Title: Quantitative literature analysis on efficacy and safety of balloon-occluded transarterial
chemoembolization for hepatocellular carcinoma
Version: 2 Date: 17 Mar 2025
Reviewer's report:
Major revision required.
This meta-analysis evaluates the efficacy and safety of balloon-occluded transarterial
chemoembolization (B-TACE) compared to non-B-TACE (C-TACE/D-TACE) in
hepatocellular carcinoma (HCC). While the study addresses an important clinical question and
employs rigorous methodology, several limitations affect the robustness of its conclusions.
Below are detailed critiques and recommendations.
Strengths:
1.. The authors conducted a systematic search across major databases (PubMed, Cochrane,
EMBASE) with clear inclusion/exclusion criteria.
2. Appropriate use of Review Manager 5.3, heterogeneity assessment (I² statistic), and funnel
plots for publication bias.
3.  Focus on tumor response (CR, PR, SD, PD), treatment effect (TE4/TE3-1), and safety (PSE,
AEs) aligns with key endpoints in HCC management.
4. Use of the Newcastle-Ottawa Scale (NOS) for non-randomized studies adds credibility to the
included evidence.
Major Weaknesses
1.  Six of seven included studies are retrospective, introducing potential selection and reporting
biases. Retrospective designs limit causal inferences and may overestimate treatment effects.
2. Moderate-to-high heterogeneity (I² = 60–76%) in CR and PSE outcomes undermines the
reliability of pooled estimates. The authors acknowledge tumor size and embolization techniques
as sources but lack subgroup analyses to address this.
3.  Combining C-TACE and D-TACE into a single "non-B-TACE" group is problematic. These
techniques differ in mechanisms (e.g., drug-eluting beads vs. lipiodol), and pooling them may
obscure distinct efficacy/safety profiles.
4. Small sample sizes for safety outcomes (e.g., grade 3 AEs: 19 vs. 77 events) reduce power
to detect rare adverse events.
5. The analysis focuses on short-term outcomes (1-month tumor response). Long-term metrics
(e.g., overall survival, recurrence rates) are critical for HCC management but omitted.
Minor Issues
1. Writing and Presentation:
- Typos (e.g., "B-TACE was safety" # "B-TACE was safe").
- Inconsistent formatting (e.g., missing axis labels in figures).
2. Exclusion of grey literature (e.g., conference abstracts, trial registries) risks publication bias.
Title: Quantitative literature analysis on efficacy and safety of balloon-occluded transarterial
chemoembolization for hepatocellular carcinoma
Version: 2 Date: 17 Mar 2025
Reviewer's report:
Major revision required.
This meta-analysis evaluates the efficacy and safety of balloon-occluded transarterial
chemoembolization (B-TACE) compared to non-B-TACE (C-TACE/D-TACE) in
hepatocellular carcinoma (HCC). While the study addresses an important clinical question and
employs rigorous methodology, several limitations affect the robustness of its conclusions.
Below are detailed critiques and recommendations.
Strengths:
1.. The authors conducted a systematic search across major databases (PubMed, Cochrane,
EMBASE) with clear inclusion/exclusion criteria.
2. Appropriate use of Review Manager 5.3, heterogeneity assessment (I² statistic), and funnel
plots for publication bias.
3.  Focus on tumor response (CR, PR, SD, PD), treatment effect (TE4/TE3-1), and safety (PSE,
AEs) aligns with key endpoints in HCC management.
4. Use of the Newcastle-Ottawa Scale (NOS) for non-randomized studies adds credibility to the
included evidence.
Major Weaknesses
1.  Six of seven included studies are retrospective, introducing potential selection and reporting
biases. Retrospective designs limit causal inferences and may overestimate treatment effects.
2. Moderate-to-high heterogeneity (I² = 60–76%) in CR and PSE outcomes undermines the
reliability of pooled estimates. The authors acknowledge tumor size and embolization techniques
as sources but lack subgroup analyses to address this.
3.  Combining C-TACE and D-TACE into a single "non-B-TACE" group is problematic. These
techniques differ in mechanisms (e.g., drug-eluting beads vs. lipiodol), and pooling them may
obscure distinct efficacy/safety profiles.
4. Small sample sizes for safety outcomes (e.g., grade 3 AEs: 19 vs. 77 events) reduce power
to detect rare adverse events.
5. The analysis focuses on short-term outcomes (1-month tumor response). Long-term metrics
(e.g., overall survival, recurrence rates) are critical for HCC management but omitted.
Minor Issues
1. Writing and Presentation:
- Typos (e.g., "B-TACE was safety" # "B-TACE was safe").
- Inconsistent formatting (e.g., missing axis labels in figures).
2. Exclusion of grey literature (e.g., conference abstracts, trial registries) risks publication bias.
Please review this paper.
user
Title: Quantitative literature analysis on efficacy and safety of balloon-occluded transarterial
chemoembolization for hepatocellular carcinoma
Version: 2 Date: 17 Mar 2025
Reviewer's report:
Major revision required.
This meta-analysis evaluates the efficacy and safety of balloon-occluded transarterial
chemoembolization (B-TACE) compared to non-B-TACE (C-TACE/D-TACE) in
hepatocellular carcinoma (HCC). While the study addresses an important clinical question and
employs rigorous methodology, several limitations affect the robustness of its conclusions.
Below are detailed critiques and recommendations.
Strengths:
1.. The authors conducted a systematic search across major databases (PubMed, Cochrane,
EMBASE) with clear inclusion/exclusion criteria.
2. Appropriate use of Review Manager 5.3, heterogeneity assessment (I² statistic), and funnel
plots for publication bias.
3.  Focus on tumor response (CR, PR, SD, PD), treatment effect (TE4/TE3-1), and safety (PSE,
AEs) aligns with key endpoints in HCC management.
4. Use of the Newcastle-Ottawa Scale (NOS) for non-randomized studies adds credibility to the
included evidence.
Major Weaknesses
1.  Six of seven included studies are retrospective, introducing potential selection and reporting
biases. Retrospective designs limit causal inferences and may overestimate treatment effects.
2. Moderate-to-high heterogeneity (I² = 60–76%) in CR and PSE outcomes undermines the
reliability of pooled estimates. The authors acknowledge tumor size and embolization techniques
as sources but lack subgroup analyses to address this.
3.  Combining C-TACE and D-TACE into a single "non-B-TACE" group is problematic. These
techniques differ in mechanisms (e.g., drug-eluting beads vs. lipiodol), and pooling them may
obscure distinct efficacy/safety profiles.
4. Small sample sizes for safety outcomes (e.g., grade 3 AEs: 19 vs. 77 events) reduce power
to detect rare adverse events.
5. The analysis focuses on short-term outcomes (1-month tumor response). Long-term metrics
(e.g., overall survival, recurrence rates) are critical for HCC management but omitted.
Minor Issues
1. Writing and Presentation:
- Typos (e.g., "B-TACE was safety" # "B-TACE was safe").
- Inconsistent formatting (e.g., missing axis labels in figures).
2. Exclusion of grey literature (e.g., conference abstracts, trial registries) risks publication bias.
assistant