Treatment Outcomes for Primary Hepatic Angiosarcoma: National Cancer Database Analysis 2004–2014
Round 1
Reviewer 1 Report
There is some discrepancy in the patient number of different categories in Table 2. For example, in the category of race. the total number of non-Spanish and Hispanic is not equal to the total number of patients (291 vs 293).
Please correct it.
Author Response
Thank you for your suggestion.
This discrepancy in numbers is characteristic of database studies as many times, a small proportion of patients will be unable to identify with race. We have not shown that minuscule number in the manuscript as these patients cannot be included in statistical analysis. They are not only excluded from the correlative analysis but also do not have any meaningful contribution to the manuscript. Likewise, such discrepancies also exist in other subcategories and cannot be rectified just because of the nature of the available data in such databases. We hope this will not hinder your approval of the manuscript.
Reviewer 2 Report
This is a valuable report using data from the National Cancer Database on primary hepatic angiosarcoma. Whether HCC is a suitable comparator for hepatic angiosarcoma is a matter of debate, but I cannot think of any other suitable comparator, and I believe that it is an unavoidable choice.
Author Response
Thank you for the encouragement. We appreciate your comments.
Reviewer 3 Report
I would like to congratulate the authors on the initiative to study a difficult topic due to its rarity and lack of effective therapeutic options.
This work focuses on treatment outcomes for primary hepatic angiosarcoma (PHA), which is an extremely rare disease and with dismal prognosis. The authors used the National Cancer Database to identify all patients diagnosed with PHA, but also hepatocellular carcinoma (HCC), to later comparison.
It seems to me that the study design was adequate and well adapted to the pre-stablished goals. In the end, this study allowed to obtain some interesting information regarding PHA, which adds some knowledge to this particular field. Due to this merits it is my opinion that this manuscript deserves to be published, however, I would like to address some issues which, in my opinion, would improve this work:
- Despite not being an english speaker native, the introduction section seems to present an english needing some revision, in order to provide a better, easier and fluid reading; the same do not apply for the remaining sections.
- While patients receiving surgery and/or chemotherapy present better survivals compared to those patients where surgical or systemic treatment was not offered, surgical and chemotherapy candidates are often younger and with localized disease, which would theoretically offer always a better prognosis. The authors recognize this issue in their discussion, however, I would like to see a more clear elaboration on these topic.
Another minor question:
Line 62: The term HCC is used for the first time without the correspondent especification of the meaning; the authors should correct this mistake.
In summary, this is a simple but important study on a rare entity which deserves further multicentric studies.
Author Response
Thank you for the astute observations.
Point 1: We appreciate the concerns of the reviewer. We have modified the presentation a little bit and have used the professional version of Grammarly to help guide grammatical errors. If further improvement is requested, we can attempt to modify the introduction even further.
Point 2: We appreciate the viewpoint of the reviewer. Although it may seem that localized disease may be more prevalent in younger patients, which in turn may impact their survival, there is no literature/reference to support this observation. At this point, mentioning this in the manuscript may lead to a controversy in the post-publication period. Hence, we will politely decline to comment on this aspect in the manuscript.
Point 3: Thank you again for pointing out the error. This was a proofreading error and has been rectified.
