Reviewer ’s report  
 
Title: Pre-treatment alphafeto protein in hepatocellular carcinoma with non -viral aetiology - 
prospective study  
 
Version: 0 Date: 17 May 2017  
 
Reviewer: Gar-Yang Chau  
 
Reviewer's report:  
 
Please include all comments for the authors in this box  rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
 
 
Please overwrite this text when adding your comments to the authors.  
 
The present manuscript analyses significance of pretreatment serum AFP level in patients with 
non-B, non -C virus related HCC (nvHCC). The authors concluded that pre -treatment AFP has a 
limited value in diagno sing nvHCC. Having an AFP value over 400ng/ml was associated with 
aggressive tumour behaviour and poor prognosis.  
 
 
Comments:  
 
1) Several groups have reported clinical significance of pre -treatment serum AFP levels in 
HCC patients. Th e present analysis did not add important new information to the current 
knowledge of HCC.  
 
 
2) The following statements were difficult to understand (Page 7, Line 44). Authors 
indicated that "Three hundred and ninety patients with hepatocellular carcinoma (H CC) 
were referred from 2011 September to 2015 September. One patient was infected with 
both hepatitis B and C viruses and excluded from the study. Rest of the patients (n=389) 
with hepatocellular carcinoma of non -viral aetiology were selected for the study ."  It is 
very unusual to have only one patient with dual hepatitis B and C infection among 390 
HCC patients.  
 
 
3) It is necessary using the multivariate Cox proportional hazards model to decide whether 
the pretreatment serum AFP was independent prognostic factors.  
 
 
4) It would be useful to know how many patients undergoing different types of treatment, 
especially curative resection in this cohort of patients.  
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 recommend additional statistical review  
 
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 i nterests'  
 
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: 17 May 2017  
 
Reviewer: Gar-Yang Chau  
 
Reviewer's report:  
 
Please include all comments for the authors in this box  rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
 
 
Please overwrite this text when adding your comments to the authors.  
 
The present manuscript analyses significance of pretreatment serum AFP level in patients with 
non-B, non -C virus related HCC (nvHCC). The authors concluded that pre -treatment AFP has a 
limited value in diagno sing nvHCC. Having an AFP value over 400ng/ml was associated with 
aggressive tumour behaviour and poor prognosis.  
 
 
Comments:  
 
1) Several groups have reported clinical significance of pre -treatment serum AFP levels in 
HCC patients. Th e present analysis did not add important new information to the current 
knowledge of HCC.  
 
 
2) The following statements were difficult to understand (Page 7, Line 44). Authors 
indicated that "Three hundred and ninety patients with hepatocellular carcinoma (H CC) 
were referred from 2011 September to 2015 September. One patient was infected with 
both hepatitis B and C viruses and excluded from the study. Rest of the patients (n=389) 
with hepatocellular carcinoma of non -viral aetiology were selected for the study ."  It is 
very unusual to have only one patient with dual hepatitis B and C infection among 390 
HCC patients.  
 
 
3) It is necessary using the multivariate Cox proportional hazards model to decide whether 
the pretreatment serum AFP was independent prognostic factors.  
 
 
4) It would be useful to know how many patients undergoing different types of treatment, 
especially curative resection in this cohort of patients.  
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 recommend additional statistical review  
 
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 i nterests'  
 
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: 17 May 2017  
 
Reviewer: Gar-Yang Chau  
 
Reviewer's report:  
 
Please include all comments for the authors in this box  rather than uploading your report as an 
attachment. Please only upload as attachments annotated versions of manuscripts, graphs, 
supporting materials or other aspects of your report which cannot be included in a text format.  
 
 
Please overwrite this text when adding your comments to the authors.  
 
The present manuscript analyses significance of pretreatment serum AFP level in patients with 
non-B, non -C virus related HCC (nvHCC). The authors concluded that pre -treatment AFP has a 
limited value in diagno sing nvHCC. Having an AFP value over 400ng/ml was associated with 
aggressive tumour behaviour and poor prognosis.  
 
 
Comments:  
 
1) Several groups have reported clinical significance of pre -treatment serum AFP levels in 
HCC patients. Th e present analysis did not add important new information to the current 
knowledge of HCC.  
 
 
2) The following statements were difficult to understand (Page 7, Line 44). Authors 
indicated that "Three hundred and ninety patients with hepatocellular carcinoma (H CC) 
were referred from 2011 September to 2015 September. One patient was infected with 
both hepatitis B and C viruses and excluded from the study. Rest of the patients (n=389) 
with hepatocellular carcinoma of non -viral aetiology were selected for the study ."  It is 
very unusual to have only one patient with dual hepatitis B and C infection among 390 
HCC patients.  
 
 
3) It is necessary using the multivariate Cox proportional hazards model to decide whether 
the pretreatment serum AFP was independent prognostic factors.  
 
 
4) It would be useful to know how many patients undergoing different types of treatment, 
especially curative resection in this cohort of patients.  
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.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
No 
 
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 recommend additional statistical review  
 
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 i nterests'  
 
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