Title: CLINICAL MANIFESTATION, STAGING AND PROGNOSIS OF
HEPATOCELLULAR CARCINOMA IN GAMBIAN PATIENTS
Version: 4 Date: 21 Aug 2023
Reviewer's report:
General comments
The authors have done well to revise the manuscript and take into consideration the reviewers'
comments. There are however still some additional revisions that could be made.
There are still some grammatical and editing corrections required in the manuscript, for example:
- This was the only specialist hepatology clinic that received referrals from across the whole
'Gambian' during the study period.
Figure 3: Survival of HCC patients according to child-'purg' class
Background
The authors state: "Sub-Saharan Africa is the most affected region owing to the high prevalence
of chronic hepatitis B virus infection." This statement may not be accurate since GLOBOCAN
data suggests otherwise. I suggest the authors confirm data from other sources such as the
following: https://gco.iarc.fr/today/home
Methods
The authors state that patients were prospectively enrolled and then followed up from time of
enrolment until death. It is appears the study design is therefore a cohort study, rather than a
cross-sectional study.
Results
The tables still require further editing for readability. For example: Table 2 requires further
editing. Which HIV status is shown? What are the Hb, WBC, etc indices shown? Are they
median with range or median with IQR? The abbreviations in the table should either be written
in full, or the abbreviations explained in the footnotes.
Limitations
The limitations of using USG for the diagnosis of HCC, especially early stage HCC should be
noted as a limitation in this study. It is possible that patients with early stage HCC could have
been missed on USG due to several factors including operator skill, which affect the sensitivity
of USG in the HCC diagnosis.
Title: CLINICAL MANIFESTATION, STAGING AND PROGNOSIS OF
HEPATOCELLULAR CARCINOMA IN GAMBIAN PATIENTS
Version: 4 Date: 21 Aug 2023
Reviewer's report:
General comments
The authors have done well to revise the manuscript and take into consideration the reviewers'
comments. There are however still some additional revisions that could be made.
There are still some grammatical and editing corrections required in the manuscript, for example:
- This was the only specialist hepatology clinic that received referrals from across the whole
'Gambian' during the study period.
Figure 3: Survival of HCC patients according to child-'purg' class
Background
The authors state: "Sub-Saharan Africa is the most affected region owing to the high prevalence
of chronic hepatitis B virus infection." This statement may not be accurate since GLOBOCAN
data suggests otherwise. I suggest the authors confirm data from other sources such as the
following: https://gco.iarc.fr/today/home
Methods
The authors state that patients were prospectively enrolled and then followed up from time of
enrolment until death. It is appears the study design is therefore a cohort study, rather than a
cross-sectional study.
Results
The tables still require further editing for readability. For example: Table 2 requires further
editing. Which HIV status is shown? What are the Hb, WBC, etc indices shown? Are they
median with range or median with IQR? The abbreviations in the table should either be written
in full, or the abbreviations explained in the footnotes.
Limitations
The limitations of using USG for the diagnosis of HCC, especially early stage HCC should be
noted as a limitation in this study. It is possible that patients with early stage HCC could have
been missed on USG due to several factors including operator skill, which affect the sensitivity
of USG in the HCC diagnosis.
Please review this paper.
user
Title: CLINICAL MANIFESTATION, STAGING AND PROGNOSIS OF
HEPATOCELLULAR CARCINOMA IN GAMBIAN PATIENTS
Version: 4 Date: 21 Aug 2023
Reviewer's report:
General comments
The authors have done well to revise the manuscript and take into consideration the reviewers'
comments. There are however still some additional revisions that could be made.
There are still some grammatical and editing corrections required in the manuscript, for example:
- This was the only specialist hepatology clinic that received referrals from across the whole
'Gambian' during the study period.
Figure 3: Survival of HCC patients according to child-'purg' class
Background
The authors state: "Sub-Saharan Africa is the most affected region owing to the high prevalence
of chronic hepatitis B virus infection." This statement may not be accurate since GLOBOCAN
data suggests otherwise. I suggest the authors confirm data from other sources such as the
following: https://gco.iarc.fr/today/home
Methods
The authors state that patients were prospectively enrolled and then followed up from time of
enrolment until death. It is appears the study design is therefore a cohort study, rather than a
cross-sectional study.
Results
The tables still require further editing for readability. For example: Table 2 requires further
editing. Which HIV status is shown? What are the Hb, WBC, etc indices shown? Are they
median with range or median with IQR? The abbreviations in the table should either be written
in full, or the abbreviations explained in the footnotes.
Limitations
The limitations of using USG for the diagnosis of HCC, especially early stage HCC should be
noted as a limitation in this study. It is possible that patients with early stage HCC could have
been missed on USG due to several factors including operator skill, which affect the sensitivity
of USG in the HCC diagnosis.
assistant