Reviewer's report
Title:Characterization and prognosis of patients with hepatocellular carcinoma
(HCC) in the non-cirrhotic liver
Version:1Date:17 March 2014
Reviewer: Marcus-Alexander A Wörns
Reviewer's report:
Schütte and colleagues report from a retrospective single institution experience
of a mixed cohort of patients with hepatocellular carcinoma (HCC) in non-cirrhotic
liver (NCL). They compared this entity with a large group of HCC patients with
pre-existing liver cirrhosis. They could confirm most of the characteristics of HCC
in NCL reported in the literature during the last decades. In addition, they could
demonstrate the usefulness of staging systems such as BCLC and CLIP also in
HCC patients with NLC. However, they detected a high percentage of patients
with advanced HCC (BCLC C, 51.6%) due to high rate of portal vein involvement
and extrahepatic spread (EHS). In the univariate analysis (BCLC and CLIP
excluded), portal vein thrombosis, EHS, level of AFP, PTT, ASAT, platelets, and
ECOG PS were identified as prognostic factors; in multivariate analysis, only
EHS and concentration of platelets were confirmed as independent prognostic
factors. These results highlight the implementation of surveillance programs to
detect HCC in NCL in earlier stages as the major challenge, particularly in
patients with signs of NAFLD or NASH.
Despite some limitations (retrospective study, low percentage of available
non-tumorous tissue) the results are relevant for clinical practice.
Major Compulsory Revisions:
Abstract: Conclusions have to be shortened and the main topic should be
highlighted: implementation of surveillance programs to detect HCC in NCL in
earlier stages as the major challenge, particularly in patients with signs of NAFLD
or NASH.
Results: Results of Table 6 should be included in the main text, and table 6
should be deleted. The influence of first-line treatment modalities (curative vs.
palliative approaches) should be incorporated into the univariate/multivariate
analysis. Some of the univariate analyses (Kaplan-Meier curves) should be
deleted from figure 2 and 3.
Discussion should be shortened to the most relevant points and subheadings
should be deleted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Characterization and prognosis of patients with hepatocellular carcinoma
(HCC) in the non-cirrhotic liver
Version:1Date:17 March 2014
Reviewer: Marcus-Alexander A Wörns
Reviewer's report:
Schütte and colleagues report from a retrospective single institution experience
of a mixed cohort of patients with hepatocellular carcinoma (HCC) in non-cirrhotic
liver (NCL). They compared this entity with a large group of HCC patients with
pre-existing liver cirrhosis. They could confirm most of the characteristics of HCC
in NCL reported in the literature during the last decades. In addition, they could
demonstrate the usefulness of staging systems such as BCLC and CLIP also in
HCC patients with NLC. However, they detected a high percentage of patients
with advanced HCC (BCLC C, 51.6%) due to high rate of portal vein involvement
and extrahepatic spread (EHS). In the univariate analysis (BCLC and CLIP
excluded), portal vein thrombosis, EHS, level of AFP, PTT, ASAT, platelets, and
ECOG PS were identified as prognostic factors; in multivariate analysis, only
EHS and concentration of platelets were confirmed as independent prognostic
factors. These results highlight the implementation of surveillance programs to
detect HCC in NCL in earlier stages as the major challenge, particularly in
patients with signs of NAFLD or NASH.
Despite some limitations (retrospective study, low percentage of available
non-tumorous tissue) the results are relevant for clinical practice.
Major Compulsory Revisions:
Abstract: Conclusions have to be shortened and the main topic should be
highlighted: implementation of surveillance programs to detect HCC in NCL in
earlier stages as the major challenge, particularly in patients with signs of NAFLD
or NASH.
Results: Results of Table 6 should be included in the main text, and table 6
should be deleted. The influence of first-line treatment modalities (curative vs.
palliative approaches) should be incorporated into the univariate/multivariate
analysis. Some of the univariate analyses (Kaplan-Meier curves) should be
deleted from figure 2 and 3.
Discussion should be shortened to the most relevant points and subheadings
should be deleted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
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Reviewer's report
Title:Characterization and prognosis of patients with hepatocellular carcinoma
(HCC) in the non-cirrhotic liver
Version:1Date:17 March 2014
Reviewer: Marcus-Alexander A Wörns
Reviewer's report:
Schütte and colleagues report from a retrospective single institution experience
of a mixed cohort of patients with hepatocellular carcinoma (HCC) in non-cirrhotic
liver (NCL). They compared this entity with a large group of HCC patients with
pre-existing liver cirrhosis. They could confirm most of the characteristics of HCC
in NCL reported in the literature during the last decades. In addition, they could
demonstrate the usefulness of staging systems such as BCLC and CLIP also in
HCC patients with NLC. However, they detected a high percentage of patients
with advanced HCC (BCLC C, 51.6%) due to high rate of portal vein involvement
and extrahepatic spread (EHS). In the univariate analysis (BCLC and CLIP
excluded), portal vein thrombosis, EHS, level of AFP, PTT, ASAT, platelets, and
ECOG PS were identified as prognostic factors; in multivariate analysis, only
EHS and concentration of platelets were confirmed as independent prognostic
factors. These results highlight the implementation of surveillance programs to
detect HCC in NCL in earlier stages as the major challenge, particularly in
patients with signs of NAFLD or NASH.
Despite some limitations (retrospective study, low percentage of available
non-tumorous tissue) the results are relevant for clinical practice.
Major Compulsory Revisions:
Abstract: Conclusions have to be shortened and the main topic should be
highlighted: implementation of surveillance programs to detect HCC in NCL in
earlier stages as the major challenge, particularly in patients with signs of NAFLD
or NASH.
Results: Results of Table 6 should be included in the main text, and table 6
should be deleted. The influence of first-line treatment modalities (curative vs.
palliative approaches) should be incorporated into the univariate/multivariate
analysis. Some of the univariate analyses (Kaplan-Meier curves) should be
deleted from figure 2 and 3.
Discussion should be shortened to the most relevant points and subheadings
should be deleted.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a statistician.
Declaration of competing interests:
I declare that I have no competing interests
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