A264 ADHERENCE TO ENHANCED POST-TREATMENT SURVEILLANCE IS ASSOCIATED WITH INCREASED DETECTION OF EARLY STAGE RECURRENCE AFTER RADIOFREQUENCY ABLATION BUT NOT SURGICAL MANAGEMENT OF HEPATOCELLULAR CARCINOMA
Bibliographic record
Abstract
Little is known about the optimal surveillance schedule after curative intent treatment of hepatocellular carcinoma (HCC). Current guidelines advocate cross-sectional imaging at 3–6 months intervals for the first 2 years, but are not backed by strong evidence of benefit. In Calgary, we perform MRI one month after radiofrequency ablation (RFA) and 3–6 months after surgery. Thereafter we alternate contrast enhanced ultrasound and MRI every 3 months for two years and then every six months for another 3 years. We conducted a retrospective study to investigate the impact of surveillance intensity on clinical outcomes following curative HCC treatment. From a combined surgery and interventional radiology database in Calgary (2012–2015), 124 unique HCC patients receiving post-treatment surveillance after successful resection (n=46) or RFA (n=78) were identified after excluding patients who received transarterial chemoembolization (TACE) (n=43), failed to achieve radiological remission (n=38) or died within three months (n=10). Baseline characteristics, imaging frequency, and clinical outcomes were collected. A surveillance rate defined as sum of actual number of images performed divided by the sum of the expected number of images in the defined surveillance period for each subject was calculated. Baseline characteristics including age, gender and liver disease were similar in both groups. The surgery group had a higher percent of Barcelona Clinic Liver Cancer (BCLC) staging 0 (p=0.00052), non-cirrhotic (p=0.0045), and first HCC (p=0.00027) then the RFA group. The two-year disease-free survival and five-year mortality rate on Kaplan-Meier analysis, as well as mean surveillance rate (89 ± 15% vs 84 ± 21%) were comparable. Interestingly, BCLC B/C recurrence (n=8) was significantly associated with a lower surveillance rate as compared to BCLC 0/A (n=32) recurrence in RFA patients (76 ± 22% vs 92 ± 14%, p=0.015), but this was not observed in the surgical cohort. Comparison of mean imaging interval (120 ± 47 days vs 82 ± 29 days, p =0.038) and time to recurrence (591 ± 245 days vs 399 ± 222 days, p=0.048) between BCLC B/C and 0/A recurrence also differed in the RFA cohort. Univariant analysis did not identify other predictors of more significant recurrence. In conclusion, high intensity post-treatment surveillance of HCC patients after locoregional therapy, but not surgical resection, appears to associated with detection of recurrence at an earlier stage. Ongoing follow-up will determine if this is associated with a survival benefit. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".