Title: Efficacy and Safety of Ultrasound-Guided Percutaneous Microwave Ablation for
Hepatocellular Carcinoma at Specific Anatomic Sites of the Liver: A Systematic Review and
Meta-Analysis
Version: 0 Date: 30 Mar 2025
Reviewer's report:
This is an interesting meta-analysis of nine studies reporting outcomes of US-guided microwave
ablation (MWA) for hepatocellular carcinoma (HCC). The authors aim to compare outcomes
between tumors located at specific anatomic sites of the liver and those in non-specific sites.
Below are a few points:
1. It is current practice to avoid treating tumors in challenging locations solely with US guidance
to minimize complications and optimize clinical outcomes. Given this, the clinical significance
of the study remains unclear.
2. The authors report that complication rates were comparable between specific and non-specific
tumor sites. However, there is no description of the nature or severity of these complications,
which limits clinical interpretation.
3. The most critical technical factor in tumor ablation is the minimal ablation margin, as
suboptimal margins are strongly associated with tumor recurrence. If an adequate margin cannot
be achieved, alternative curative treatments should be considered. However, ablation margins
were neither evaluated nor discussed in this meta-analysis.
4. In the inclusion criteria, tumors within 5 mm of the intestine or kidney are classified as specific
anatomic site tumors. How many such tumors were included in the study? Given that these
tumors can be safely ablated using hydrodissection, what was the rationale for including them
in the specific anatomic site category?
5. The exclusion criteria state that studies without a control group were excluded. However, this
is unclear, as most included studies are cohort studies rather than case-control studies.
6. Given that the same search criteria were applied across all databases, how do the authors
explain the presence of only 498 duplicate records? Additionally, how often did the authors
encounter missing data that required contacting the original study authors?
7. Several references, such as Reference 25 (Journal of Oncology), could not be retrieved. The
authors should carefully verify all references to ensure accuracy and completeness.
Title: Efficacy and Safety of Ultrasound-Guided Percutaneous Microwave Ablation for
Hepatocellular Carcinoma at Specific Anatomic Sites of the Liver: A Systematic Review and
Meta-Analysis
Version: 0 Date: 30 Mar 2025
Reviewer's report:
This is an interesting meta-analysis of nine studies reporting outcomes of US-guided microwave
ablation (MWA) for hepatocellular carcinoma (HCC). The authors aim to compare outcomes
between tumors located at specific anatomic sites of the liver and those in non-specific sites.
Below are a few points:
1. It is current practice to avoid treating tumors in challenging locations solely with US guidance
to minimize complications and optimize clinical outcomes. Given this, the clinical significance
of the study remains unclear.
2. The authors report that complication rates were comparable between specific and non-specific
tumor sites. However, there is no description of the nature or severity of these complications,
which limits clinical interpretation.
3. The most critical technical factor in tumor ablation is the minimal ablation margin, as
suboptimal margins are strongly associated with tumor recurrence. If an adequate margin cannot
be achieved, alternative curative treatments should be considered. However, ablation margins
were neither evaluated nor discussed in this meta-analysis.
4. In the inclusion criteria, tumors within 5 mm of the intestine or kidney are classified as specific
anatomic site tumors. How many such tumors were included in the study? Given that these
tumors can be safely ablated using hydrodissection, what was the rationale for including them
in the specific anatomic site category?
5. The exclusion criteria state that studies without a control group were excluded. However, this
is unclear, as most included studies are cohort studies rather than case-control studies.
6. Given that the same search criteria were applied across all databases, how do the authors
explain the presence of only 498 duplicate records? Additionally, how often did the authors
encounter missing data that required contacting the original study authors?
7. Several references, such as Reference 25 (Journal of Oncology), could not be retrieved. The
authors should carefully verify all references to ensure accuracy and completeness.
Please review this paper.
user
Title: Efficacy and Safety of Ultrasound-Guided Percutaneous Microwave Ablation for
Hepatocellular Carcinoma at Specific Anatomic Sites of the Liver: A Systematic Review and
Meta-Analysis
Version: 0 Date: 30 Mar 2025
Reviewer's report:
This is an interesting meta-analysis of nine studies reporting outcomes of US-guided microwave
ablation (MWA) for hepatocellular carcinoma (HCC). The authors aim to compare outcomes
between tumors located at specific anatomic sites of the liver and those in non-specific sites.
Below are a few points:
1. It is current practice to avoid treating tumors in challenging locations solely with US guidance
to minimize complications and optimize clinical outcomes. Given this, the clinical significance
of the study remains unclear.
2. The authors report that complication rates were comparable between specific and non-specific
tumor sites. However, there is no description of the nature or severity of these complications,
which limits clinical interpretation.
3. The most critical technical factor in tumor ablation is the minimal ablation margin, as
suboptimal margins are strongly associated with tumor recurrence. If an adequate margin cannot
be achieved, alternative curative treatments should be considered. However, ablation margins
were neither evaluated nor discussed in this meta-analysis.
4. In the inclusion criteria, tumors within 5 mm of the intestine or kidney are classified as specific
anatomic site tumors. How many such tumors were included in the study? Given that these
tumors can be safely ablated using hydrodissection, what was the rationale for including them
in the specific anatomic site category?
5. The exclusion criteria state that studies without a control group were excluded. However, this
is unclear, as most included studies are cohort studies rather than case-control studies.
6. Given that the same search criteria were applied across all databases, how do the authors
explain the presence of only 498 duplicate records? Additionally, how often did the authors
encounter missing data that required contacting the original study authors?
7. Several references, such as Reference 25 (Journal of Oncology), could not be retrieved. The
authors should carefully verify all references to ensure accuracy and completeness.
assistant