Title: Comparison of preoperative two-dimensional shear wave elastography, indocyanine
green clearance test and biomarkers for post hepatectomy liver failure prediction
Version: 2 Date: 04 Feb 2021
Reviewer's report:
This is a retrospective analysis which compares the performance of 2D-SWE, ICG-R15, ALBI,
APRI and FIB-4 to preoperatively predict PHLF for HCC patients undergoing major liver
resection. This comparison is of great clinical value because hepatobiliary surgeons often think
about which one should be trusted in the face of conflicting results.
Major points:
1. The sample size is too small to systematically compare different methods for prediction of
PHLF. Patients between February 2019 and September 2019 were involved in this analysis.
Could you include more patients by extending the time range?
2. The incidence of PHLF is relatively low, which is 10.5% (9/86), 8.6% (5/58) and 9.7%
(14/144) in the development group, validation group and total patients, respectively. And the
grade of PHLF according to ISGLS is not shown. Importantly, patients with grade A PHLF
require no change in the clinical management. If most patients are grade A PHLF patents, the
diagnosis or prediction of PHLF is less meaningful in clinical. Could you show the grade of
PHLF in table 1?
3. Whether the AUC of test A is superior to that of test B needs statistically test, such as Delong
test, rather than directly comparing the exact value of their AUCs.
4. More importantly, for comparison of different diagnostic tests, comparing AUCs between
tests is meaningless. Because AUC involves more than one cutoff value. When we do a
diagnostic test, we just perform diagnosis with a specific cutoff. Therefore, the authors must
compare the sensitivity and specificity with a specific cutoff value between different diagnostic
tests with appropriate statistical methods.
Minor points:
1. The comparison of baseline characteristics between the development group and validation
group should be shown.
2. Language expression of this manuscript needs to be improved.
Title: Comparison of preoperative two-dimensional shear wave elastography, indocyanine
green clearance test and biomarkers for post hepatectomy liver failure prediction
Version: 2 Date: 04 Feb 2021
Reviewer's report:
This is a retrospective analysis which compares the performance of 2D-SWE, ICG-R15, ALBI,
APRI and FIB-4 to preoperatively predict PHLF for HCC patients undergoing major liver
resection. This comparison is of great clinical value because hepatobiliary surgeons often think
about which one should be trusted in the face of conflicting results.
Major points:
1. The sample size is too small to systematically compare different methods for prediction of
PHLF. Patients between February 2019 and September 2019 were involved in this analysis.
Could you include more patients by extending the time range?
2. The incidence of PHLF is relatively low, which is 10.5% (9/86), 8.6% (5/58) and 9.7%
(14/144) in the development group, validation group and total patients, respectively. And the
grade of PHLF according to ISGLS is not shown. Importantly, patients with grade A PHLF
require no change in the clinical management. If most patients are grade A PHLF patents, the
diagnosis or prediction of PHLF is less meaningful in clinical. Could you show the grade of
PHLF in table 1?
3. Whether the AUC of test A is superior to that of test B needs statistically test, such as Delong
test, rather than directly comparing the exact value of their AUCs.
4. More importantly, for comparison of different diagnostic tests, comparing AUCs between
tests is meaningless. Because AUC involves more than one cutoff value. When we do a
diagnostic test, we just perform diagnosis with a specific cutoff. Therefore, the authors must
compare the sensitivity and specificity with a specific cutoff value between different diagnostic
tests with appropriate statistical methods.
Minor points:
1. The comparison of baseline characteristics between the development group and validation
group should be shown.
2. Language expression of this manuscript needs to be improved.
Please review this paper.
user
Title: Comparison of preoperative two-dimensional shear wave elastography, indocyanine
green clearance test and biomarkers for post hepatectomy liver failure prediction
Version: 2 Date: 04 Feb 2021
Reviewer's report:
This is a retrospective analysis which compares the performance of 2D-SWE, ICG-R15, ALBI,
APRI and FIB-4 to preoperatively predict PHLF for HCC patients undergoing major liver
resection. This comparison is of great clinical value because hepatobiliary surgeons often think
about which one should be trusted in the face of conflicting results.
Major points:
1. The sample size is too small to systematically compare different methods for prediction of
PHLF. Patients between February 2019 and September 2019 were involved in this analysis.
Could you include more patients by extending the time range?
2. The incidence of PHLF is relatively low, which is 10.5% (9/86), 8.6% (5/58) and 9.7%
(14/144) in the development group, validation group and total patients, respectively. And the
grade of PHLF according to ISGLS is not shown. Importantly, patients with grade A PHLF
require no change in the clinical management. If most patients are grade A PHLF patents, the
diagnosis or prediction of PHLF is less meaningful in clinical. Could you show the grade of
PHLF in table 1?
3. Whether the AUC of test A is superior to that of test B needs statistically test, such as Delong
test, rather than directly comparing the exact value of their AUCs.
4. More importantly, for comparison of different diagnostic tests, comparing AUCs between
tests is meaningless. Because AUC involves more than one cutoff value. When we do a
diagnostic test, we just perform diagnosis with a specific cutoff. Therefore, the authors must
compare the sensitivity and specificity with a specific cutoff value between different diagnostic
tests with appropriate statistical methods.
Minor points:
1. The comparison of baseline characteristics between the development group and validation
group should be shown.
2. Language expression of this manuscript needs to be improved.
assistant