Reviewer's report
Title:Meta-analysis of radiofrequency ablation versus hepatic resection for
hepatocellular carcinoma
Version: 1Date:24 January 2010
Reviewer: Linda M Wong
Reviewer's report:
Major Compulsory Revisions:
1. The authors have studied 10 trials of liver resection vs RFA for hepatocellular
cancer and performed a meta-analysis to try to determine which of the two
therapies is superior. The problem and the question posed by the authors are
well defined however the inclusion and exclusion criteria are not so clear. Was
there a tumor size criteria for inclusion or exclusion? Did this exclude any patient
that may have been rescued by liver transplant for failure of the initial therapy?
Were they all cirrhotics? Differences in viral hepatitis? Patients undergoing these
two treatments may be rather heterogeneous which is why it is so difficult to
conduct a randomized clinical trial.
2. The data is sound and they do mention the limitations in the discussion.
However, could they expand more on the populations of the trials – in terms of
age, tumor number, tumor size, Child –Pugh score etc. This appears to be on the
supplemental table but this is not discussed in the results section or the
discussion.
3. Although the meta-analysis suggests that there is no difference in the early
survival at 1 and 3 years, there is a survival advantage at 5 yrs for hepatic
resection. Is this because the liver resection patients were younger, had better
liver function, were not cirrhotic, had smaller tumors or something else? It’s not
clear that a meta-analysis would be able to sort this out, but they should at least
comment on this.
4. The title and abstract seem to convey what has been found and the writing is
acceptable, but perhaps they need to say that this is a meta-analysis of RFA vs
HR for small HCC, if that is their inclusion criteria otherwise the reader is just not
sure what this study covers.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Meta-analysis of radiofrequency ablation versus hepatic resection for
hepatocellular carcinoma
Version: 1Date:24 January 2010
Reviewer: Linda M Wong
Reviewer's report:
Major Compulsory Revisions:
1. The authors have studied 10 trials of liver resection vs RFA for hepatocellular
cancer and performed a meta-analysis to try to determine which of the two
therapies is superior. The problem and the question posed by the authors are
well defined however the inclusion and exclusion criteria are not so clear. Was
there a tumor size criteria for inclusion or exclusion? Did this exclude any patient
that may have been rescued by liver transplant for failure of the initial therapy?
Were they all cirrhotics? Differences in viral hepatitis? Patients undergoing these
two treatments may be rather heterogeneous which is why it is so difficult to
conduct a randomized clinical trial.
2. The data is sound and they do mention the limitations in the discussion.
However, could they expand more on the populations of the trials – in terms of
age, tumor number, tumor size, Child –Pugh score etc. This appears to be on the
supplemental table but this is not discussed in the results section or the
discussion.
3. Although the meta-analysis suggests that there is no difference in the early
survival at 1 and 3 years, there is a survival advantage at 5 yrs for hepatic
resection. Is this because the liver resection patients were younger, had better
liver function, were not cirrhotic, had smaller tumors or something else? It’s not
clear that a meta-analysis would be able to sort this out, but they should at least
comment on this.
4. The title and abstract seem to convey what has been found and the writing is
acceptable, but perhaps they need to say that this is a meta-analysis of RFA vs
HR for small HCC, if that is their inclusion criteria otherwise the reader is just not
sure what this study covers.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Meta-analysis of radiofrequency ablation versus hepatic resection for
hepatocellular carcinoma
Version: 1Date:24 January 2010
Reviewer: Linda M Wong
Reviewer's report:
Major Compulsory Revisions:
1. The authors have studied 10 trials of liver resection vs RFA for hepatocellular
cancer and performed a meta-analysis to try to determine which of the two
therapies is superior. The problem and the question posed by the authors are
well defined however the inclusion and exclusion criteria are not so clear. Was
there a tumor size criteria for inclusion or exclusion? Did this exclude any patient
that may have been rescued by liver transplant for failure of the initial therapy?
Were they all cirrhotics? Differences in viral hepatitis? Patients undergoing these
two treatments may be rather heterogeneous which is why it is so difficult to
conduct a randomized clinical trial.
2. The data is sound and they do mention the limitations in the discussion.
However, could they expand more on the populations of the trials – in terms of
age, tumor number, tumor size, Child –Pugh score etc. This appears to be on the
supplemental table but this is not discussed in the results section or the
discussion.
3. Although the meta-analysis suggests that there is no difference in the early
survival at 1 and 3 years, there is a survival advantage at 5 yrs for hepatic
resection. Is this because the liver resection patients were younger, had better
liver function, were not cirrhotic, had smaller tumors or something else? It’s not
clear that a meta-analysis would be able to sort this out, but they should at least
comment on this.
4. The title and abstract seem to convey what has been found and the writing is
acceptable, but perhaps they need to say that this is a meta-analysis of RFA vs
HR for small HCC, if that is their inclusion criteria otherwise the reader is just not
sure what this study covers.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
assistant