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Dear Editor,
We read Ng KT’s paper [1] with great interest. This study investigated the prognostic value of post-transplant cytokines on tumor recurrence after liver transplantation (LT) for hepatocellular carcinoma (HCC). A prediction model for post-LT tumor recurrence was generated by the logistic regression. They found that the P3C-UCSF-AFP score significantly predicted post-LT tumor recurrence and poor survival, and the P3C-UCSF-AFP score was validated to significantly predict post-LT 2-year and 5-year tumor recurrence. Finally, they concluded that the integrated P3C-UCSF-AFP score can predict post-LT tumor recurrence accurately. However, in this letter, we raise some statistical concerns about this study which may change the result of this study.
As we know, 1 covariate per 10 outcome events are demanded in logistic regression analysis [2]. Forty recurrence cases of 150 HCC recipients could at most analyze 4 variables in this study. However, there are 11 variables in Table 1 for the logistic regression analyses of the P3C score and clinical factors. Moreover, 9 variables based on 35 dead patients were analyzed for the predicted role of P3C score on overall survival and disease-free survival of HCC recipients after LT. However, 35 dead patients at most analyzed 4 variables in this study, but there are 9 variables. Thus, these overcrowded analysis models in Ng KT’s study may result in unreliable results. Finally, the accurately predicting role of the P3C score or P3C-UCSF-AFP score in post-LT tumor recurrence may not be accurate, further validation study should validate their conclusion.
However, despite these comments, we show great gratitude to Ng KT et al. for their outstanding study.
References
Ng KT, Liu J, Yeung OW, Pang L, Shiu HC, Liu H, et al. Post-transplant inflammatory cytokine signature adds value for predicting tumor recurrence after liver transplantation for hepatocellular carcinoma. Hepatol Int. 2023;17:1596–1609
van Smeden M, Moons KG, de Groot JA, Collins GS, Altman DG, Eijkemans MJ, et al. Sample size for binary logistic prediction models: beyond events per variable criteria. Stat Methods Med Res. 2019;28:2455–2474
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Chen, B., Huang, B. Regarding the role of post-transplant inflammatory cytokine signature on predicting tumor recurrence after liver transplantation for hepatocellular carcinoma. Hepatol Int (2024). https://doi.org/10.1007/s12072-024-10683-5
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DOI: https://doi.org/10.1007/s12072-024-10683-5