Title: CIRRHOSIS IN INTRAHEPATIC CHOLANGIOCARCINOMA: PROGNOSTIC
IMPORTANCE AND IMPACT ON SURVIVAL
Version: 3 Date: 16 Jun 2022
Reviewer's report:
This manuscript reported cirrhosis is associated with worse overall survival (OS) in patients
with iCCA using National Cancer Database (NCDB). The study showed that significant
differences were found for grade, pathologic stage, and tumor size across cirrhosis status, and
highlighted that cirrhosis was an independent factor for poor prognosis in iCCA patients. The
manuscript showed a potential role of cirrhosis in iCCA treatment and clinically practicality for
predicting the outcome of iCCA paitents. However, multiple weaknesses are noted, including
overinterpretation of the data and lack of innovation to support the conclusion of the manuscript.
Specific comments:
1. The role of cirrhosis in the treatment and prognosis of intrahepatic cholangiocarcinoma has
been reported before, and in 8th AJCC Tumor-Node-Metastasis (TNM) staging system, the
cirrhosis has been mentioned as an additional prognostic factor in iCCA patients. The authors
should highlight the innovation and particularity of this study compared with previous studies.
2. In table 5, the authors showed that after adjusting for sex, insurance, median income, race,
ethnicity, Charleson-Devo comorbidity score and timing of first course treatment, the presence
of cirrhosis among iCCA patients was associated with a reduced likelihood of both short-
term survival (OR=0.72, p=0.009) and long-term (OR= 0.77, p=0.031) survival, the authors
need to explain why these socio-demographic variables were selected for multivariable logistic
regression instead of the usual clinical variables, because the influence of socio-demographic
parameters on the prognosis of tumor patients remains to be further explored
3. In table 2, the author mainly mentioned tumor size and distant metastasis. However, lymph
node metastasis, vascular invasion and other important clinical parameters were not mentioned.
Relevant data or explanations need to be supplemented.
Title: CIRRHOSIS IN INTRAHEPATIC CHOLANGIOCARCINOMA: PROGNOSTIC
IMPORTANCE AND IMPACT ON SURVIVAL
Version: 3 Date: 16 Jun 2022
Reviewer's report:
This manuscript reported cirrhosis is associated with worse overall survival (OS) in patients
with iCCA using National Cancer Database (NCDB). The study showed that significant
differences were found for grade, pathologic stage, and tumor size across cirrhosis status, and
highlighted that cirrhosis was an independent factor for poor prognosis in iCCA patients. The
manuscript showed a potential role of cirrhosis in iCCA treatment and clinically practicality for
predicting the outcome of iCCA paitents. However, multiple weaknesses are noted, including
overinterpretation of the data and lack of innovation to support the conclusion of the manuscript.
Specific comments:
1. The role of cirrhosis in the treatment and prognosis of intrahepatic cholangiocarcinoma has
been reported before, and in 8th AJCC Tumor-Node-Metastasis (TNM) staging system, the
cirrhosis has been mentioned as an additional prognostic factor in iCCA patients. The authors
should highlight the innovation and particularity of this study compared with previous studies.
2. In table 5, the authors showed that after adjusting for sex, insurance, median income, race,
ethnicity, Charleson-Devo comorbidity score and timing of first course treatment, the presence
of cirrhosis among iCCA patients was associated with a reduced likelihood of both short-
term survival (OR=0.72, p=0.009) and long-term (OR= 0.77, p=0.031) survival, the authors
need to explain why these socio-demographic variables were selected for multivariable logistic
regression instead of the usual clinical variables, because the influence of socio-demographic
parameters on the prognosis of tumor patients remains to be further explored
3. In table 2, the author mainly mentioned tumor size and distant metastasis. However, lymph
node metastasis, vascular invasion and other important clinical parameters were not mentioned.
Relevant data or explanations need to be supplemented.
Please review this paper.
user
Title: CIRRHOSIS IN INTRAHEPATIC CHOLANGIOCARCINOMA: PROGNOSTIC
IMPORTANCE AND IMPACT ON SURVIVAL
Version: 3 Date: 16 Jun 2022
Reviewer's report:
This manuscript reported cirrhosis is associated with worse overall survival (OS) in patients
with iCCA using National Cancer Database (NCDB). The study showed that significant
differences were found for grade, pathologic stage, and tumor size across cirrhosis status, and
highlighted that cirrhosis was an independent factor for poor prognosis in iCCA patients. The
manuscript showed a potential role of cirrhosis in iCCA treatment and clinically practicality for
predicting the outcome of iCCA paitents. However, multiple weaknesses are noted, including
overinterpretation of the data and lack of innovation to support the conclusion of the manuscript.
Specific comments:
1. The role of cirrhosis in the treatment and prognosis of intrahepatic cholangiocarcinoma has
been reported before, and in 8th AJCC Tumor-Node-Metastasis (TNM) staging system, the
cirrhosis has been mentioned as an additional prognostic factor in iCCA patients. The authors
should highlight the innovation and particularity of this study compared with previous studies.
2. In table 5, the authors showed that after adjusting for sex, insurance, median income, race,
ethnicity, Charleson-Devo comorbidity score and timing of first course treatment, the presence
of cirrhosis among iCCA patients was associated with a reduced likelihood of both short-
term survival (OR=0.72, p=0.009) and long-term (OR= 0.77, p=0.031) survival, the authors
need to explain why these socio-demographic variables were selected for multivariable logistic
regression instead of the usual clinical variables, because the influence of socio-demographic
parameters on the prognosis of tumor patients remains to be further explored
3. In table 2, the author mainly mentioned tumor size and distant metastasis. However, lymph
node metastasis, vascular invasion and other important clinical parameters were not mentioned.
Relevant data or explanations need to be supplemented.
assistant