![]() ![]() Indeed, unmeasured confounders are limited in observational studies, and it's essential to interpret the results cautiously. In our study, we observed that antidepressant use in the hepatocellular carcinoma (HCC) associated with lower risks of overall mortality (adjusted hazard ratio: 0.69) and cancer-specific mortality (adjusted hazard ratio: 0.63).1 Based on Ergun’s commentary, HCC disease stage may serve as an important unmeasured confounder in our study, and there may be potential misclassification bias. Indeed, given the methodological limitations and the observational nature of the study, it is essential to approach the results with caution and careful evaluation Were all prescribed antidepressants used with full adherence? Or were there patients in the comparison group who used antidepressants without a prescription? Such critical details could have an impact on the outcomes. ![]() As the authors rightly pointed out, crucial details about antidepressant dosages, duration of use, and adherence rates are missing. Given the inherently poor prognosis of advanced-stage HCC patients, this could potentially influence the results. It is observed that the rate of chemotherapy and sorafenib use is much lower in the group of antidepressant users, indirectly implying that patients in this group may be at an earlier stage. One of the most significant methodological concerns is the lack of adjustment for HCC disease stage in the analysis. The study addresses an intriguing research question however, it suffers from several limitations. ![]() Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment. ![]()
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