Reviewer ’s report  
 
Title: Pre-treatment alphafeto protein in hepatocellular carcinoma with non -viral aetiology - 
prospective study  
 
Version: 0 Date: 08 Sep 2016  
 
Reviewer: Christopher Bowlus  
 
Reviewer's report:  
 
The manuscript describes a study of AFP in a large cohort of HCC patient in Sri Lanka without 
evidence of chronic viral hepatitis. The findings support the results of other studies which have 
noted that an elevated AFP is associated with more advanced HCC, vascular invasion, and 
decreased survival. Although these findings are not novel, they do have significance given the 
unique population studied.  
 
 
 
There are several minor concerns which should be addressed.  
 
 
1. It is unclear what population this cohort represents. Does it reflect t he entire country? A 
large city?  
 
 
2. The Methods section reports "multiple variable analysis" but I am unable to find any 
results that are multivariable. This would be of particular interest in the survival data and 
might benefit from a proportional hazard analysis.  
 
 
3. In the Results section:  
 
 
a. "Chid" should be changed to "Child" and "child" should be changed to "Child -Pugh"  
 
 
b. The sentence "Background cirrhosis…." Should be moved before the sentence "The 
Child class…."  
 
 
c. On line 22, it is unclear what "d isease" is referring to in the sentence "stage three of the 
disease." Please clarify.  
 
d. Throughout the text and table, there are p -values written as P = 0.00. If applicable, this 
should be P < 0.01 or P < 0.001. Also, there should be consistency in "P" an d "p".  
4. Table 1 should be reformatted. In addition to median, the ranges or interquartile ranges 
and the number of cases should be noted for each group within every variable.  
 
 
5. Figure 1 should be reformatted as a histogram rather than a scatterplot.  
 
 
 
The manuscript should also be reviewed for minor grammatical errors.   
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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.  
 
Yes 
 
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:  
 
Needs some language corrections before being published  
 
 
 
 
 
 
 
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 fo r 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 h ave 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 Acc ess 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: Pre-treatment alphafeto protein in hepatocellular carcinoma with non -viral aetiology - 
prospective study  
 
Version: 0 Date: 08 Sep 2016  
 
Reviewer: Christopher Bowlus  
 
Reviewer's report:  
 
The manuscript describes a study of AFP in a large cohort of HCC patient in Sri Lanka without 
evidence of chronic viral hepatitis. The findings support the results of other studies which have 
noted that an elevated AFP is associated with more advanced HCC, vascular invasion, and 
decreased survival. Although these findings are not novel, they do have significance given the 
unique population studied.  
 
 
 
There are several minor concerns which should be addressed.  
 
 
1. It is unclear what population this cohort represents. Does it reflect t he entire country? A 
large city?  
 
 
2. The Methods section reports "multiple variable analysis" but I am unable to find any 
results that are multivariable. This would be of particular interest in the survival data and 
might benefit from a proportional hazard analysis.  
 
 
3. In the Results section:  
 
 
a. "Chid" should be changed to "Child" and "child" should be changed to "Child -Pugh"  
 
 
b. The sentence "Background cirrhosis…." Should be moved before the sentence "The 
Child class…."  
 
 
c. On line 22, it is unclear what "d isease" is referring to in the sentence "stage three of the 
disease." Please clarify.  
 
d. Throughout the text and table, there are p -values written as P = 0.00. If applicable, this 
should be P < 0.01 or P < 0.001. Also, there should be consistency in "P" an d "p".  
4. Table 1 should be reformatted. In addition to median, the ranges or interquartile ranges 
and the number of cases should be noted for each group within every variable.  
 
 
5. Figure 1 should be reformatted as a histogram rather than a scatterplot.  
 
 
 
The manuscript should also be reviewed for minor grammatical errors.   
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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.  
 
Yes 
 
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:  
 
Needs some language corrections before being published  
 
 
 
 
 
 
 
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 fo r 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 h ave 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 Acc ess 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: Pre-treatment alphafeto protein in hepatocellular carcinoma with non -viral aetiology - 
prospective study  
 
Version: 0 Date: 08 Sep 2016  
 
Reviewer: Christopher Bowlus  
 
Reviewer's report:  
 
The manuscript describes a study of AFP in a large cohort of HCC patient in Sri Lanka without 
evidence of chronic viral hepatitis. The findings support the results of other studies which have 
noted that an elevated AFP is associated with more advanced HCC, vascular invasion, and 
decreased survival. Although these findings are not novel, they do have significance given the 
unique population studied.  
 
 
 
There are several minor concerns which should be addressed.  
 
 
1. It is unclear what population this cohort represents. Does it reflect t he entire country? A 
large city?  
 
 
2. The Methods section reports "multiple variable analysis" but I am unable to find any 
results that are multivariable. This would be of particular interest in the survival data and 
might benefit from a proportional hazard analysis.  
 
 
3. In the Results section:  
 
 
a. "Chid" should be changed to "Child" and "child" should be changed to "Child -Pugh"  
 
 
b. The sentence "Background cirrhosis…." Should be moved before the sentence "The 
Child class…."  
 
 
c. On line 22, it is unclear what "d isease" is referring to in the sentence "stage three of the 
disease." Please clarify.  
 
d. Throughout the text and table, there are p -values written as P = 0.00. If applicable, this 
should be P < 0.01 or P < 0.001. Also, there should be consistency in "P" an d "p".  
4. Table 1 should be reformatted. In addition to median, the ranges or interquartile ranges 
and the number of cases should be noted for each group within every variable.  
 
 
5. Figure 1 should be reformatted as a histogram rather than a scatterplot.  
 
 
 
The manuscript should also be reviewed for minor grammatical errors.   
 
 
 
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
No 
 
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.  
 
Yes 
 
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:  
 
Needs some language corrections before being published  
 
 
 
 
 
 
 
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 fo r 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 h ave 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 Acc ess 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