Review for 10.1186/s12876-021-01761-1 (2021)

Reviewer’s report
Title: 
Plasma interleukin-17 and alpha-fetoprotein combination effectively predicts imminent
hepatocellular carcinoma occurrence in liver cirrhotic patients
Version: 
1 
Date: 
01 Feb 2021
Reviewer's report:
Thank you to the authors for their reviewed manuscript. They have tackled most of my concerns but the
biggest issue that I still see for this paper is the lack of novelty. This is a descriptive paper with a lot of
clinical data but a lack of novelty. To me, AFP is just as good as IL-17 at predicting HCC occurrence. 
Major concerns:
1. The authors stated in one of their responses that "If there is an underlying mechanical mechanism
involving both IL-17 and other clinical variables, then there may be an obvious numerical correlation
between them": I do not agree with this. Correlation between a marker and a clinical manifestation is not a
determinant of an underlying mechanism. There is the possibility that IL-17 is affected indirectly or that it
is a "passenger" cytokine and that other markers play a more prominent role. Correlation does not indicate
causation. 
2. The authors state that Il-17 can be useful in patients that get HCC but that did not have high AFP levels.
If this is true, the only way that there will be some novelty is if the authors can show that IL-17 can predict
HCC occurrence in patients without prominent AFP elevation. Can IL-17 do this?
3. It would be great if authors can compare their data from patients in Taiwan to those in Japan to see if
IL-17 is a good marker for general HCC occurrence regardless of geographical locations.
4. Where there any other cytokines measured in this study? How do they compare to IL-17 at predicting
HCC occurrence?
Publons Reviewer Recognition
. Springer Nature can send verification of this review directly to Publons
(a subsidiary of Clarivate Analytics). If you would like to take advantage of this service, please click on
the “Yes” option below. Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted to Publons after the final
decision on the manuscript has been made. If you have already registered at Publons, they will notify you
of the receipt of this review and update your profile 
as per your settings and their policy. If you are not
registered with Publons, you will receive an email from them asking you to register in order for them to
be able to recognize your review on your new profile page. Publons may use the Review Data to generate
derivative metadata for the benefit of Publons and you as a reviewer, carefully considering the sensitivity
of such information. For example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help editors to identify candidate
reviewers. Please find the details of processing in Publons’ privacy policy
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the
following questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or salary from an
organisation that may in any way gain or lose financially from the publication of this manuscript,
either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an organization that holds or has
applied for patents relating to the content of the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this paper?
If you can answer no to all of the above, write 'I declare that I have no competing interests' below. If your
reply is yes to any, please give details below.
I declare that I have no competing interests
Reviewer Publication Consent.
 I agree for my report to be made available under an Open Access
Creative Commons CC-BY License (
 http://creativecommons.org/licenses/by/4.0
) if this manuscript is
accepted for publication. Any comments that I do not wish to be included in the published report have
been included as confidential comments to the editor, which will not be published.
If you are not happy
for us to publish this report, please contact the editorial office before completing the review.
If you
wish, you can include your name in your published report. Please note you must decide whether to
include your name at the start of the process and confirm this decision whenever prompted. If you
change your decision later, we will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name with my report. (default)
Is the study design appropriate to answer the research question (including the use of appropriate controls),
and are the conclusions supported by the evidence presented?
No
Are the methods sufficiently described to allow the study to be repeated?
Yes
Is the use of statistics and treatment of uncertainties appropriate?
Yes
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free from apparent
manipulation?
Yes