Reviewer's report
Title:Alpha-Fetoprotein Level as a Biomarker of Liver Fibrosis Status in 621
consecutive patients with Chronic Hepatitis B
Version: 1Date:13 September 2013
Reviewer: Vincenza Calvaruso
Reviewer's report:
In this manuscript Liu and co-workers aimed at identifying the role of
Alpha-Fetoprotein Level as a biomarker of liver fibrosis in a cohort of patients
with chronic hepatitis B. .
However, there are several limitations of the manuscript:
One of the main features of chronic hepatitis B is the occurrence of acute flares
which have an important role in the progression of the disease. However this
significant difference of the inflammation grade during the time, make extremely
difficult the evaluation of performance of fibrosis biomarkers. This is particularly
evident for a marker which is strongly influenced by inflammation like AFP.
A repeated and dynamic evaluation of the biomarker may be more useful in this
setting.
The performance of AFP in the evaluation of the different grades and stages
could be not considered satisfasfactory (AUROC always lower than 0.80).
A proof of the unreliability of the AFP in this setting is demonstrated also by the
fact that the median values of AFP at liver inflammation stages null (6.1 ng/ml)
was higher than the median value of stage G1-G3.
Moreover the analysis using with AFP cut off > 400 ng/ml should be eliminated
because a test with high specificity but so low sensitivity is not clinically relevant.
I suppose that only a very few number of subjects had AFP higher than 400
ng/ml.
As the author stated in the discussion they applied the accepted pathological
staging system used in China but there are no known comparisons between this
system and other universal systems. This is an important limitation of the study.
The discussion is too long and the session explaining the performances of the
available not invasive tests of liver fibrosis should be eliminated.
All figures showing the histological features of the differences stages of liver
fibrosis did not add any informations to the study results and should be
eliminated.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
No competing interests to declare
Reviewer's report
Title:Alpha-Fetoprotein Level as a Biomarker of Liver Fibrosis Status in 621
consecutive patients with Chronic Hepatitis B
Version: 1Date:13 September 2013
Reviewer: Vincenza Calvaruso
Reviewer's report:
In this manuscript Liu and co-workers aimed at identifying the role of
Alpha-Fetoprotein Level as a biomarker of liver fibrosis in a cohort of patients
with chronic hepatitis B. .
However, there are several limitations of the manuscript:
One of the main features of chronic hepatitis B is the occurrence of acute flares
which have an important role in the progression of the disease. However this
significant difference of the inflammation grade during the time, make extremely
difficult the evaluation of performance of fibrosis biomarkers. This is particularly
evident for a marker which is strongly influenced by inflammation like AFP.
A repeated and dynamic evaluation of the biomarker may be more useful in this
setting.
The performance of AFP in the evaluation of the different grades and stages
could be not considered satisfasfactory (AUROC always lower than 0.80).
A proof of the unreliability of the AFP in this setting is demonstrated also by the
fact that the median values of AFP at liver inflammation stages null (6.1 ng/ml)
was higher than the median value of stage G1-G3.
Moreover the analysis using with AFP cut off > 400 ng/ml should be eliminated
because a test with high specificity but so low sensitivity is not clinically relevant.
I suppose that only a very few number of subjects had AFP higher than 400
ng/ml.
As the author stated in the discussion they applied the accepted pathological
staging system used in China but there are no known comparisons between this
system and other universal systems. This is an important limitation of the study.
The discussion is too long and the session explaining the performances of the
available not invasive tests of liver fibrosis should be eliminated.
All figures showing the histological features of the differences stages of liver
fibrosis did not add any informations to the study results and should be
eliminated.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
No competing interests to declare
Please review this paper.
user
Reviewer's report
Title:Alpha-Fetoprotein Level as a Biomarker of Liver Fibrosis Status in 621
consecutive patients with Chronic Hepatitis B
Version: 1Date:13 September 2013
Reviewer: Vincenza Calvaruso
Reviewer's report:
In this manuscript Liu and co-workers aimed at identifying the role of
Alpha-Fetoprotein Level as a biomarker of liver fibrosis in a cohort of patients
with chronic hepatitis B. .
However, there are several limitations of the manuscript:
One of the main features of chronic hepatitis B is the occurrence of acute flares
which have an important role in the progression of the disease. However this
significant difference of the inflammation grade during the time, make extremely
difficult the evaluation of performance of fibrosis biomarkers. This is particularly
evident for a marker which is strongly influenced by inflammation like AFP.
A repeated and dynamic evaluation of the biomarker may be more useful in this
setting.
The performance of AFP in the evaluation of the different grades and stages
could be not considered satisfasfactory (AUROC always lower than 0.80).
A proof of the unreliability of the AFP in this setting is demonstrated also by the
fact that the median values of AFP at liver inflammation stages null (6.1 ng/ml)
was higher than the median value of stage G1-G3.
Moreover the analysis using with AFP cut off > 400 ng/ml should be eliminated
because a test with high specificity but so low sensitivity is not clinically relevant.
I suppose that only a very few number of subjects had AFP higher than 400
ng/ml.
As the author stated in the discussion they applied the accepted pathological
staging system used in China but there are no known comparisons between this
system and other universal systems. This is an important limitation of the study.
The discussion is too long and the session explaining the performances of the
available not invasive tests of liver fibrosis should be eliminated.
All figures showing the histological features of the differences stages of liver
fibrosis did not add any informations to the study results and should be
eliminated.
Level of interest: An article of insufficient interest to warrant publication in a
scientific/medical journal
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
No competing interests to declare
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