The Contribution of Cirrhosis Progression in Liver Dysfunction After Stereotactic Body Radiation Therapy
Bibliographic record
Abstract
PURPOSE: Patients with cirrhosis and hepatocellular carcinoma (HCC) often have progressive liver dysfunction after stereotactic body radiation therapy (SBRT), but the relative contribution of direct radiation toxicity versus cirrhosis progression is unknown. Our goal was to estimate the proportion of post-SBRT deterioration in the albumin-bilirubin (ALBI) score that is due to cirrhosis progression versus radiation toxicity. METHODS AND MATERIALS: We first developed mixed-effects models to predict longitudinal ALBI trajectories among 6789 patients with cirrhosis within the University of Michigan system who did not have HCC. This resulted in a model for the expected change in ALBI over time due solely to cirrhosis progression. The model was then applied to a multi-institutional data set of 260 patients with cirrhosis and HCC treated with SBRT, resulting in patient-level predictions for ALBI deterioration due to cirrhosis progression alone. This predicted post-SBRT ALBI trajectory due to cirrhosis progression was then compared with the observed trajectory for each patient, resulting in an estimate of the proportion of post-SBRT ALBI change attributable to cirrhosis progression versus radiation toxicity. RESULTS: In the cirrhosis cohort used for longitudinal modeling, ALBI trajectories were nonlinear, with an average 0.25-point improvement in the first year, followed by a worsening of 0.08 points on average per year. In the HCC cohort, the median baseline ALBI was -2.19 (unitless), reflecting a median albumin of 3.50 g/dL and a total bilirubin of 1.20 mg/dL. After SBRT, the mean ALBI increased (worsened) to -1.86 at 12 months. The estimated proportion of post-SBRT ALBI worsening due to cirrhosis was 14.2% (95% CI, 9.5%-18.8%) at 6 months and 24.9% (95% CI, 15.0%-34.7%) at 12 months, with the remainder attributed to SBRT. CONCLUSIONS: A significant proportion of post-SBRT liver function decline is due to the natural progression of cirrhotic liver dysfunction, and this proportion increases with time. These findings should improve estimates of SBRT treatment toxicity.
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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 | 0.003 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 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".