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Commentary: comparisons of upper gastrointestinal bleeding mortality by admission time

We thank Drs Wong and Wong for their comments about our study. We fully agree that the model for endstage liver disease (MELD) scoring system plays an important role in determining the degree of liver dysfunction in chronic liver disease patients, in terms of outcome prediction. However, the MELD is a composite prognostic model composed of three variables. Our study aimed to develop a scoring system containing both tumour and cirrhosis factors to accurately predict the outcome in patients with small hepatocellular carcinoma (HCC). Ascites is a wellknown factor to impact the survival of cirrhotic patients with or without HCC. To avoid inter-observer bias, the imaging studies were evaluated by two experienced medical experts to assess the severity of ascites and ensure a consistent result. The effect of antiviral treatment for preventing postoperative tumour recurrence in HCC patients has been a controversial issue. A recent multicentre randomised controlled trial from Taiwan showed that adjuvant interferon a-2b did not reduce the incidence of post-operative recurrence of viral hepatitis-related HCC. The factor of antiviral treatment was not included in the analysis because the aetiology of chronic liver injury in our study population was quite heterogeneous, including single and dual viral infection, alcohol, metabolic and cryptogenic liver disease. Moreover, different anti-cancer treatment modalities were given to our patients. In fact, only a small proportion of patients received different forms of antiviral treatment for a variable duration sometime before or after anti-cancer treatment, making the statistical analysis of using antivirals less robust. The methods of diagnosis and surveillance programme of HCC are mostly according to current guidelines. Some of our patients may not have followed medical advice exactly, or did not receive surveillance for HCC on a regular basis, and it can be argued that these patients could be diagnosed at a late stage, thus with a relatively poor prognosis. However, we believe that the presentation of HCC at diagnosis is a more objective, crucial and reproducible factor to affect the long-term outcome.