Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 1 Date: 06 Nov 2023
Reviewer's report:
In this study, the authors aimed to to establish a nomogram of risk factors affecting the prognosis
of patients with alpha-fetoprotein (AFP) -negative Hepatocellular carcinoma (HCC) and to
evaluate its diagnostic efficiency.
They analyzed data from patients with AFP-negative initial diagnosis of HCC (ANHC),
collected from the Surveillance, Epidemiology, and End Results (SEER) database for model
establishment and validation and constructed nomograms with overall survival (OS) and cancer-
specific survival (CSS) as clinical endpoint events and constructed survival analysis by using
Kaplan-Meier curve.  The study included 1811 patients and they found in the multivariate
analysis, that the independent risk factors affecting prognosis were age, ethnicity, tumor
size, tumor grade, surgery, chemotherapy, and radiotherapy. The nomogram-based model
related C-indexes were 0.762 (95% confidence interval (CI): 0.752-0.772) and 0.752 (95%
CI: 0.740-0.769) for predicting OS, and 0.785 (95% CI: 0.774-0.795) and 0.779 (95% CI:
0.762-0.795) for predicting CSS. The nomogram model showed that the predicted death was
consistent with the actual value. The ROC analysis and DCA showed that the nomogram had
good clinical value compared with TNM staging.
Therefore, they concluded that  age, ethnicity, tumor diameter, tumor grade, surgery,
chemotherapy, and radiotherapy were independent prognostic factors for patients with ANHC.
Although the topic addressed is of clinical interest, the study suffers from important issues
limiting the impact of study results. 1) TNM staging system: this is a staging system not taking
into account the residual live function and underlying liver disease, both of which have a
significant prognostic impact; 2) regarding treatments, it is not clearly described how (which
criteria) surgical treatment, liver transplantation, chemotherapy (which one?) and radiotherapy
were decided; 3) were HCC patients under imaging surveillance for HCC, as recommended by
international guidelines?
Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 1 Date: 06 Nov 2023
Reviewer's report:
In this study, the authors aimed to to establish a nomogram of risk factors affecting the prognosis
of patients with alpha-fetoprotein (AFP) -negative Hepatocellular carcinoma (HCC) and to
evaluate its diagnostic efficiency.
They analyzed data from patients with AFP-negative initial diagnosis of HCC (ANHC),
collected from the Surveillance, Epidemiology, and End Results (SEER) database for model
establishment and validation and constructed nomograms with overall survival (OS) and cancer-
specific survival (CSS) as clinical endpoint events and constructed survival analysis by using
Kaplan-Meier curve.  The study included 1811 patients and they found in the multivariate
analysis, that the independent risk factors affecting prognosis were age, ethnicity, tumor
size, tumor grade, surgery, chemotherapy, and radiotherapy. The nomogram-based model
related C-indexes were 0.762 (95% confidence interval (CI): 0.752-0.772) and 0.752 (95%
CI: 0.740-0.769) for predicting OS, and 0.785 (95% CI: 0.774-0.795) and 0.779 (95% CI:
0.762-0.795) for predicting CSS. The nomogram model showed that the predicted death was
consistent with the actual value. The ROC analysis and DCA showed that the nomogram had
good clinical value compared with TNM staging.
Therefore, they concluded that  age, ethnicity, tumor diameter, tumor grade, surgery,
chemotherapy, and radiotherapy were independent prognostic factors for patients with ANHC.
Although the topic addressed is of clinical interest, the study suffers from important issues
limiting the impact of study results. 1) TNM staging system: this is a staging system not taking
into account the residual live function and underlying liver disease, both of which have a
significant prognostic impact; 2) regarding treatments, it is not clearly described how (which
criteria) surgical treatment, liver transplantation, chemotherapy (which one?) and radiotherapy
were decided; 3) were HCC patients under imaging surveillance for HCC, as recommended by
international guidelines?
Please review this paper.
user
Title: Prediction of survival and analysis of prognostic factors for patients with AFP negative
hepatocellular carcinoma: A population-based study
Version: 1 Date: 06 Nov 2023
Reviewer's report:
In this study, the authors aimed to to establish a nomogram of risk factors affecting the prognosis
of patients with alpha-fetoprotein (AFP) -negative Hepatocellular carcinoma (HCC) and to
evaluate its diagnostic efficiency.
They analyzed data from patients with AFP-negative initial diagnosis of HCC (ANHC),
collected from the Surveillance, Epidemiology, and End Results (SEER) database for model
establishment and validation and constructed nomograms with overall survival (OS) and cancer-
specific survival (CSS) as clinical endpoint events and constructed survival analysis by using
Kaplan-Meier curve.  The study included 1811 patients and they found in the multivariate
analysis, that the independent risk factors affecting prognosis were age, ethnicity, tumor
size, tumor grade, surgery, chemotherapy, and radiotherapy. The nomogram-based model
related C-indexes were 0.762 (95% confidence interval (CI): 0.752-0.772) and 0.752 (95%
CI: 0.740-0.769) for predicting OS, and 0.785 (95% CI: 0.774-0.795) and 0.779 (95% CI:
0.762-0.795) for predicting CSS. The nomogram model showed that the predicted death was
consistent with the actual value. The ROC analysis and DCA showed that the nomogram had
good clinical value compared with TNM staging.
Therefore, they concluded that  age, ethnicity, tumor diameter, tumor grade, surgery,
chemotherapy, and radiotherapy were independent prognostic factors for patients with ANHC.
Although the topic addressed is of clinical interest, the study suffers from important issues
limiting the impact of study results. 1) TNM staging system: this is a staging system not taking
into account the residual live function and underlying liver disease, both of which have a
significant prognostic impact; 2) regarding treatments, it is not clearly described how (which
criteria) surgical treatment, liver transplantation, chemotherapy (which one?) and radiotherapy
were decided; 3) were HCC patients under imaging surveillance for HCC, as recommended by
international guidelines?
assistant