess the differenc e in mean scores between the two groups. 
The way it is presented in the manuscript, it looks like a few liver functions were 
dichotomized and the two sample T -test was used to assess the difference in the QOL 
scores between the two groups of liver function s. However, the rationale of such 
dichotomization should be presented. For example, why child class was groups as A vs 
B+C, ALBI grade was grouped as G1 vs G2+3 etc. Alternatively, the comparison of the 
QOL scores can be done for more than two groups using  One-way ANOVA or Kruskall 
Wallis test.  
 
2. Next, a large number of pairwise comparisons were done and presented in the 
manuscript. However, no multiple testing adjustments are done. The type I error 
increases as number of comparisons increase and therefor e appropriate adjustments are 
required before drawing any interpretations. There are several methods to do that e.g. 
Bonferroni method, Benzamini and Hochberg's FDR method etc. This will help in 
controlling false positives.  
 
3. The authors talk about overa ll survival (OS) but there is no analysis or discussion 
presented in the manuscript about any survival analysis. Perhaps, survival analysis is out 
of scope of this manuscript.  
 
4. In the results section, authors have simply described the large number of cor relations in 
words. It would be helpful to the readers if the authors present the selected important 
results in the form of figures and diagrams. For example, the comparison across the 
groups can be presented with boxplots, and comparison of the continuous  variables with 
scatter plots with trend lines on them.   
 
5. There are several grammatical errors throughout the manuscript. At some places, it is 
very hard to understand what the authors mean. Professional English language edit is 
required to improve the manuscript.  
 
ADDITIONAL REQUESTS/SUGGESTIONS:  
 
NA" 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to  the authors.  
 
No 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
No 
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comm ents to the authors.  
 
No 
 
Are you able to assess any statistics in the manuscript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, consideri ng the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an 
organisation that may in any way gain or lose financially from the publication of this 
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation that 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 -financi al 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.  
 
This reviewer has been recruited by a partner organization, Research Square. Reviewers with 
declared or apparent competing interests are not utilized for these reviews. This reviewer ha s 
agreed to publication of their comments online under a Creative Commons Attribution License 
attributed to Research Square and was paid a small honorarium for completing the review within 
a specified timeframe. Honoraria for reviews such as this are paid regardless of the reviewer 
recommendation.  
 
I agree to the open peer review policy of the journal. I understand that my name will be included 
on my report to the authors and, if the manuscript is accepted for publication, my named report 
including any attachments I upload will be posted on the websi te 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 confidential comments 
to the editors, which will not be published.  
 
I agree to the open peer review policy of the journal   
assistant