Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease

Round 1

Reviewer 1 Report

Comments to Authors 

            This study showed that considering a large number of NAFLD population, optimal screening tests must meet several criteria including high sensitivity, cost effectiveness and availability.

          Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver injury in many countries. NAFLD includes a spectrum of syndromes, ranging from simple steatosis, non-alcoholic steatohepatitis (NASH) to fibrosis, cirrhosis and hepatocellular carcinoma (HCC) [1]. Although HCC is mainly caused by hepatitis B or C virus infection, the incidence of HCC related to alcohol abuse or (NAFLD) has risen markedly in recent decades [2]. It was summarize the most recent evidence on the epidemiology and risk factors for HCC in patients with NAFLD, with and without cirrhosis, and the evidence supporting surveillance for early HCC detection in these patients, reviewing the potential limitations of currently recommended surveillance strategies, and assessing data on the accuracy of potential new screening tools [3].

           Authors are kindly requested to emphasize the current concepts about these issues in the context of recent knowledge and the available literature. This articles should be quoted in the References list.

References

1. What is the role of adiponectin in obesity related non-alcoholic fatty liver disease?. World J Gastroenterol. 2013; 19 (6): 802-812. doi:10.3748/wjg.v19.i6.802.
2. Should you advocate for hepatocellular carcinoma surveillance in patients with alcohol-related liver disease or non-alcoholic fatty liver disease?. Clin Mol Hepatol. 2020;26(2):183-184. doi:10.3350/cmh.2020.0042.
3. Surveillance for Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease: Universal or Selective?. Cancers (Basel). 2020;12(6):E1422. Published 2020 May 31. doi:10.3390/cancers12061422.

Author Response

Reviewer　１

This study showed that considering a large number of NAFLD population, optimal screening tests must meet several criteria including high sensitivity, cost effectiveness and availability.Non-alcoholic fatty liver disease (NAFLD) is the most common type of chronic liver injury in many countries. NAFLD includes a spectrum of syndromes, ranging from simple steatosis, non-alcoholic steatohepatitis (NASH) to fibrosis, cirrhosis and hepatocellular carcinoma (HCC) [1]. Although HCC is mainly caused by hepatitis B or C virus infection, the incidence of HCC related to alcohol abuse or (NAFLD) has risen markedly in recent decades [2]. It was summarize the most recent evidence on the epidemiology and risk factors for HCC in patients with NAFLD, with and without cirrhosis, and the evidence supporting surveillance for early HCC detection in these patients, reviewing the potential limitations of currently recommended surveillance strategies, and assessing data on the accuracy of potential new screening tools [3].Authors are kindly requested to emphasize the current concepts about these issues in the context of recent knowledge and the available literature. This articles should be quoted in the References list.

References

1. What is the role of adiponectin in obesity related non-alcoholic fatty liver disease?. World J Gastroenterol. 2013; 19 (6): 802-812. doi:10.3748/wjg.v19.i6.802.
2. Should you advocate for hepatocellular carcinoma surveillance in patients with alcohol-related liver disease or non-alcoholic fatty liver disease?. Clin Mol Hepatol. 2020;26(2):183-184. doi:10.3350/cmh.2020.0042.
3. Surveillance for Hepatocellular Carcinoma in Patients with Non-Alcoholic Fatty Liver Disease: Universal or Selective?. Cancers (Basel). 2020;12(6):E1422. Published 2020 May 31. doi:10.3390/cancers12061422.

Answer: In agreement with you, three papers were cited as references [2], [4] and [27] (revised manuscript).

Reviewer 2 Report

The manuscript entitled: ‘Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease’ aim to present an complete guide for HCC surveillance in NAFLD. The manuscript is very well written and provide new information regarding the protocols for HCC diagnosis. I have some minor comments for the authors:

1. When you discuss the ‚carcinogenic risk in NAFLD’ you present the annual rate of HCC only in Japan. As the manuscript intend to be of worlwide importance please include statistics also for other regions.
2. When you present M2BPGi as a biomarker for liver fibrosis please extend its description . Also please specify the methods for M2BPGi detection.
3. Please check the manuscript for spaces and punctuation erors

Author Response

Reviewer 2

The manuscript entitled: ‘Surveillance of Hepatocellular Carcinoma in Nonalcoholic Fatty Liver Disease’ aim to present an complete guide for HCC surveillance in NAFLD. The manuscript is very well written and provide new information regarding the protocols for HCC diagnosis. I have some minor comments for the authors:

1. When you discuss the ‚carcinogenic risk in NAFLD’ you present the annual rate of HCC only in Japan. As the manuscript intend to be of worldwide importance please include statistics also for other regions.

Answer: In agreement with you, global evidences were mentioned in the section 2 and 4.

2. When you present M2BPGi as a biomarker for liver fibrosis please extend its description . Also please specify the methods for M2BPGi detection.

Answer: As you suggested, the methods for M2BPGi detection was mentioned in the section 5.

3. Please check the manuscript for spaces and punctuation errors

Answer: English editing was performed using MDPI editing services.