Review for 10.1186/s12876-023-02750-2 (2023)

Title: The care cascade for hepatitis C virus and prognosis of chronic hepatitis C patients treated
with antiviral agents in a tertiary hospital
Version: 1 Date: 05 Apr 2022
Reviewer's report:
Yoo and colleagues reported the status of HCV care in a tertiary hospital in Korea. Thanks to
the DAA for HCV infection, active HCV testing can be more important these days. Some issues
should be addressed for improvement of this paper.
General Comment
Abstract
#1. I would like to suggest to the authors that they modify the sentence “Few studies have
analyzed…” Because a study on larger size than this one in Korea was recently published. (Choi
J et al., Gut Liver 2022 Mar 31. Doi:10.5009/gnl210416) In addition, please cite this paper in
the introduction.
#2. In the result section, “494 (57.6%) patients received antiviral treatment, and 443 (89.7%)
experienced …” of whom? Please clarify this.
Main text
#1. Except figure 1, most contents in the main text focused on patient who were treated rather
than the care cascade for HCV. Table 1 also described baseline characteristics of patients
(n=421) with antiviral treatment. I would like to suggest changing the title or adding this
information in the title.
#2. If the authors want to analyze about care cascade of HCV control in Korea, more information
should be described. For example, how many or what proportions of patients did not perform
HCV RNA testing despite of anti-HCV positivity, what were their characteristics, including
their LFT, demographics, and presence of underlying liver disease. Discussion should also be
followed regarding why certain portion of patients with anti-HCV positivity were not able to
test HCV RNA.
#3. In addition, one of barrier for HCV care cascade is lack of appropriate referral system
between non-GI and GI department. Are there any data about this issue?
#4. The authors mentioned that patients with follow-up more than 6 months were included in
the long-term outcome analysis depicted in Figure 2. However, when I see the Figure 2A some
patients were already censored before 6 months of follow-up. Please check this was right. This
issue similarly presents in the Figure 3 and 4
#5. Regarding the Figure 3A, I would like to cut down the X-axis to just 5 – 6 years. Because
no patient left beyond 6 years in SVR (-) group.
#6. Despite the 0.051 p value, the two groups appeared to be distinct in Figure 3B. Failure to
reach statistical significance may be regarded as a lack of statistical power, rather than real non-
difference.
#7. In the last paragraph of result section, there was only 1 patient left after 10 years of follow-
up period. Why the authors used different denominator for cumulative HCC incidence between
the LC (13 years) and non-LC group (15 years). I would like to suggest to revise these with
annual incidence.
#8. Almost half of the Discussion’s content focused on the status and importance of the HCV
care cascade. However, again, the study’s primary findings concerned patients who received
antiviral treatment and their long-term outcomes. If possible, I would like to propose that you
offer additional information regarding the current state of the HCV care cascade, including any
serial trends in this care cascade, are there any speculations as to why certain patients did not
receive treatment? Why did some patients did not perform HCV RNA testing?
#9. I do not think the number and rate of event were not necessary in the Figure 2, 3, and 4. It
looks redundant and make the figures busy. Number at risk could be enough to interpret the K-
M curve as most other papers.