A270 DEVELOPMENT OF HEPATOCELLULAR CARCINOMA IN PATIENTS WITH CIRRHOSIS FROM CHRONIC HEPATITIS C VIRUS TREATED WITH DIRECT ANTIVIRAL AGENTS: THE VICTORIA EXPERIENCE
Bibliographic record
Abstract
The development of direct acting antivirals (DAA) has improved sustained virologic response (SVR) rates in patients with chronic hepatitis C virus (HCV). Patients with cirrhosis from HCV have an increased risk of hepatocellular carcinoma (HCC) with a historic incidence of 1% per year. There has been recent controversy as to the rate of HCC occurrence in patients who have achieved SVR with DAA. The aim of this study was to assess the risk of HCC in patients with cirrhosis from HCV treated with DAA in a Canadian population. The primary hypothesis tested is: Does the rate of hepatocellular carcinoma in this cohort of cirrhotic patients treated with a DAA differ from published historic rates in the pre-DAA era? We performed a retrospective cohort study of 147 consecutive patients at Percuro Clinical Research Limited from January 2014 to January 2017. All patients had liver cirrhosis as determined by fibroscan or liver biopsy and were treated with a DAA. Incidence rates were compared to historic rates gathered from published reviews of comparable populations treated with interferon/ribavirin based treatments. Interim analysis shows demographics of 61% male (90/147), 67% genotype 1 (99/147), 19% genotype 3 (28/147) and mean fibroscan 26 kPa. SVR at 12 weeks was confirmed in 80% (117/147) and 7% (11/147) were virologic failures or relapsed. 57% of patients had documented follow-up imaging and average follow-up length was 397 days. Nine cases of de novo HCC (6%) during the follow-up period were identified with a mean time to diagnosis of 220 days from treatment end. Further analysis will be presented based on regression or hazard analysis. Our local experience confirms high sustained viral response rates but also suggests a higher incidence of hepatocellular carcinoma than historic data. Baseline and follow-up imaging rates were lower than expected and we would suggest considering multiphasic imaging prior to treatment commencement in patients with cirrhosis. We encourage other centres in Canada to monitor hepatocellular carcinoma rates post therapy to contribute to a future nationwide study. 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 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| 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".