Review for 10.1186/s12876-021-01807-4 (2021)

Reviewer’s report
Title: 
Surgical resection significantly promotes the overall survival of patients
with hepatocellular carcinoma: a propensity score matching analysis
Version: 
0 
Date: 
08 Mar 2021
Reviewer's report:
This is a potentially interesting retrospective study evaluating the prognostic
impact of SR over non surgical therapies in different BCLC stages.
The authors used a large cohort of patients and their results are important and
original. 
However, I have some major methodological doubts:
1) In order to avoid a too consisten decrease in sample size after PSM (see Table
1 and 3), I suggest to use inverse probability of treatment weights instead of
PSM. Moreover, standardized difference of mean (D value) should be used
instead of p values to compare subgroups.
2) In tables 1, 3 and 4 I did not find some fundamental variables for the
comparison of subgroups: alpha-fetoprotein, macroscpic vascular invasion,
extra-hepatic metastases, performance status, MELD score, clinically relevant
portal hyperthension. These variables are crucial to define differences among
groups and consequently to match them.
3) The authors should clearly describe how did they define BCLC stages. For
example, in BCLC stage B patients a relevant proportion of patients had single
tumor. However, BCLC B stage shoudl include only multinodular HCC since
BCLC scheme includes single tumor larger than 5 cm in stage A and not B.
Morevoer, in the definition of BCLC C patients, how many patients were in
stage C for vascular invasion or metastases, and how many for performance
status >0? The authors could maintain this distribution of patients probably if
they used ITA.LI.CA staging instead of BCLC staging. ITA.LI.CA staging is
similar to BCLC but it doesn't include many confusing aspect of BCLC (i.e.
absence of cut off size of 5 cm, role of performance status). References :
Treatment of Hepatocellular Carcinoma in the Precision Medicine Era: From
Treatment Stage Migration to Therapeutic Hierarchy. Vitale, A., Trevisani, F.,
Farinati, F., Cillo, U. Hepatology, 2020, 72(6), pp. 2206-2218, and The concept
of therapeutic hierarchy for patients with hepatocellular carcinoma: A
multicenter cohort study Vitale, A., Farinati, F., Pawlik, T.M., ...Trevisani, F.,
Cillo, U. Liver International, 2019, 39(8), pp. 1478-1489.
4) Which is the role of Liver Transplantation in different BCLC stages in
Taiwan? See reference: Is resectable hepatocellular carcinoma a contraindication
to liver transplantation? A novel decision model based on number of patients
needed to transplant as measure of transplant benefit Vitale, A., Cucchetti, A.,
Qiao, G.L., ...Cillo, U., Pinna, A.D. Journal of Hepatology, 2014, 60(6), pp.
1165-1171
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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?
Yes
Are the methods sufficiently described to allow the study to be repeated?
No
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No
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Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes