Letter: Positivity of High-Sensitivity HBsAg Test Was Significantly Associated With Poor Prognosis in Patients With Non-HBV-Related HCC

We have read a recent article titled ‘Positivity of high-sensitivity HBsAg test, not previous HBV infection, indicates poor prognosis in patients with non-HBV-related HCC’, with great interest [1]. This study is significant, as it provides insights into the role of high-sensitivity HBs antigen positivity (hHBsAg+) in prognosis evaluation. These findings have important implications for estimating overall survival (OS) among non-HBV-related hepatocellular carcinoma. While recognising the value of this study, we would like to make the following comments.

First, although the Cox regression model is widely acknowledged for its utility, its use in scenarios with potential competing risks might lead to overestimation. Consequently, for the OS explored in this paper, especially when different variables are potentially interrelated, employing a competing risks model appears more fitting. Traditional analysis techniques might not adequately account for the influence of secondary events on the primary study endpoint. A competing risk model might provide a more comprehensive viewpoint [2].

Second, the authors' inclusion of important information such as Barcelona Clinic Liver Cancer stage and laboratory tests to adjust for potential covariates is commendable. However, considering other potential confounders such as the presence of prophylactic antiviral treatment, treatment methods, Charlson Comorbidity Index, nutrition condition and family income might further enhance the robustness of these findings [3-5].

Last, to our knowledge, men are twice as likely as women to develop non-viral liver fibrosis and five times as likely to develop hepatocellular carcinoma [6]. Given significant sex-specific disparities, a separate analysis for the subgroup could offer more nuanced insights.

This article is a significant step forward in our understanding of the relationship between hHBsAg+ and poor prognosis. A more comprehensive prediction could be an intriguing topic for further investigation.

Xiaosong Li: conceptualization, investigation, methodology, writing – original draft. Xiping Shen: methodology, investigation, writing – original draft. Ji Wu: conceptualization, writing – review and editing, methodology, investigation, supervision.

The authors have nothing to report.

The authors declare no conflicts of interest.

This article is linked to Yasuura et al papers. To view these articles, visit https://doi.org/10.1111/apt.18229 and https://doi.org/10.1111/apt.18340.