Reviewer’s report
Title: Aspirin Decreases Hepatocellular Carcinoma Risk in Hepatitis C Virus Carriers: A
Nationwide Cohort Study
Version: 1 Date: 11 Oct 2019
Reviewer: Theodoros Androutsakos
Reviewer's report:
Congratulations for your work. However I have some questions and suggestions about it.
1. As HCV usually causes HCC in cirrhotic patients, or at least patients with F3 fibrosis, it is
strange that the vast majority of your HCC patietns had no moderate or severe liver disease. I
think that if this is the case you should comment on why this is happening, otherwise you
should state how 'moderate or severe liver disease' is defined. 
2. Since Genotype 3 (and maybe 6) is regarded as more 'carcinogenic' it would be interesting to
see what kind of genotypes these patients had (I understand this might not be feasible as this is a
retrospective study)
3. HIV coinfection also leads to higher incidence of HCC. Did any of your patients had HIV
coinfection or what that also an exclusion criterion?
4. What about alcohol consumption? Alcohol overconsumption also leads to a higher incidence
of HCC among HCV infected individuals
5. I think you should explain a little bit more the pathophysiological reason on why aspirin
would inhibit carcinogenesis
Overall I think your work could get published but it needs a little bit more work
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments 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, considering 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-financial 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.
I declare that I have no competing interests
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 website 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: Aspirin Decreases Hepatocellular Carcinoma Risk in Hepatitis C Virus Carriers: A
Nationwide Cohort Study
Version: 1 Date: 11 Oct 2019
Reviewer: Theodoros Androutsakos
Reviewer's report:
Congratulations for your work. However I have some questions and suggestions about it.
1. As HCV usually causes HCC in cirrhotic patients, or at least patients with F3 fibrosis, it is
strange that the vast majority of your HCC patietns had no moderate or severe liver disease. I
think that if this is the case you should comment on why this is happening, otherwise you
should state how 'moderate or severe liver disease' is defined. 
2. Since Genotype 3 (and maybe 6) is regarded as more 'carcinogenic' it would be interesting to
see what kind of genotypes these patients had (I understand this might not be feasible as this is a
retrospective study)
3. HIV coinfection also leads to higher incidence of HCC. Did any of your patients had HIV
coinfection or what that also an exclusion criterion?
4. What about alcohol consumption? Alcohol overconsumption also leads to a higher incidence
of HCC among HCV infected individuals
5. I think you should explain a little bit more the pathophysiological reason on why aspirin
would inhibit carcinogenesis
Overall I think your work could get published but it needs a little bit more work
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments 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, considering 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-financial 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.
I declare that I have no competing interests
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 website 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: Aspirin Decreases Hepatocellular Carcinoma Risk in Hepatitis C Virus Carriers: A
Nationwide Cohort Study
Version: 1 Date: 11 Oct 2019
Reviewer: Theodoros Androutsakos
Reviewer's report:
Congratulations for your work. However I have some questions and suggestions about it.
1. As HCV usually causes HCC in cirrhotic patients, or at least patients with F3 fibrosis, it is
strange that the vast majority of your HCC patietns had no moderate or severe liver disease. I
think that if this is the case you should comment on why this is happening, otherwise you
should state how 'moderate or severe liver disease' is defined. 
2. Since Genotype 3 (and maybe 6) is regarded as more 'carcinogenic' it would be interesting to
see what kind of genotypes these patients had (I understand this might not be feasible as this is a
retrospective study)
3. HIV coinfection also leads to higher incidence of HCC. Did any of your patients had HIV
coinfection or what that also an exclusion criterion?
4. What about alcohol consumption? Alcohol overconsumption also leads to a higher incidence
of HCC among HCV infected individuals
5. I think you should explain a little bit more the pathophysiological reason on why aspirin
would inhibit carcinogenesis
Overall I think your work could get published but it needs a little bit more work
Are the methods appropriate and well described?
If not, please specify what is required in your comments to the authors.
Yes
Does the work include the necessary controls?
If not, please specify which controls are required in your comments to the authors.
Yes
Are the conclusions drawn adequately supported by the data shown?
If not, please explain in your comments 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, considering 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-financial 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.
I declare that I have no competing interests
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 website 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