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June 18, 2024, 15:47

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Letter to the editor regarding ‘Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma’ Chengzhi Bai1,2 Xiaoping Wang3, Shanhong Tang1* 1.Department of Gastroenterology, The General Hospital of Western Theater Command, Chengdu, Sichuan, China 610083 2. Southwest Jiaotong University School of Medicine, Chengdu, China 610031 3. Suining Central Hospital, Suining, China 629000 * Correspondence: this work should be addressed to Shanhong Tang; Dear Editor： We read with interest the recent article by He and his team: Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma. The authors found that total tumor diameter (TTD, vascular invasion (VI), AFP and cytokeratin-18 epitopes M30 (CK18-M30) are important factors affecting the outcome of liver cancer patients after liver transplantation, and constructed corresponding nomogram prediction models, and verified the effectiveness of their models through calibration curves and decision curves [1]. We support and appreciate the authors' work and agree with their conclusions, but have some questions about some of the details in the article. Firstly, all indexes are converted into binary variables, but the critical value of each variable is not explained. In addition, categorizing continuous variables can lead to less efficient and less reliable models [2]. Therefore, we believe that continuous variable data should be included in the analysis and the model should be built. The first is that it may improve the predictive effectiveness and reliability of the model, and the second is that it can provide more in-depth analysis of the critical values and changes of the indicators. Secondly, AFP is a marker of liver cancer, but it also has great significance in the normal liver regeneration process. Previous studies by our team have confirmed that patients with higher AFP levels after artificial liver transplantation have a better prognosis, and AFP is also of high clinical value in predicting the prognosis of liver failure [3-4]. In this study, AFP is analyzed as a binary variable, and the potential value of this index is not deeply explored. Therefore, we suggest that it can be further analyzed as a continuity variable. Finally, the study only included tumor markers and related indicators as factors for analysis. In fact, common clinical indicators also have high predictive value in analyzing its prognosis. Multidimensional evaluation of the prognosis after liver transplantation can predict the outcome more comprehensively. For example, the nutritional status of prealbumin and albumin is reflected, the compensatory capacity of the liver is reflected by liver function indexes such as bilirubin [5-6]. In addition, there are many differences between liver cancer patients in China and those in other countries, such as hepatitis B, which is common in liver disease patients in China. Therefore, consideration of the etiology of liver cancer should also be included in the prognostic risk analysis of liver transplantation [7]. We believe that the research can also add the above indicators to analyze and build a model to make the model more complete and reliable. In conclusion, we believe that the study needs to address these issues to make the results more reliable. References: [1] He, L, Ji, W, Jin, H, et al. Development of a nomogram for predicting liver transplantation prognosis in hepatocellular carcinoma WORLD J GASTROENTERO. 2024; 30 (21): 2763-2776. doi: 10.3748/wjg.v30.i21.2763. [2] Schellingerhout, JM, Heymans, MW, de Vet, HC, et al. Categorizing continuous variables resulted in different predictors in a prognostic model for nonspecific neck pain. J CLIN EPIDEMIOL. 2009; 62 J CLIN EPIDEMIOL. doi: 10.1016/j.jclinepi.2008.10.010 [3] Wang, X, Shen, C, Yang, J, et al. Alpha-Fetoprotein as a Predictive Marker for Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure. CAN J GASTROENTEROL. 2018; 2018 1232785. doi: 10.1155/2018/1232785 [4] Wang, X, Shen, C, Yang, J, et al. Alpha-Fetoprotein as a Predictive Marker for Patients with Hepatitis B-Related Acute-on-Chronic Liver Failure. CAN J GASTROENTEROL. 2018; 2018 1232785. doi: 10.1155/2018/1232785 [5] Li, J, Du, M, Li, H, et al. Low Prealbumin Levels Were Associated with Increased Frequency of Hepatic Encephalopathy in Hepatitis B Virus (HBV)-Related Decompensated Cirrhosis. Med Sci Monit. 2023; 29 e937772. doi: 10.12659/MSM.937772 [6] Cui, S, Cao, S, Chen, Q, et al. Preoperative systemic inflammatory response index predicts the prognosis of patients with hepatocellular carcinoma after liver transplantation. Front Immunol. 2023; 14 1118053. doi: 10.3389/fimmu.2023.1118053 [7] Li, X, Zhang, L, Pu, C, et al. Liver transplantation in Acute-on-Chronic liver failure: Timing of transplantation and selection of patient population. Front Med (Lausanne). 2022; 9 Front Med (Lausanne). doi: 10.3389/fmed.2022.1030336

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