Title: Prognostic Implications of CK19 Positivity in Patients with Early
Recurrent Hepatocellular Carcinoma after Hepatic Resection Undergoing Transarterial
Chemoembolization
Version: 1 Date: 05 Feb 2024
Reviewer's report:
In the manuscript entitled “Prognostic Implications of CK19 Positivity in Patients
with Early Recurrent Hepatocellular Carcinoma after Hepatic Resection Undergoing
Transarterial Chemoembolization”, the authors examined the survival outcomes of transarterial
chemoembolization (TACE) between patients with early recurrent hepatocellular carcinoma
(rHCC) after hepatic resection, stratified by cytokeratin (CK) 19 expression.
They concluded that in patients with early rHCC after hepatic resection, those with CK19-
positive expression had poorer survival outcomes following TACE compared to CK19-negative
patients. They also suggested the need for additional therapies to improve survival in CK19-
positive individuals. The result of this study was very interesting and informative, but there are
several concerns about this study.
[Major comments]
1. The major concern of this study was that this study is the retrospective study conducted by
single institution and the number of cases is 62 patients and it was too small to state the definitive
conclusion.
2. The surgical procedure and tumor information of initial resection for HCC were unclear.
These information could influence the patients’ prognosis.
3. The radiological imaging follow-up was unclear. The modalities of follow-up could influence
the tumor recurrence. Moreover, the cause of death of the enrolled patients was unclear. The
information of death, cancer-related or not, was important.
4. In Table 2, the univariate and multivariate analysis using a Cox model was conducted. In
univariate analysis, the factor of CK19 was not significant. Why did the authors apply the factor
of CK19 into the multivariate analysis?
5. The author stated that TACE may be more effective in rHCC patients with CK19-negative
expression. However, in order to state this hypothesis, the comparison of the survival outcomes
between rHCC patients who did not undergo TACE and who underwent TACE stratified by
CK19 expression would be necessary.
Title: Prognostic Implications of CK19 Positivity in Patients with Early
Recurrent Hepatocellular Carcinoma after Hepatic Resection Undergoing Transarterial
Chemoembolization
Version: 1 Date: 05 Feb 2024
Reviewer's report:
In the manuscript entitled “Prognostic Implications of CK19 Positivity in Patients
with Early Recurrent Hepatocellular Carcinoma after Hepatic Resection Undergoing
Transarterial Chemoembolization”, the authors examined the survival outcomes of transarterial
chemoembolization (TACE) between patients with early recurrent hepatocellular carcinoma
(rHCC) after hepatic resection, stratified by cytokeratin (CK) 19 expression.
They concluded that in patients with early rHCC after hepatic resection, those with CK19-
positive expression had poorer survival outcomes following TACE compared to CK19-negative
patients. They also suggested the need for additional therapies to improve survival in CK19-
positive individuals. The result of this study was very interesting and informative, but there are
several concerns about this study.
[Major comments]
1. The major concern of this study was that this study is the retrospective study conducted by
single institution and the number of cases is 62 patients and it was too small to state the definitive
conclusion.
2. The surgical procedure and tumor information of initial resection for HCC were unclear.
These information could influence the patients’ prognosis.
3. The radiological imaging follow-up was unclear. The modalities of follow-up could influence
the tumor recurrence. Moreover, the cause of death of the enrolled patients was unclear. The
information of death, cancer-related or not, was important.
4. In Table 2, the univariate and multivariate analysis using a Cox model was conducted. In
univariate analysis, the factor of CK19 was not significant. Why did the authors apply the factor
of CK19 into the multivariate analysis?
5. The author stated that TACE may be more effective in rHCC patients with CK19-negative
expression. However, in order to state this hypothesis, the comparison of the survival outcomes
between rHCC patients who did not undergo TACE and who underwent TACE stratified by
CK19 expression would be necessary.
Please review this paper.
user
Title: Prognostic Implications of CK19 Positivity in Patients with Early
Recurrent Hepatocellular Carcinoma after Hepatic Resection Undergoing Transarterial
Chemoembolization
Version: 1 Date: 05 Feb 2024
Reviewer's report:
In the manuscript entitled “Prognostic Implications of CK19 Positivity in Patients
with Early Recurrent Hepatocellular Carcinoma after Hepatic Resection Undergoing
Transarterial Chemoembolization”, the authors examined the survival outcomes of transarterial
chemoembolization (TACE) between patients with early recurrent hepatocellular carcinoma
(rHCC) after hepatic resection, stratified by cytokeratin (CK) 19 expression.
They concluded that in patients with early rHCC after hepatic resection, those with CK19-
positive expression had poorer survival outcomes following TACE compared to CK19-negative
patients. They also suggested the need for additional therapies to improve survival in CK19-
positive individuals. The result of this study was very interesting and informative, but there are
several concerns about this study.
[Major comments]
1. The major concern of this study was that this study is the retrospective study conducted by
single institution and the number of cases is 62 patients and it was too small to state the definitive
conclusion.
2. The surgical procedure and tumor information of initial resection for HCC were unclear.
These information could influence the patients’ prognosis.
3. The radiological imaging follow-up was unclear. The modalities of follow-up could influence
the tumor recurrence. Moreover, the cause of death of the enrolled patients was unclear. The
information of death, cancer-related or not, was important.
4. In Table 2, the univariate and multivariate analysis using a Cox model was conducted. In
univariate analysis, the factor of CK19 was not significant. Why did the authors apply the factor
of CK19 into the multivariate analysis?
5. The author stated that TACE may be more effective in rHCC patients with CK19-negative
expression. However, in order to state this hypothesis, the comparison of the survival outcomes
between rHCC patients who did not undergo TACE and who underwent TACE stratified by
CK19 expression would be necessary.
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