A78 DIRECT-ACTING ANTIVIRALS ARE NOT ASSOCIATED WITH EARLY TUMOR RECURRENCE AFTER CURATIVE TREATMENTS IN HEPATITIS C-RELATED HEPATOCELLULAR CARCINOMA
Notice bibliographique
Résumé
Interferon (IFN)-free regimens using new direct acting antivirals (DAA) have revolutionized the treatment of chronic hepatitis C (HCV) infection and demonstrate a sustained viral response (SVR) of over 90%. Recent publications have suggested an association between DAA therapy and early hepatocellular carcinoma (HCC) recurrence raising concerns about their safety. Therefore, we conducted a retrospective study to investigate the impact of DAA initiation on early tumor recurrence after curative treatments in hepatitis C-related HCC. From a combined surgery (January 2008-December 2015) and interventional radiology (January 2012-December 2015) database, 103 unique HCV infected patients with primary or recurrent HCC were identified. After excluding patients who failed to achieve complete radiological response (n=19), received transarterial chemoembolization (TACE) (n=17), received anti-viral therapy prior to HCC diagnosis or therapy (n=14), were lost to follow-up (n=7), died within 3 months of therapy (n=6), and received interferon containing DAA regimens (n=3), 37 HCV infected patients with complete response to their curative HCC therapy for at least 3 months, including 20 who subsequently received DAA therapy, were identified. With the exception of age (Control 64 years vs DAA 58 years, p<0.0133), baseline gender, total bilirubin, albumin, MELD score, alpha-feto protein levels, percentage of patients with primary HCC, and total tumor volume did not differ between the control and DAA group. Both groups were predominately infected with genotype 1 (Control 86% vs DAA 75%), while the remaining patients in the control and DAA group were infected with genotype 2 and 3, respectively. The overall median clinical remission period for the entire cohort was 26 months. Median interval between HCC treatment and the start of DAA treatment was 12.5 months, but ranged from 2 to 42 months. During a median observation time of 8 months that ranged from 2 to 20 month in the DAA group, 5 (25%) cases of recurrence were observed. Kaplan-Meier analysis showed improved probability of staying in clinical remission in the DAA group (<0.0001), even in subgroup analysis limiting the interval between HCC treatment and the start of antiviral therapy to less than 2 years. BCLC staging of recurrent disease was similar in both groups. (BCLC 0/A: Control 64% vs DAA 60%; BCLC B/C: Control 28% vs DAA 40%). In this preliminary analysis, DAA treatment after curative HCC therapy was not associated with early recurrence. Future studies using a larger cohort and longer follow up period is needed to confirm these findings. None
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».