Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 3 Date: 22 Dec 2023
Reviewer's report:
In this revised version the authors did not provide necessary improvement. In particular,
The use of  TNM staging system not taking into account the residual live function and
underlying liver disease,  make the study of suboptima clinical impact and the authors added
these shortcomings in the Limitations section. Regarding treatments,  the authors stated that all
patients enrolled in this study were from the SEER database and cannot
guarantee that all patients receive HCC surveillance regulararly.
The discussion did not take into account current systemic treatment approaches. In particular,
the author should recall and discuss the recent evidence of significantly improved efficacy and
safety of combination treatments based on tyrosine kinase inhibitors plus immune checkpoint
inhibitors as reently well-described in a comprehensive review (Expert Rev Anticancer Ther.
2023 Mar;23(3):279-291. doi: 10.1080/14737140.2023.2181162.).
The AFP-negative HCC is an important topic, however, the authors did not discuss the changing
features of HCC. During the last 2 decades, several aspects of HCC scenario have changed,
as well as its management. The improvement in patient survival observed in the last period
translated into a higher number of patients who are candidate for curative treatments and to
an improved management and survival of intermediate stage patients, as well as a signifcant
improvemed managment of systemic therapies, as previously demonstrated (Liver Int. 2021
Mar;41(3):585-597. doi: 10.1111/liv.14735. ).
Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 3 Date: 22 Dec 2023
Reviewer's report:
In this revised version the authors did not provide necessary improvement. In particular,
The use of  TNM staging system not taking into account the residual live function and
underlying liver disease,  make the study of suboptima clinical impact and the authors added
these shortcomings in the Limitations section. Regarding treatments,  the authors stated that all
patients enrolled in this study were from the SEER database and cannot
guarantee that all patients receive HCC surveillance regulararly.
The discussion did not take into account current systemic treatment approaches. In particular,
the author should recall and discuss the recent evidence of significantly improved efficacy and
safety of combination treatments based on tyrosine kinase inhibitors plus immune checkpoint
inhibitors as reently well-described in a comprehensive review (Expert Rev Anticancer Ther.
2023 Mar;23(3):279-291. doi: 10.1080/14737140.2023.2181162.).
The AFP-negative HCC is an important topic, however, the authors did not discuss the changing
features of HCC. During the last 2 decades, several aspects of HCC scenario have changed,
as well as its management. The improvement in patient survival observed in the last period
translated into a higher number of patients who are candidate for curative treatments and to
an improved management and survival of intermediate stage patients, as well as a signifcant
improvemed managment of systemic therapies, as previously demonstrated (Liver Int. 2021
Mar;41(3):585-597. doi: 10.1111/liv.14735. ).
Please review this paper.
user
Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 3 Date: 22 Dec 2023
Reviewer's report:
In this revised version the authors did not provide necessary improvement. In particular,
The use of  TNM staging system not taking into account the residual live function and
underlying liver disease,  make the study of suboptima clinical impact and the authors added
these shortcomings in the Limitations section. Regarding treatments,  the authors stated that all
patients enrolled in this study were from the SEER database and cannot
guarantee that all patients receive HCC surveillance regulararly.
The discussion did not take into account current systemic treatment approaches. In particular,
the author should recall and discuss the recent evidence of significantly improved efficacy and
safety of combination treatments based on tyrosine kinase inhibitors plus immune checkpoint
inhibitors as reently well-described in a comprehensive review (Expert Rev Anticancer Ther.
2023 Mar;23(3):279-291. doi: 10.1080/14737140.2023.2181162.).
The AFP-negative HCC is an important topic, however, the authors did not discuss the changing
features of HCC. During the last 2 decades, several aspects of HCC scenario have changed,
as well as its management. The improvement in patient survival observed in the last period
translated into a higher number of patients who are candidate for curative treatments and to
an improved management and survival of intermediate stage patients, as well as a signifcant
improvemed managment of systemic therapies, as previously demonstrated (Liver Int. 2021
Mar;41(3):585-597. doi: 10.1111/liv.14735. ).
assistant