Title: Efficacy and Safety of Ultrasound-Guided Percutaneous Microwave Ablation for
Hepatocellular Carcinoma at Specific Anatomic Sites of the Liver: A Systematic Review and
Meta-Analysis
Version: 0 Date: 11 Apr 2025
Reviewer's report:
This systematic review and meta-analysis evaluates the efficacy and safety of ultrasound-guided
percutaneous microwave ablation (MWA) for hepatocellular carcinoma (HCC) at specific
anatomical sites compared to non-specific sites. The authors included nine studies (2,381
patients) and found no significant differences in 1-, 3-, or 5-year survival rates, complete ablation
rates, or major complications between groups. The study concludes that MWA is equally
effective and safe for HCC at challenging anatomical locations, supported by low heterogeneity
and robust sensitivity analyses.
Major Comments
1. Handling of Missing Data
- The manuscript reports "NA" entries in baseline characteristics (e.g., Liu A, 2018: missing
control group demographics). Clarify how missing data were addressed (e.g., exclusion,
imputation) to ensure validity.
2. Subgroup Analysis
- While heterogeneity was low, subgroup analyses based on *specific tumor locations* (e.g.,
subcapsular vs. near vessels/gallbladder) are absent. Such analyses could reveal nuanced
differences in outcomes and should be acknowledged as a limitation.
3. Study Design Heterogeneity
- The inclusion of both prospective and retrospective cohort studies introduces potential bias. A
sensitivity analysis excluding retrospective studies (if feasible) would strengthen conclusions.
4. Generalizability of Findings
- The definition of "specific sites" includes diverse locations (e.g., diaphragm, vessels,
gallbladder). The aggregated results may mask site-specific risks. Discuss whether outcomes
might vary for tumors adjacent to critical structures (e.g., gallbladder vs. diaphragm).
5. Clinical Relevance of Non-Significant Results
- While statistical non-significance is emphasized, the confidence intervals for major
complications (OR=1.44, 95% CI: 0.59–3.51) suggest a possible trend toward higher risk in
specific sites. This should be addressed in the discussion.
Minor Comments
1. Abbreviations and Definitions
- Define "PSM" (Propensity Score Matching) in Table 1 or the methods section. Ensure all
abbreviations (e.g., NOS) are consistently explained.
2. Standardization of Terminology
- Standardize terminology in Table 1 under "Location of Liver Cancer" (e.g., "Adjacent to large
vessels" vs. "Near diaphragm").
3. Figure/Table Referencing
- The manuscript references Figure 1 (PRISMA flow diagram) and Figures 2–3 (forest plots),
but these were not included in the provided content. Verify numbering and ensure all figures
are accessible.
4. Grammar and Syntax
- Minor revisions needed for readability:
- *Original:* "patients who are not candidates for surgery or who refuse surgery"
- *Revised:* "patients ineligible for or declining surgery"
5. Conflict of Interest Statement
- The declaration states "no conflict of interest," but authors from the same institution (928
Hospital) may warrant explicit confirmation of independence.
Title: Efficacy and Safety of Ultrasound-Guided Percutaneous Microwave Ablation for
Hepatocellular Carcinoma at Specific Anatomic Sites of the Liver: A Systematic Review and
Meta-Analysis
Version: 0 Date: 11 Apr 2025
Reviewer's report:
This systematic review and meta-analysis evaluates the efficacy and safety of ultrasound-guided
percutaneous microwave ablation (MWA) for hepatocellular carcinoma (HCC) at specific
anatomical sites compared to non-specific sites. The authors included nine studies (2,381
patients) and found no significant differences in 1-, 3-, or 5-year survival rates, complete ablation
rates, or major complications between groups. The study concludes that MWA is equally
effective and safe for HCC at challenging anatomical locations, supported by low heterogeneity
and robust sensitivity analyses.
Major Comments
1. Handling of Missing Data
- The manuscript reports "NA" entries in baseline characteristics (e.g., Liu A, 2018: missing
control group demographics). Clarify how missing data were addressed (e.g., exclusion,
imputation) to ensure validity.
2. Subgroup Analysis
- While heterogeneity was low, subgroup analyses based on *specific tumor locations* (e.g.,
subcapsular vs. near vessels/gallbladder) are absent. Such analyses could reveal nuanced
differences in outcomes and should be acknowledged as a limitation.
3. Study Design Heterogeneity
- The inclusion of both prospective and retrospective cohort studies introduces potential bias. A
sensitivity analysis excluding retrospective studies (if feasible) would strengthen conclusions.
4. Generalizability of Findings
- The definition of "specific sites" includes diverse locations (e.g., diaphragm, vessels,
gallbladder). The aggregated results may mask site-specific risks. Discuss whether outcomes
might vary for tumors adjacent to critical structures (e.g., gallbladder vs. diaphragm).
5. Clinical Relevance of Non-Significant Results
- While statistical non-significance is emphasized, the confidence intervals for major
complications (OR=1.44, 95% CI: 0.59–3.51) suggest a possible trend toward higher risk in
specific sites. This should be addressed in the discussion.
Minor Comments
1. Abbreviations and Definitions
- Define "PSM" (Propensity Score Matching) in Table 1 or the methods section. Ensure all
abbreviations (e.g., NOS) are consistently explained.
2. Standardization of Terminology
- Standardize terminology in Table 1 under "Location of Liver Cancer" (e.g., "Adjacent to large
vessels" vs. "Near diaphragm").
3. Figure/Table Referencing
- The manuscript references Figure 1 (PRISMA flow diagram) and Figures 2–3 (forest plots),
but these were not included in the provided content. Verify numbering and ensure all figures
are accessible.
4. Grammar and Syntax
- Minor revisions needed for readability:
- *Original:* "patients who are not candidates for surgery or who refuse surgery"
- *Revised:* "patients ineligible for or declining surgery"
5. Conflict of Interest Statement
- The declaration states "no conflict of interest," but authors from the same institution (928
Hospital) may warrant explicit confirmation of independence.
Please review this paper.
user
Title: Efficacy and Safety of Ultrasound-Guided Percutaneous Microwave Ablation for
Hepatocellular Carcinoma at Specific Anatomic Sites of the Liver: A Systematic Review and
Meta-Analysis
Version: 0 Date: 11 Apr 2025
Reviewer's report:
This systematic review and meta-analysis evaluates the efficacy and safety of ultrasound-guided
percutaneous microwave ablation (MWA) for hepatocellular carcinoma (HCC) at specific
anatomical sites compared to non-specific sites. The authors included nine studies (2,381
patients) and found no significant differences in 1-, 3-, or 5-year survival rates, complete ablation
rates, or major complications between groups. The study concludes that MWA is equally
effective and safe for HCC at challenging anatomical locations, supported by low heterogeneity
and robust sensitivity analyses.
Major Comments
1. Handling of Missing Data
- The manuscript reports "NA" entries in baseline characteristics (e.g., Liu A, 2018: missing
control group demographics). Clarify how missing data were addressed (e.g., exclusion,
imputation) to ensure validity.
2. Subgroup Analysis
- While heterogeneity was low, subgroup analyses based on *specific tumor locations* (e.g.,
subcapsular vs. near vessels/gallbladder) are absent. Such analyses could reveal nuanced
differences in outcomes and should be acknowledged as a limitation.
3. Study Design Heterogeneity
- The inclusion of both prospective and retrospective cohort studies introduces potential bias. A
sensitivity analysis excluding retrospective studies (if feasible) would strengthen conclusions.
4. Generalizability of Findings
- The definition of "specific sites" includes diverse locations (e.g., diaphragm, vessels,
gallbladder). The aggregated results may mask site-specific risks. Discuss whether outcomes
might vary for tumors adjacent to critical structures (e.g., gallbladder vs. diaphragm).
5. Clinical Relevance of Non-Significant Results
- While statistical non-significance is emphasized, the confidence intervals for major
complications (OR=1.44, 95% CI: 0.59–3.51) suggest a possible trend toward higher risk in
specific sites. This should be addressed in the discussion.
Minor Comments
1. Abbreviations and Definitions
- Define "PSM" (Propensity Score Matching) in Table 1 or the methods section. Ensure all
abbreviations (e.g., NOS) are consistently explained.
2. Standardization of Terminology
- Standardize terminology in Table 1 under "Location of Liver Cancer" (e.g., "Adjacent to large
vessels" vs. "Near diaphragm").
3. Figure/Table Referencing
- The manuscript references Figure 1 (PRISMA flow diagram) and Figures 2–3 (forest plots),
but these were not included in the provided content. Verify numbering and ensure all figures
are accessible.
4. Grammar and Syntax
- Minor revisions needed for readability:
- *Original:* "patients who are not candidates for surgery or who refuse surgery"
- *Revised:* "patients ineligible for or declining surgery"
5. Conflict of Interest Statement
- The declaration states "no conflict of interest," but authors from the same institution (928
Hospital) may warrant explicit confirmation of independence.
assistant