Title: Contrast-enhanced CT findings-based model to predict MVI in patients with
hepatocellular carcinoma
Version: 2 Date: 29 Sep 2022
Reviewer's report:
Dr. Yue and colleagues present a study to help guide decision making in patients with resectable
HCC; specifically, they seek to predict microvascular invasion with known preoperative clinical
data. I commend the effort given the dismal prognosis that this finding confers when identified in
resection specimens. This effort culminates in a nomogram that utilizes radiologic appearance of
tumor margin, direct bilirubin level, maximum tumor diameter and AFP to assign a risk of MVI,
and they attain an impressive AUC in the external validation cohort from a separate hospital.
My comments are as follows:
1) Almost all of these patients have HBV related HCC (87 - 89.8% in various cohorts). While
epidemiologically c/w East Asian series, this may or may not generalize to Western populations.
While this may not be addressable with their data sets, I think some comment on this in the
discussion would be helpful for context especially as the pathogenesis of HBV related HCC is
not necessarily as dependent on cirrhosis.
2) in the discussion the authors note that patients found to be at high risk of MVI preoperatively
should undergo more careful pathologic assessment and intensified surveillance. I think the
manuscript findings would be strengthened by expanding on the ramifications of knowing MVI
apriori of resection given the substantially elevated risk of recurrence. Is there rationale to
explore neoadjuvant approaches in these patients?
In summary, Dr. Yue and colleagues have crafted a nomogram that performs very well. To what
end can it be used, and in what population?
Title: Contrast-enhanced CT findings-based model to predict MVI in patients with
hepatocellular carcinoma
Version: 2 Date: 29 Sep 2022
Reviewer's report:
Dr. Yue and colleagues present a study to help guide decision making in patients with resectable
HCC; specifically, they seek to predict microvascular invasion with known preoperative clinical
data. I commend the effort given the dismal prognosis that this finding confers when identified in
resection specimens. This effort culminates in a nomogram that utilizes radiologic appearance of
tumor margin, direct bilirubin level, maximum tumor diameter and AFP to assign a risk of MVI,
and they attain an impressive AUC in the external validation cohort from a separate hospital.
My comments are as follows:
1) Almost all of these patients have HBV related HCC (87 - 89.8% in various cohorts). While
epidemiologically c/w East Asian series, this may or may not generalize to Western populations.
While this may not be addressable with their data sets, I think some comment on this in the
discussion would be helpful for context especially as the pathogenesis of HBV related HCC is
not necessarily as dependent on cirrhosis.
2) in the discussion the authors note that patients found to be at high risk of MVI preoperatively
should undergo more careful pathologic assessment and intensified surveillance. I think the
manuscript findings would be strengthened by expanding on the ramifications of knowing MVI
apriori of resection given the substantially elevated risk of recurrence. Is there rationale to
explore neoadjuvant approaches in these patients?
In summary, Dr. Yue and colleagues have crafted a nomogram that performs very well. To what
end can it be used, and in what population?
Please review this paper.
user
Title: Contrast-enhanced CT findings-based model to predict MVI in patients with
hepatocellular carcinoma
Version: 2 Date: 29 Sep 2022
Reviewer's report:
Dr. Yue and colleagues present a study to help guide decision making in patients with resectable
HCC; specifically, they seek to predict microvascular invasion with known preoperative clinical
data. I commend the effort given the dismal prognosis that this finding confers when identified in
resection specimens. This effort culminates in a nomogram that utilizes radiologic appearance of
tumor margin, direct bilirubin level, maximum tumor diameter and AFP to assign a risk of MVI,
and they attain an impressive AUC in the external validation cohort from a separate hospital.
My comments are as follows:
1) Almost all of these patients have HBV related HCC (87 - 89.8% in various cohorts). While
epidemiologically c/w East Asian series, this may or may not generalize to Western populations.
While this may not be addressable with their data sets, I think some comment on this in the
discussion would be helpful for context especially as the pathogenesis of HBV related HCC is
not necessarily as dependent on cirrhosis.
2) in the discussion the authors note that patients found to be at high risk of MVI preoperatively
should undergo more careful pathologic assessment and intensified surveillance. I think the
manuscript findings would be strengthened by expanding on the ramifications of knowing MVI
apriori of resection given the substantially elevated risk of recurrence. Is there rationale to
explore neoadjuvant approaches in these patients?
In summary, Dr. Yue and colleagues have crafted a nomogram that performs very well. To what
end can it be used, and in what population?
assistant