Racial Diversity in the Decline in Hepatocellular Carcinoma and Increasing Age at Diagnosis in a Primarily African American Medical Center Population

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The authors presented the manuscript titled “Racial Diversity in the Decline in Hepatocellular Carcinoma and Increasing Age at Diagnosis in a Primarily African American Medical Center Population”, highlighting the critical role of hepatitis C treatment in reducing hepatocellular carcinoma incidence within the African American population. While the topic is highly relevant and timely, the manuscript requires substantial revisions before it can be considered for publication.

Major comments:

1. The data analysis section is currently missing and needs to be clearly described.
2. The ICD-10 codes used for identifying HCC cases should be explicitly stated.
3. It is recommended to add data labels (values) on top of the bars in figures to improve clarity and presentation.
4. In Section 3.2, the authors refer to "risk" and "risk factors," but appear to be presenting prevalence data. To properly address risk, the manuscript needs to include measures of association with corresponding confidence intervals.
5. In Section 3.3, p-values are reported without specifying the statistical tests used. The methods section must clearly describe all statistical procedures applied and software version.
6. Figure 2 is of low resolution and should be replaced with a higher-quality version.
7. Similar to Section 3.3, Section 3.4 includes p-values without any mention of the corresponding statistical tests in the methods section. This should be clarified.
8. In Figure 3, it is suggested to present rates (e.g., number of HCC cases per total patients or individuals at risk) instead of raw counts. Rates offer a more meaningful basis for comparison across time points.

Comments on the Quality of English Language

There are multiple typographical errors in the manuscript. Please thoroughly proofread the document before the next submission.

Author Response

Reviwer 1

The authors presented the manuscript titled “Racial Diversity in the Decline in Hepatocellular Carcinoma and Increasing Age at Diagnosis in a Primarily African American Medical Center Population”, highlighting the critical role of hepatitis C treatment in reducing hepatocellular carcinoma incidence within the African American population. While the topic is highly relevant and timely, the manuscript requires substantial revisions before it can be considered for publication.

Major comments:

1. The data analysis section is currently missing and needs to be clearly described. Resolved by including information and also by including more information in the figures related to stastical evaluation.
2. The ICD-10 codes used for identifying HCC cases should be explicitly stated.
3. It is recommended to add data labels (values) on top of the bars in figures to improve clarity and presentation.
4. In Section 3.2, the authors refer to "risk" and "risk factors," but appear to be presenting prevalence data. To properly address risk, the manuscript needs to include measures of association with corresponding confidence intervals. We respectively disagree with the statemtn that risk relates to prevelance.  The graphs present % of the population wich each risk factor but does not attempt to define prevelance in the population.  Stastical evaluation statement is included in legend and also addressed as part of another comment.
5. In Section 3.3, p-values are reported without specifying the statistical tests used. The methods section must clearly describe all statistical procedures applied and software version. Resolved.
6. Figure 2 is of low resolution and should be replaced with a higher-quality version. Resolved.
7. Similar to Section 3.3, Section 3.4 includes p-values without any mention of the corresponding statistical tests in the methods section. This should be clarified. Resolved.
8. In Figure 3, it is suggested to present rates (e.g., number of HCC cases per total patients or individuals at risk) instead of raw counts. Rates offer a more meaningful basis for comparison across time points.  Given the similarities with respect to the % of patients overlapping, we prefer to use the number of patients so as to provide for a better separation of the three lines as opposed to using % which creates an overlap which is not visually appealing.   We did shift  Figure 4 to % since it does not present an overlap problem.  We did however  include the number of patients above each point because it provides the reader with an accurate picture of the numbers of patients.

Reviewer 2 Report

Comments and Suggestions for Authors

The authors could improve the discussion in the manuscript adding some more comments on the potential role of several baseline factors on the incidence of HCC in this subpopulation, with particular regard to diabetes (cite the review PMID: 23845075). In this regard, comment also on the potential beneficial role of newer drugs GLP-1RAs 

The graphs are quite unclear, maybe too much written

Author Response

Reviwer 2

The authors could improve the discussion in the manuscript adding some more comments on the potential role of several baseline factors on the incidence of HCC in this subpopulation, with particular regard to diabetes (cite the review PMID: 23845075). In this regard, comment also on the potential beneficial role of newer drugs GLP-1Ras. We note that we did include an extensive discussion related to metabolic disease and HCC also commenting that many cryptogenic patients actually have metabolic disease, especially diabetes.  We have included the reference and included diaberttes as a major factor in MASLD and the potential role that CLP-1 agonists, along with redmideron might begin to make a n impact on the development of HCC.

 

The graphs are quite unclear, maybe too much written. The graphs have been  revised and newer copies added.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript is OK now. Thank you!

Author Response

Thank you!