A78 DIRECT-ACTING ANTIVIRALS ARE NOT ASSOCIATED WITH EARLY TUMOR RECURRENCE AFTER CURATIVE TREATMENTS IN HEPATITIS C-RELATED HEPATOCELLULAR CARCINOMA
Bibliographic record
Abstract
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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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 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| 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".