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: 18 Apr 2025
Reviewer:  Mohamed Elbasiony
Reviewer's report:
"Dynamic Changes in Liver Stiffness Measurement by 2D Shear-Wave Elastography Predict
HCC in CHB Patients with Well-Controlled Viremia"
I read the manuscript with interest. The study retrospectively analyzes 303 chronic hepatitis B
(CHB) patients (including 45 cirrhotic patients) with well-controlled viremia (HBV DNA <100
IU/mL sustained for >6 months) from 2016 to 2020. Patients underwent follow-up every 3–6
months with 2–11 reliable liver stiffness measurements (LSMs) via 2D shear-wave elastography
(SWE). While the work addresses an important clinical question, I have the following comments
and suggestions to improve clarity and interpretation:
Methodology – Interval Between LSMs:
The manuscript states that the interval between the first and last LSM ranged from 23 to
48 months. Such a wide variability in follow-up durations could introduce heterogeneity in
assessing dynamic LSM changes. Could the authors clarify how this variability was addressed
statistically and whether it may have influenced the predictive accuracy of LSM trends for HCC
development?
HCC Incidence Discrepancy:
The study reports that 27/303  patients developed HCC during follow-up. This incidence appears
notably higher than the widely cited annual HCC rates in non-cirrhotic (#1%) and cirrhotic (#2–
3%) CHB populations. Could the authors discuss potential reasons for this discrepancy? For
instance, were there high-risk subgroups?
Cohort Timeline Consistency:
The Methods section mentions 609 CHB patients who underwent 2D SWE between 2016 and
2020, but the Results describe a 7-year cumulative HCC incidence. This raises questions about
the timeline of enrollment, follow-up duration, and cohort selection. Please clarify how the 7-
year analysis aligns with the 2016–2020
Missing HBeAg Status Data:
HBeAg status (positive/negative) is a well-established factor influencing HBV-related
outcomes, including HCC risk. However, patient characteristics do not include HBeAg status.
Could the authors provide this information and assess its potential confounding effect on HCC
incidence in their cohort?
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: 18 Apr 2025
Reviewer:  Mohamed Elbasiony
Reviewer's report:
"Dynamic Changes in Liver Stiffness Measurement by 2D Shear-Wave Elastography Predict
HCC in CHB Patients with Well-Controlled Viremia"
I read the manuscript with interest. The study retrospectively analyzes 303 chronic hepatitis B
(CHB) patients (including 45 cirrhotic patients) with well-controlled viremia (HBV DNA <100
IU/mL sustained for >6 months) from 2016 to 2020. Patients underwent follow-up every 3–6
months with 2–11 reliable liver stiffness measurements (LSMs) via 2D shear-wave elastography
(SWE). While the work addresses an important clinical question, I have the following comments
and suggestions to improve clarity and interpretation:
Methodology – Interval Between LSMs:
The manuscript states that the interval between the first and last LSM ranged from 23 to
48 months. Such a wide variability in follow-up durations could introduce heterogeneity in
assessing dynamic LSM changes. Could the authors clarify how this variability was addressed
statistically and whether it may have influenced the predictive accuracy of LSM trends for HCC
development?
HCC Incidence Discrepancy:
The study reports that 27/303  patients developed HCC during follow-up. This incidence appears
notably higher than the widely cited annual HCC rates in non-cirrhotic (#1%) and cirrhotic (#2–
3%) CHB populations. Could the authors discuss potential reasons for this discrepancy? For
instance, were there high-risk subgroups?
Cohort Timeline Consistency:
The Methods section mentions 609 CHB patients who underwent 2D SWE between 2016 and
2020, but the Results describe a 7-year cumulative HCC incidence. This raises questions about
the timeline of enrollment, follow-up duration, and cohort selection. Please clarify how the 7-
year analysis aligns with the 2016–2020
Missing HBeAg Status Data:
HBeAg status (positive/negative) is a well-established factor influencing HBV-related
outcomes, including HCC risk. However, patient characteristics do not include HBeAg status.
Could the authors provide this information and assess its potential confounding effect on HCC
incidence in their cohort?
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: 18 Apr 2025
Reviewer:  Mohamed Elbasiony
Reviewer's report:
"Dynamic Changes in Liver Stiffness Measurement by 2D Shear-Wave Elastography Predict
HCC in CHB Patients with Well-Controlled Viremia"
I read the manuscript with interest. The study retrospectively analyzes 303 chronic hepatitis B
(CHB) patients (including 45 cirrhotic patients) with well-controlled viremia (HBV DNA <100
IU/mL sustained for >6 months) from 2016 to 2020. Patients underwent follow-up every 3–6
months with 2–11 reliable liver stiffness measurements (LSMs) via 2D shear-wave elastography
(SWE). While the work addresses an important clinical question, I have the following comments
and suggestions to improve clarity and interpretation:
Methodology – Interval Between LSMs:
The manuscript states that the interval between the first and last LSM ranged from 23 to
48 months. Such a wide variability in follow-up durations could introduce heterogeneity in
assessing dynamic LSM changes. Could the authors clarify how this variability was addressed
statistically and whether it may have influenced the predictive accuracy of LSM trends for HCC
development?
HCC Incidence Discrepancy:
The study reports that 27/303  patients developed HCC during follow-up. This incidence appears
notably higher than the widely cited annual HCC rates in non-cirrhotic (#1%) and cirrhotic (#2–
3%) CHB populations. Could the authors discuss potential reasons for this discrepancy? For
instance, were there high-risk subgroups?
Cohort Timeline Consistency:
The Methods section mentions 609 CHB patients who underwent 2D SWE between 2016 and
2020, but the Results describe a 7-year cumulative HCC incidence. This raises questions about
the timeline of enrollment, follow-up duration, and cohort selection. Please clarify how the 7-
year analysis aligns with the 2016–2020
Missing HBeAg Status Data:
HBeAg status (positive/negative) is a well-established factor influencing HBV-related
outcomes, including HCC risk. However, patient characteristics do not include HBeAg status.
Could the authors provide this information and assess its potential confounding effect on HCC
incidence in their cohort?
assistant