Reviewer's report
Title:A novel biomarker TERTmRNA is applicable for an early detection of
hepatoma
Version: 1Date:6 October 2009
Reviewer: Patrizia Pontisso
Reviewer's report:
The authors describe the diagnostic performance of serum human telomerase
reverse transcriptase mRNA for hepatocellular carcinoma. The results indicate
that this approach is highly sensitive and specific, allowing the conclusion that
hTERT mRNA is superior to conventional tumor markers in the diagnosis and
recurrence of HCC.
The availability of useful diagnostic markers for primary liver tumors is still an
unmet clinical need and the study has addressed such an important issue. To
better define the clinical relevance of the study, the following points should be
addressed:
1. HCC occurs in the majority of the cases on a cirrhotic liver, and cirrhosis is the
population at risk, where other tumor markers, such AFP, are frequently positive,
lowering the specificity of the biomarker, when compared to this population. On
the basis of these considerations, it would be interesting to calculate the
diagnostic performances of hTERT mRNA, including ROC curve analysis, using
cirrhotic patients and not healthy subjects as controls.
2. The clinical significance of monitoring the effect of therapies using hTERT
mRNA has been reported only in two representative cases. It is unclear whether
the concordance with clinical outcome is a common behavior in all patients or
whether this has not been evaluated in all treated patients. At list 12 months
follow-up after treatment should be required to draw any conclusion on the
prognostic value of the behavior of this marker.
3. The authors describe that the level of hTERT mRNA correlates with tumor
differentiation. However, in Fig. 6 (panel D) the higher levels were shown in
poorly differentiated cases, while in the discussion (pag.16) they report that
“…hTERT mRNA expression was closely associated with well to moderate
differentiation degree..” This point should be clarified.
Minor comments:
- In the Patients and Methods section the list of all the clinical parameters, also
reported in Fig 2 (and not in Figure 1) is redundant.
- The authors should specify how the diagnosis of HCC was achieved in tumors
of size <10mm.
- English should be substantially improved
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests' below.
Reviewer's report
Title:A novel biomarker TERTmRNA is applicable for an early detection of
hepatoma
Version: 1Date:6 October 2009
Reviewer: Patrizia Pontisso
Reviewer's report:
The authors describe the diagnostic performance of serum human telomerase
reverse transcriptase mRNA for hepatocellular carcinoma. The results indicate
that this approach is highly sensitive and specific, allowing the conclusion that
hTERT mRNA is superior to conventional tumor markers in the diagnosis and
recurrence of HCC.
The availability of useful diagnostic markers for primary liver tumors is still an
unmet clinical need and the study has addressed such an important issue. To
better define the clinical relevance of the study, the following points should be
addressed:
1. HCC occurs in the majority of the cases on a cirrhotic liver, and cirrhosis is the
population at risk, where other tumor markers, such AFP, are frequently positive,
lowering the specificity of the biomarker, when compared to this population. On
the basis of these considerations, it would be interesting to calculate the
diagnostic performances of hTERT mRNA, including ROC curve analysis, using
cirrhotic patients and not healthy subjects as controls.
2. The clinical significance of monitoring the effect of therapies using hTERT
mRNA has been reported only in two representative cases. It is unclear whether
the concordance with clinical outcome is a common behavior in all patients or
whether this has not been evaluated in all treated patients. At list 12 months
follow-up after treatment should be required to draw any conclusion on the
prognostic value of the behavior of this marker.
3. The authors describe that the level of hTERT mRNA correlates with tumor
differentiation. However, in Fig. 6 (panel D) the higher levels were shown in
poorly differentiated cases, while in the discussion (pag.16) they report that
“…hTERT mRNA expression was closely associated with well to moderate
differentiation degree..” This point should be clarified.
Minor comments:
- In the Patients and Methods section the list of all the clinical parameters, also
reported in Fig 2 (and not in Figure 1) is redundant.
- The authors should specify how the diagnosis of HCC was achieved in tumors
of size <10mm.
- English should be substantially improved
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests' below.
Please review this paper.
user
Reviewer's report
Title:A novel biomarker TERTmRNA is applicable for an early detection of
hepatoma
Version: 1Date:6 October 2009
Reviewer: Patrizia Pontisso
Reviewer's report:
The authors describe the diagnostic performance of serum human telomerase
reverse transcriptase mRNA for hepatocellular carcinoma. The results indicate
that this approach is highly sensitive and specific, allowing the conclusion that
hTERT mRNA is superior to conventional tumor markers in the diagnosis and
recurrence of HCC.
The availability of useful diagnostic markers for primary liver tumors is still an
unmet clinical need and the study has addressed such an important issue. To
better define the clinical relevance of the study, the following points should be
addressed:
1. HCC occurs in the majority of the cases on a cirrhotic liver, and cirrhosis is the
population at risk, where other tumor markers, such AFP, are frequently positive,
lowering the specificity of the biomarker, when compared to this population. On
the basis of these considerations, it would be interesting to calculate the
diagnostic performances of hTERT mRNA, including ROC curve analysis, using
cirrhotic patients and not healthy subjects as controls.
2. The clinical significance of monitoring the effect of therapies using hTERT
mRNA has been reported only in two representative cases. It is unclear whether
the concordance with clinical outcome is a common behavior in all patients or
whether this has not been evaluated in all treated patients. At list 12 months
follow-up after treatment should be required to draw any conclusion on the
prognostic value of the behavior of this marker.
3. The authors describe that the level of hTERT mRNA correlates with tumor
differentiation. However, in Fig. 6 (panel D) the higher levels were shown in
poorly differentiated cases, while in the discussion (pag.16) they report that
“…hTERT mRNA expression was closely associated with well to moderate
differentiation degree..” This point should be clarified.
Minor comments:
- In the Patients and Methods section the list of all the clinical parameters, also
reported in Fig 2 (and not in Figure 1) is redundant.
- The authors should specify how the diagnosis of HCC was achieved in tumors
of size <10mm.
- English should be substantially improved
Level of interest: An article of importance in its field
Quality of written English: Not suitable for publication unless extensively edited
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests' below.
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