Review for 10.1186/s12876-021-02004-z (2021)

Title: Impact of cone-beam computed tomography with automated feeder detection software
on the survival outcome of patients with hepatocellular carcinoma during treatment with
conventional transarterial chemoembolization
Version: 1 Date: 21 Oct 2021
Reviewer's report:
SPECIFIC COMMENTS
This manuscript is pleasurable and flowing; no major issues are appreciable.
Although language used is appropriate, I (I am not a native English speaker) recommend to
Authors to obtain a certified native speaker with proficiencies in the scientific-medical field to
complete properly this paper (if not jet done). Moreover, I recommend making a further revision
of the manuscript to fix some typing/language errors.
TITLE
The title is clear and direct. Personally, I believe it could be improved, for example:
“Impact of cone-beam computed tomography with automated feeder detection software on the
survival outcome of patients with hepatocellular carcinoma during treated with conventional
chemoembolization”. If the editor agrees, the authors could consider the change of the title.
ABSTRACT
The abstract is well structured in all its section and, therefore, it properly reflects the main text
highlighting the most important aspects of this paper. Consequently, adjustments are not needed.
KEYWORDS
Authors did not correctly reported keywords from MeSH Browser. In particular I checked for
example “Survival benefit” on MeSH Browser and this is not a KW. This is important, in
my personal opinion, in order to increase the traceability of this paper (and consequently the
possibility of the Journal to be cited by Readers and Stakeholders). I suggest the check of all KW.
INTRODUCTION
Although the introduction fits the context of the study, it is concise. Sometime, many concepts
clearly explicated in an exhaustive introduction could help readers to become passionate about
reading the paper and using it as a reference.
In my opinion, the introduction should be expanded with comments on the different types of
transarterial chemoembolization. In particular, it is demonstrated that there is a non-superiority
of transarterial chemoembolization with respect to bland embolization in hepatocarcinoma
patients. Please, could the Authors discuss this argument here (or in Materials and Methods
or in Discussion) answering the reason why they used conventional TACE. Furthermore, it
is very important to introduce same sencences concerning the theme of the costs. In fact, it
was demonstrated that direct incremental costs of DEB-TACE can be acceptable in respect
to conventional TACE, relying on financial resources available from the payer perspective
[Dig Liver Dis. 2016 Jul;48(7):798-805. doi: 10.1016/j.dld.2016.03.031. PMID: 27263056.].
Please, could the Authors cite this article and discuss it here (or in Materials and Methods or in
Discussion) answering the reason why they used conventional TACE in terms of costs?
MATERIALS & METHODS
In the section Outcome and treatment evaluation, pag.9, regarding the sentence: “We used
the modified Response Evaluation Criteria in Solid Tumors (mRECIST) to assess HCC after
treatment [15].”. It is well known that the decision on whether a HCC patient is a responder
or progressor after treatment may vary among different operators, especially in case of a non-
specifically trained radiologist and, therefore, regardless of the adopted criteria, patients should
be evaluated by experienced radiologists to minimize variability in this critical instance [Eur
Radiol. 2018;28(9):3611-3620. doi:10.1007/s00330-018-5393-3]. Please, could the Authors
report the methodology used (an experienced radiologist evaluated CT or MRI?) citing the
aforementioned paper [Eur Radiol. 2018;28(9):3611-3620. doi:10.1007/s00330-018-5393-3].
Furthermore, in the same section Outcome and treatment evaluation, it is rebundant to report all
the definitions of CR, PR, etc…Please, remove.
It is clear that the focus of the work is not radiological. However, the usefulness of the results
of this paper is the possibility to be introduced the results in the clinical practice and therefore
it is essential to report the type of chemo-embolization that has been performed by the Authors.
In particular, according to [Ann Hepatol. 2021;22:100278. doi:10.1016/j.aohep.2020.10.006],
the Authors declared that performed chemotherapeutic-in-oil (Cio), anticancer-in-oil-emulsion?
Why they did not use water-in-oil? How did they shake the cocktail? Furthermore, how did they
decide to use mitomycin or doxorubicin? These arguments are important to understand on which
population it is possible to apply the model the Authors propose.
RESULTS
Results remain clear and well-structured, and no further adjustments are needed.
DISCUSSION
In my opinion, the topics of the discussion are very beautiful but overall the discussion is too
long. The authors must decide to reduce the text which otherwise becomes difficult to read.
TABLES & FIGURES
Tables & Figures are satisfactory and they correctly match the quality standard of this Journal.