Protracted Course of Relapsing-Remitting Fibrolamellar Hepatocellular Carcinoma in an Adolescent
Bibliographic record
Abstract
Hepatocellular carcinoma (HCC) is a global healthcare problem commonest in males with hepatic cirrhosis or hepatitis B virus infection. Fibrolamellar HCC is a subtype seen mainly in younger patients without conventional risk factors and perhaps has a somewhat more favorable prognosis than typical HCC. Here we report a case of fibrolamellar HCC presenting in an adolescent with a prolonged, relapsing-remitting course characterized by prolonged exposure to sorafenib including in the adjuvant context, use of adjuvant doxorubicin chemotherapy, resection of multiple metachronous pulmonary metastases and dramatic response to radiotherapy delivered as tomotherapy to her metastatic hilar lymphadenopathy. We speculate on the possible synergistic interactions between radiotherapy and her anti-angiogenic therapy and on what systemic treatment options might be open to her in the future including further targeted therapy and also immunotherapy including immune checkpoint blockade such as anti-CTLA4 and PD-1. J Med Cases. 2015;6(3):113-118 doi: http://dx.doi.org/10.14740/jmc2060w
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".