Title: Prognostic Performance of Hong Kong Liver Cancer with Barcelona Clinic Liver Cancer
staging systems in Hepatocellular Carcinoma
Version: 0 Date: 27 Jan 2024
Reviewer:  zeki Abdurahman
Reviewer's report:
I would like to thank the authors for conducting this very important study of external validation
of the HKLC staging in an African setting . The aggressive approach of HKLC staging and
treatment recommendation  system might be more appropriate  in the African setting than the
conservative BCLC approach for several reasons.
However, i have some issues that need clarification and a few comments
1-In the methodology, did you have any exclusion criteria? The original development of HKLC
staging paper by Thomas Yau et al (Gastroenterology2014;146:1691-1700) for instance , has
excluded patients who died within a week of diagnosis. such exclusions would affect the overall
survival comparisons between the papers.
2-The survival benefit observed in your study for selected patients with BCLC-B & BCLC-
C who received  more aggressive  treatment according to HKLC staging was only slight
compared to some other studies (Gastroenerology2014:146:1691-1700).This is probably due
to the very high number of HCV related HCC (almost 80%) in your patients.The benefit of
more aggressive HKLC recommended treatment for selected BCLC-B & BCLC-C patients has
been shown to be better for patients with HBV related HCC rather than HCV related HCC
patients(Medicine(Baltimore).2015 oct;95(41):e 17772). I feel it might be appropriate to discuss
this point in your discussion (evidence based) to emphasise the point that HCC  patients in most
of Africa, which are predominantly HBV related, might benefit more with HKLC staging &
treatment recomendation than the BCLC staging and treatment guideline.
3-The retrospective nature of the study should be mentioned as a limitation because certain
patient factors could have played a role in selecting some patients for HKLC recommended
aggressive  treatment rather than the BCLC recommended conservative treatment.
4- Few grammatical ,spelling and punctation errors need corrections
Overall,I believe It is an excellently conducted study addressing a very important issue as it
pertains to the region and internationally.
Title: Prognostic Performance of Hong Kong Liver Cancer with Barcelona Clinic Liver Cancer
staging systems in Hepatocellular Carcinoma
Version: 0 Date: 27 Jan 2024
Reviewer:  zeki Abdurahman
Reviewer's report:
I would like to thank the authors for conducting this very important study of external validation
of the HKLC staging in an African setting . The aggressive approach of HKLC staging and
treatment recommendation  system might be more appropriate  in the African setting than the
conservative BCLC approach for several reasons.
However, i have some issues that need clarification and a few comments
1-In the methodology, did you have any exclusion criteria? The original development of HKLC
staging paper by Thomas Yau et al (Gastroenterology2014;146:1691-1700) for instance , has
excluded patients who died within a week of diagnosis. such exclusions would affect the overall
survival comparisons between the papers.
2-The survival benefit observed in your study for selected patients with BCLC-B & BCLC-
C who received  more aggressive  treatment according to HKLC staging was only slight
compared to some other studies (Gastroenerology2014:146:1691-1700).This is probably due
to the very high number of HCV related HCC (almost 80%) in your patients.The benefit of
more aggressive HKLC recommended treatment for selected BCLC-B & BCLC-C patients has
been shown to be better for patients with HBV related HCC rather than HCV related HCC
patients(Medicine(Baltimore).2015 oct;95(41):e 17772). I feel it might be appropriate to discuss
this point in your discussion (evidence based) to emphasise the point that HCC  patients in most
of Africa, which are predominantly HBV related, might benefit more with HKLC staging &
treatment recomendation than the BCLC staging and treatment guideline.
3-The retrospective nature of the study should be mentioned as a limitation because certain
patient factors could have played a role in selecting some patients for HKLC recommended
aggressive  treatment rather than the BCLC recommended conservative treatment.
4- Few grammatical ,spelling and punctation errors need corrections
Overall,I believe It is an excellently conducted study addressing a very important issue as it
pertains to the region and internationally.
Please review this paper.
user
Title: Prognostic Performance of Hong Kong Liver Cancer with Barcelona Clinic Liver Cancer
staging systems in Hepatocellular Carcinoma
Version: 0 Date: 27 Jan 2024
Reviewer:  zeki Abdurahman
Reviewer's report:
I would like to thank the authors for conducting this very important study of external validation
of the HKLC staging in an African setting . The aggressive approach of HKLC staging and
treatment recommendation  system might be more appropriate  in the African setting than the
conservative BCLC approach for several reasons.
However, i have some issues that need clarification and a few comments
1-In the methodology, did you have any exclusion criteria? The original development of HKLC
staging paper by Thomas Yau et al (Gastroenterology2014;146:1691-1700) for instance , has
excluded patients who died within a week of diagnosis. such exclusions would affect the overall
survival comparisons between the papers.
2-The survival benefit observed in your study for selected patients with BCLC-B & BCLC-
C who received  more aggressive  treatment according to HKLC staging was only slight
compared to some other studies (Gastroenerology2014:146:1691-1700).This is probably due
to the very high number of HCV related HCC (almost 80%) in your patients.The benefit of
more aggressive HKLC recommended treatment for selected BCLC-B & BCLC-C patients has
been shown to be better for patients with HBV related HCC rather than HCV related HCC
patients(Medicine(Baltimore).2015 oct;95(41):e 17772). I feel it might be appropriate to discuss
this point in your discussion (evidence based) to emphasise the point that HCC  patients in most
of Africa, which are predominantly HBV related, might benefit more with HKLC staging &
treatment recomendation than the BCLC staging and treatment guideline.
3-The retrospective nature of the study should be mentioned as a limitation because certain
patient factors could have played a role in selecting some patients for HKLC recommended
aggressive  treatment rather than the BCLC recommended conservative treatment.
4- Few grammatical ,spelling and punctation errors need corrections
Overall,I believe It is an excellently conducted study addressing a very important issue as it
pertains to the region and internationally.
assistant