To the Editor, We read with interest the paper 'Development of pre and postoperative nomograms to predict individual survival for ideal liver resection candidates with hepatocellular carcinoma' published in an upcoming issue of Liver International. It is an interesting study that specifically focused on the feasibility of nomograms in predicting long-term survival for patients with hepatocellular carcinoma (HCC) undergoing surgical resection. Nevertheless, a few concerns and drawbacks may deserve the readers' attention. Firstly, in Zeng et al's study, overall survival (mortality) is the only end point for observation. However, since post-resection tumour recurrence is quite common for HCC, most liver surgeons and medical oncologists in liver cancer would agree that tumour recurrence is a more suitable primary end point for surgical HCC. Notably, our recent study showed that 59% (308/522) of patients developed tumour recurrence within 5 years of resection. Therefore, tumour recurrence or cancer-free survival should be selected as the primary end point in this study. This issue is critical because post-recurrence anticancer therapy would greatly impact the long-term survival. Unfortunately, this information was not mentioned in Zeng et al's study which is primarily a big data-based analysis in which the exact timing of tumour recurrence is usually not available.
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