Title: The prognostic role of albumin-bilirubin grade in the mortality of extrahepatic
cholangiocarcinoma patients
Version: 0 Date: 20 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction references several studies that support the significance of liver function in
predicting outcomes for iCCA and eCCA, but a bit more detail on these studies could be helpful.
For instance, elaborating on why ALBI is superior or more reliable than CP in some situations
would provide stronger reasoning for its inclusion in the study.
-While the introduction provides a solid rationale for the study's aim, it could benefit from more
detail on the limitations of the existing literature on ALBI in eCCA patients. Specifically, how
the findings from studies on iCCA might not translate to eCCA, and why this justifies the need
for further research.
-The introduction mentions the poor prognosis of eCCA patients but could delve a bit deeper
into the specific challenges in predicting survival for this group. A more explicit mention of
the difficulty in predicting mortality and the potential consequences for clinical management
(treatment decisions, prognostication, etc.) could strengthen the argument for why mortality
prediction is an important goal of the study.
-The explanation of the ALBI score formula and its interpretation is solid, but more clarity on
how the score compares to other liver function assessments (e.g., CP) in predicting mortality or
overall survival for eCCA patients would be helpful. Additionally, a brief explanation of why
certain clinical markers (e.g., liver enzymes, WBC, INR) are chosen for the study would be
useful to tie them to the broader context of liver dysfunction in CCA.
-While the study shows a significant correlation between ALBI grading and survival, the
explanation of how ALBI grade functions as a predictor of liver function could be expanded.
Providing more insight into why ALBI might be a better marker than other scores, such as CP,
in this cohort could strengthen the argument for its clinical relevance.
-While the discussion mentions confounding variables and biases due to the retrospective design,
it could go further in discussing the specific factors that could have confounded the results. For
example, were there any biases in how patients were selected for Whipple surgery or how their
liver function was assessed preoperatively? Further detail on potential confounders would add
more nuance to the discussion.
-Although the discussion does a good job of addressing ALBI’s role, it could benefit from a
bit more depth in comparing ALBI with other liver function tests in eCCA specifically. For
example, how does ALBI compare to newer markers like MELD or serum biomarkers in terms
of predictive power for mortality in eCCA?
Title: The prognostic role of albumin-bilirubin grade in the mortality of extrahepatic
cholangiocarcinoma patients
Version: 0 Date: 20 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction references several studies that support the significance of liver function in
predicting outcomes for iCCA and eCCA, but a bit more detail on these studies could be helpful.
For instance, elaborating on why ALBI is superior or more reliable than CP in some situations
would provide stronger reasoning for its inclusion in the study.
-While the introduction provides a solid rationale for the study's aim, it could benefit from more
detail on the limitations of the existing literature on ALBI in eCCA patients. Specifically, how
the findings from studies on iCCA might not translate to eCCA, and why this justifies the need
for further research.
-The introduction mentions the poor prognosis of eCCA patients but could delve a bit deeper
into the specific challenges in predicting survival for this group. A more explicit mention of
the difficulty in predicting mortality and the potential consequences for clinical management
(treatment decisions, prognostication, etc.) could strengthen the argument for why mortality
prediction is an important goal of the study.
-The explanation of the ALBI score formula and its interpretation is solid, but more clarity on
how the score compares to other liver function assessments (e.g., CP) in predicting mortality or
overall survival for eCCA patients would be helpful. Additionally, a brief explanation of why
certain clinical markers (e.g., liver enzymes, WBC, INR) are chosen for the study would be
useful to tie them to the broader context of liver dysfunction in CCA.
-While the study shows a significant correlation between ALBI grading and survival, the
explanation of how ALBI grade functions as a predictor of liver function could be expanded.
Providing more insight into why ALBI might be a better marker than other scores, such as CP,
in this cohort could strengthen the argument for its clinical relevance.
-While the discussion mentions confounding variables and biases due to the retrospective design,
it could go further in discussing the specific factors that could have confounded the results. For
example, were there any biases in how patients were selected for Whipple surgery or how their
liver function was assessed preoperatively? Further detail on potential confounders would add
more nuance to the discussion.
-Although the discussion does a good job of addressing ALBI’s role, it could benefit from a
bit more depth in comparing ALBI with other liver function tests in eCCA specifically. For
example, how does ALBI compare to newer markers like MELD or serum biomarkers in terms
of predictive power for mortality in eCCA?
Please review this paper.
user
Title: The prognostic role of albumin-bilirubin grade in the mortality of extrahepatic
cholangiocarcinoma patients
Version: 0 Date: 20 Feb 2025
Reviewer:  Anwar Ashraf Abouelnasr
Reviewer's report:
Dear Authors, please address the following points below
-The introduction references several studies that support the significance of liver function in
predicting outcomes for iCCA and eCCA, but a bit more detail on these studies could be helpful.
For instance, elaborating on why ALBI is superior or more reliable than CP in some situations
would provide stronger reasoning for its inclusion in the study.
-While the introduction provides a solid rationale for the study's aim, it could benefit from more
detail on the limitations of the existing literature on ALBI in eCCA patients. Specifically, how
the findings from studies on iCCA might not translate to eCCA, and why this justifies the need
for further research.
-The introduction mentions the poor prognosis of eCCA patients but could delve a bit deeper
into the specific challenges in predicting survival for this group. A more explicit mention of
the difficulty in predicting mortality and the potential consequences for clinical management
(treatment decisions, prognostication, etc.) could strengthen the argument for why mortality
prediction is an important goal of the study.
-The explanation of the ALBI score formula and its interpretation is solid, but more clarity on
how the score compares to other liver function assessments (e.g., CP) in predicting mortality or
overall survival for eCCA patients would be helpful. Additionally, a brief explanation of why
certain clinical markers (e.g., liver enzymes, WBC, INR) are chosen for the study would be
useful to tie them to the broader context of liver dysfunction in CCA.
-While the study shows a significant correlation between ALBI grading and survival, the
explanation of how ALBI grade functions as a predictor of liver function could be expanded.
Providing more insight into why ALBI might be a better marker than other scores, such as CP,
in this cohort could strengthen the argument for its clinical relevance.
-While the discussion mentions confounding variables and biases due to the retrospective design,
it could go further in discussing the specific factors that could have confounded the results. For
example, were there any biases in how patients were selected for Whipple surgery or how their
liver function was assessed preoperatively? Further detail on potential confounders would add
more nuance to the discussion.
-Although the discussion does a good job of addressing ALBI’s role, it could benefit from a
bit more depth in comparing ALBI with other liver function tests in eCCA specifically. For
example, how does ALBI compare to newer markers like MELD or serum biomarkers in terms
of predictive power for mortality in eCCA?
assistant