Title: Construction and validation of a predictive model for hepatocellular carcinoma based on
serum markers
Version: 2 Date: 03 Jul 2022
Reviewer:  Yutaka Midorikawa
Reviewer's report:
Comment on the manuscript 3a48cbe1-1130-4474-9bb5-524d64c19cb1 by Zheng, et al.
Despite of the development of imaging modalities and serum marker, it is still difficult to
detect HCC at early stage. Furthermore, prognosis of the HCC patients is still poor even after
curative resection, because of the dysfunction of the background liver. The authors established
a non-invasive predictive model which could predict the HCC onset and survival of patients
undergoing liver resection. The concept of the paper is intriguing, however, there are major
concerns that need to be addressed.
There are several questions and suggestions for corrections.
1) The aim of this study is unclear. In Introduction, the purpose of this study is to diagnosis a
small HCC, however, there is no description about the tumor status. The Changzhou cohort did
not really include advanced stage HCC?
2) In Figure 2, the predictive score was lower 9 months before diagnosis of HCC. If so, all
patients in this cohort was diagnosed not to have HCC at this point?
3) The predictive model included not only tumor marker but also liver function. Therefore, I
assume that this model is available for the prediction of survivals of patients after operation, but
not for diagnosis of small HCC.
4) Survival curves should be shown as validation using Wuxi cohort.
5) Given that etiology of HCC patients is not only HBV but also HCV, alcoholic, and NASH,
HBV as a characteristic for score model should be excluded in order to be available world-wide.
6) The first sentence in Conclusion of Abstract should be removed.
7) Limitations of the study should be in Discussion, not in Conclusions.
Title: Construction and validation of a predictive model for hepatocellular carcinoma based on
serum markers
Version: 2 Date: 03 Jul 2022
Reviewer:  Yutaka Midorikawa
Reviewer's report:
Comment on the manuscript 3a48cbe1-1130-4474-9bb5-524d64c19cb1 by Zheng, et al.
Despite of the development of imaging modalities and serum marker, it is still difficult to
detect HCC at early stage. Furthermore, prognosis of the HCC patients is still poor even after
curative resection, because of the dysfunction of the background liver. The authors established
a non-invasive predictive model which could predict the HCC onset and survival of patients
undergoing liver resection. The concept of the paper is intriguing, however, there are major
concerns that need to be addressed.
There are several questions and suggestions for corrections.
1) The aim of this study is unclear. In Introduction, the purpose of this study is to diagnosis a
small HCC, however, there is no description about the tumor status. The Changzhou cohort did
not really include advanced stage HCC?
2) In Figure 2, the predictive score was lower 9 months before diagnosis of HCC. If so, all
patients in this cohort was diagnosed not to have HCC at this point?
3) The predictive model included not only tumor marker but also liver function. Therefore, I
assume that this model is available for the prediction of survivals of patients after operation, but
not for diagnosis of small HCC.
4) Survival curves should be shown as validation using Wuxi cohort.
5) Given that etiology of HCC patients is not only HBV but also HCV, alcoholic, and NASH,
HBV as a characteristic for score model should be excluded in order to be available world-wide.
6) The first sentence in Conclusion of Abstract should be removed.
7) Limitations of the study should be in Discussion, not in Conclusions.
Please review this paper.
user
Title: Construction and validation of a predictive model for hepatocellular carcinoma based on
serum markers
Version: 2 Date: 03 Jul 2022
Reviewer:  Yutaka Midorikawa
Reviewer's report:
Comment on the manuscript 3a48cbe1-1130-4474-9bb5-524d64c19cb1 by Zheng, et al.
Despite of the development of imaging modalities and serum marker, it is still difficult to
detect HCC at early stage. Furthermore, prognosis of the HCC patients is still poor even after
curative resection, because of the dysfunction of the background liver. The authors established
a non-invasive predictive model which could predict the HCC onset and survival of patients
undergoing liver resection. The concept of the paper is intriguing, however, there are major
concerns that need to be addressed.
There are several questions and suggestions for corrections.
1) The aim of this study is unclear. In Introduction, the purpose of this study is to diagnosis a
small HCC, however, there is no description about the tumor status. The Changzhou cohort did
not really include advanced stage HCC?
2) In Figure 2, the predictive score was lower 9 months before diagnosis of HCC. If so, all
patients in this cohort was diagnosed not to have HCC at this point?
3) The predictive model included not only tumor marker but also liver function. Therefore, I
assume that this model is available for the prediction of survivals of patients after operation, but
not for diagnosis of small HCC.
4) Survival curves should be shown as validation using Wuxi cohort.
5) Given that etiology of HCC patients is not only HBV but also HCV, alcoholic, and NASH,
HBV as a characteristic for score model should be excluded in order to be available world-wide.
6) The first sentence in Conclusion of Abstract should be removed.
7) Limitations of the study should be in Discussion, not in Conclusions.
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