Review for 10.1186/s12876-021-01944-w (2021)

Title: Preoperative ALBI grade predicts the outcomes in non-B non-C HCC patients undergoing
primary curative resection
Version: 2 Date: 19 May 2021
Reviewer's report:
In general, the paper has clear logic, novel ideas and comprehensive discussion. However,  there
are some problems with contents and language. Some comments are listed as follows:
1.In the methodological section of the abstract, not all the patients with BCLC Stage B or C
were excluded, so the specific exclusion condition of "BCLC Stage B or C" should be described;
Meanwhile, the formula of ALBI score, “ALBI score was log10 [albumin (mg/dL) x 17.1] x
0.66–albumin (g/dL) x 0.85” should be carefully checked and preferably in accordance with
context;
2.In the result section of the abstract, for example,“In predictors for mortality, AFP (p=0.004),
ALBI grade (p=0.004), tumor number (P=0.003) and tumor stages (pTNM stages) (p<0.001)
were independent prognostic factors”, in the sentence, the p value of AFP is inconsistent
with the data in Table 3; Similarly, the title and data of Figure 3 are inconsistent with the
text descriptions, for example,“NBNC-HCC patients with ALBI grade I had better OS than
those with ALBI grades II/III in cirrhotic status (p=0.012) (Figure 3A), however, there was no
significant difference in cirrhotic status (Figure 3B)”, which should be checked carefully in the
text;
3.There are many factors which affect HCC recurrence, DFS and OS after HCC
resection.Therefore, related factors should be considered during follow-up and analyzed .If the
information is difficult to be collected, it may be described by citing some relevant literature,
which is also one of the limitations and can be added to the discussion.
4.There are some spelling and grammar mistakes in this paper, which should be further
improved. For example,“clinic opathologic features was analyzed”, the word “opathologic”
should be revised.In addition, grammar of the sentences should be revised.For example,
“However, the number of HCC patients with neither HBV nor HCV infection, also known as
non-B, non-C HCC (NBNC-HCC), has been increasing annually, currently accounting for 11%
of all cases in Taiwan7, it is similar with Korea and Japan8, 9, an HCV-endemic country”;
“Recently, there are many studies demonstrated the albumin-bilirubin (ALBI) grade, which was
described in 2015 by Johnson et al”;
“Because the prevalence of nonviral HCC is increasing in Taiwan, it is a good time to evaluate
the effect of the pre-operative ALBI grades in predicting the outcomes of patients with NBNC-
HCC after primary curative hepatectomy.”;
“We retrospectively reviewed the Kaohsiung Chang Gung Memorial Hospital HCC registry
data, and consisted of data for 2137 HCC patients received HCC resection from January 2001
to April 2016.”;
“76 patients had been received HCC treatment before resection”;
“Factors those were significant in the univariate analysis (p <0.05) were included in a
multivariate analysis by using a Cox forward stepwise variable selection process of the estimated
OS and DFS.”;
“patients with NBNC-HCC had a higher proportion of diabetes, this result was compatible with
a large cohort study in Taiwan, which enrolled 3,843 patients with HCC from The Taiwan Liver
Cancer Network (TLCN)”;
“In addition, the degrees of fatty change of liver tissue in our cohort were similar with the above
study done by Huang, it was significantly more associated with patients with NBNC-HCC than
patients with HBV-HCC or HCV-HCC.”;
“OBI is the combined result of host immune control and different genomic expressions of the
virus, it leads to a virological quiescent state”;
“Second, this was a retrospective data from medical record and some patient were lost follow
up”.