RESUMEN
BACKGROUND AND AIM: Transarterial chemoembolization (TACE) is one of the standard modalities used to treat unresectable hepatocellular carcinoma (HCC), but the effectiveness of TACE for treating patients with a solitary small (≤3 cm) HCC and well-preserved liver function has not been definitively established. This study aimed to determine the therapeutic impact of TACE in patients with these characteristics. METHODS: This multicenter (four university hospitals) retrospective cohort study analyzed the medical records of 250 patients with a solitary small (≤3 cm) HCC and Child-Turcotte-Pugh (CTP) class A liver function diagnosed over 10 years. Posttreatment outcomes, including overall survival (OS), recurrence-free survival (RFS), and adverse events, were assessed following TACE therapy. RESULTS: One hundred and thirty-eight of the 250 patients (55.2%) treated with TACE achieved complete remission (CR). Overall median OS was 77.7 months, and median OS was significantly longer in the CR group than in the non-CR group (89.1 vs. 58.8 months, P = 0.001). Median RFS was 19.1 months in the CR group. Subgroup analysis identified hypertension, an elevated serum albumin level, and achieving CR as significant positive predictors of OS, whereas diabetes, hepatitis c virus infection, and tumor size (>2 cm) were poor prognostic factors of OS. CONCLUSIONS: The study demonstrates the effectiveness of TACE as a viable alternative for treating solitary small (≤3 cm) HCC in CTP class A patients.
RESUMEN
OBJECTIVES: This study sought to uncover whether having a gastrointestinal (GI) hospitalist available during weekday daytime hours results in higher-quality medical care compared to care provided by a team of residents. METHODS: Our hospitalist GI team consisted of two gastroenterologists working weekday daytime hours and two physician assistants. The team of conventional care headed by thirteen professors, comprised twelve residents and eight physician assistants. We conducted a retrospective cohort study in South Korea between March 2 and December 9, 2020 The hospitalist team treated 528 patients, while the conventional care team treated 2,335. We assessed the medical parameters of length of stay (LOS), rates of in-hospital mortality, transfer to the intensive care unit, and readmission rate within 30 days. Furthermore, we gathered feedback from nurses working with both teams. RESULTS: The study found that there was no significant difference in LOS between infections (P = 0.422) and other GI diseases like bleeding (P = 0.226). There was no significant difference in the rates of in-hospital mortality (P = 0.865) and transfer to the intensive care unit (P = 0.486) between the two teams. However, the hospitalist team had notably lower readmission rates than the conventional care team (P = 0.002) as well as a lower unscheduled readmission rate (P = 0.046). Furthermore, the survey results indicated that nurses who worked with the hospitalist team had significantly better responses than those who worked with the conventional care team (P < 0.001). CONCLUSIONS: This study indicates that having GI hospitalists work weekday daytime hours improves patient care, and treatment and reduces readmission rates.
Asunto(s)
Médicos Hospitalarios , Humanos , Estudios Retrospectivos , Readmisión del Paciente , Calidad de la Atención de Salud , Tiempo de Internación , Grupo de Atención al PacienteRESUMEN
Non-invasive brain-computer interfaces (BCIs) based on an event-related potential (ERP) component, P300, elicited via the oddball paradigm, have been extensively developed to enable device control and communication. While most P300-based BCIs employ visual stimuli in the oddball paradigm, auditory P300-based BCIs also need to be developed for users with unreliable gaze control or limited visual processing. Specifically, auditory BCIs without additional visual support or multi-channel sound sources can broaden the application areas of BCIs. This study aimed to design optimal stimuli for auditory BCIs among artificial (e.g., beep) and natural (e.g., human voice and animal sounds) sounds in such circumstances. In addition, it aimed to investigate differences between auditory and visual stimulations for online P300-based BCIs. As a result, natural sounds led to both higher online BCI performance and larger differences in ERP amplitudes between the target and non-target compared to artificial sounds. However, no single type of sound offered the best performance for all subjects; rather, each subject indicated different preferences between the human voice and animal sound. In line with previous reports, visual stimuli yielded higher BCI performance (average 77.56%) than auditory counterparts (average 54.67%). In addition, spatiotemporal patterns of the differences in ERP amplitudes between target and non-target were more dynamic with visual stimuli than with auditory stimuli. The results suggest that selecting a natural auditory stimulus optimal for individual users as well as making differences in ERP amplitudes between target and non-target stimuli more dynamic may further improve auditory P300-based BCIs. Supplementary Information: The online version contains supplementary material available at 10.1007/s11571-022-09901-3.
RESUMEN
Perceptual decisions involve a process that evolves over time until it reaches a decision boundary. It's important to understand how this process unfolds. Recent psychophysical data indicates that the visual system extracts motion axis information faster than motion direction information (Kwon et al., 2015, J Vision). To understand the underlying mechanisms, we developed a biophysically realistic cortical network model of decision making. We generalized the two-variable reduced spiking neural network (Wong et al., 2006, J Neuroscience) to four-variable. The network input is based on motion energy (Adelson et al., 1985, Josa a) and the temporal profile of surround influence (Tadin et al., 2006, J Neuroscience). The model reproduces the prior experimental findings, showing the motion axis extraction before direction extraction. It reveals a stronger axis-wise inhibitory connection between the selective neural populations than the direction-wise inhibitory connection. We further designed a recurrent deep neural network to validate the neural population connectivity pattern. Our model provides a quantitative explanation for the temporal evolution of motion direction judgments. The results show that the spatiotemporal filtering for visual motion integration, the center-surround antagonism, and stronger axis-wise inhibitory connection between the selective neural populations can explain how the visual system can extract motion axis orientation before detecting motion direction.
Asunto(s)
Juicio , Redes Neurales de la Computación , Humanos , Movimiento (Física)RESUMEN
The perceived duration of time does not veridically reflect the physical duration but is distorted by various factors, such as the stimulus magnitude or the observer's emotional state. Here, we showed that knowledge about an event's termination time is another significant factor. We often experience time passage differently when we know that an event will terminate soon. To quantify this, we asked 33 university students to report a rotating clock hand's duration with or without a termination cue that indicated the position at which the clock hand disappeared. The results showed that the presence of the termination cue dilated perceived durations, and the dilating effect was larger when the stimulus duration was longer, or the speed of the rotating stimulus was slower. A control experiment with a start-cue excluded the possibility that the cue's mere existence caused the results. Further computational analyses based on the attention theory-of-time perception revealed that the size of dilation is best explained by neither an event's duration nor the distance traveled by the clock hand, but by how long the clock hand spends time near the termination cue. The results imply that an event-termination cue generates a field in which the perceived time dilates.
RESUMEN
Neural coding of auditory stimulus frequency is well-documented; however, the cortical signals and perceptual correlates of pitch have not yet been comprehensively investigated. This study examined the temporal patterns of event-related potentials (ERP) in response to single tones of pitch chroma, with an assumption that these patterns would be more prominent in musically-trained individuals than in non-musically-trained individuals. Participants with and without musical training (N = 20) were presented with seven notes on the C major scale (C4, D4, E4, F4, G4, A4, and B4), and whole-brain activities were recorded. A linear regression analysis between the ERP amplitude and the seven notes showed that the ERP amplitude increased or decreased as the frequency of the pitch increased. Remarkably, these linear correlations were anti-symmetric between the hemispheres. Specifically, we found that ERP amplitudes of the left and right frontotemporal areas decreased and increased, respectively, as the pitch frequency increased. Although linear slopes were significant in both groups, the musically-trained group exhibited marginally steeper slope, and their ERP amplitudes were most discriminant for frequency of tone of pitch at earlier latency than in the non-musically-trained group (~ 460 ms vs ~ 630 ms after stimulus onset). Thus, the ERP amplitudes in frontotemporal areas varied according to the pitch frequency, with the musically-trained participants demonstrating a wider range of amplitudes and inter-hemispheric anti-symmetric patterns. Our findings may provide new insights on cortical processing of musical pitch, revealing anti-symmetric processing of musical pitch between hemispheres, which appears to be more pronounced in musically-trained people. Supplementary Information: The online version contains supplementary material available at 10.1007/s13534-023-00274-y.
RESUMEN
Introduction: Efficient coding that minimizes informational redundancy of neural representations is a widely accepted neural coding principle. Despite the benefit, maximizing efficiency in neural coding can make neural representation vulnerable to random noise. One way to achieve robustness against random noise is smoothening neural responses. However, it is not clear whether the smoothness of neural responses can hold robust neural representations when dynamic stimuli are processed through a hierarchical brain structure, in which not only random noise but also systematic error due to temporal lag can be induced. Methods: In the present study, we showed that smoothness via spatio-temporally efficient coding can achieve both efficiency and robustness by effectively dealing with noise and neural delay in the visual hierarchy when processing dynamic visual stimuli. Results: The simulation results demonstrated that a hierarchical neural network whose bidirectional synaptic connections were learned through spatio-temporally efficient coding with natural scenes could elicit neural responses to visual moving bars similar to those to static bars with the identical position and orientation, indicating robust neural responses against erroneous neural information. It implies that spatio-temporally efficient coding preserves the structure of visual environments locally in the neural responses of hierarchical structures. Discussion: The present results suggest the importance of a balance between efficiency and robustness in neural coding for visual processing of dynamic stimuli across hierarchical brain structures.
RESUMEN
Introduction: Identifying biomarkers for depression from brain activity is important for the diagnosis and treatment of depression disorders. We investigated spatial correlations of the amplitude fluctuations of electroencephalography (EEG) oscillations as a potential biomarker of depression. The amplitude fluctuations of EEG oscillations intrinsically reveal both temporal and spatial correlations, indicating rapid and functional organization of the brain networks. Amid these correlations, long-range temporal correlations are reportedly impaired in patients with depression, exhibiting amplitude fluctuations closer to a random process. Based on this occurrence, we hypothesized that the spatial correlations of amplitude fluctuations would also be altered by depression. Methods: In the present study, we extracted the amplitude fluctuations of EEG oscillations by filtering them through infraslow frequency band (0.05-0.1 Hz). Results: We found that the amplitude fluctuations of theta oscillations during eye-closed rest depicted lower levels of spatial correlation in patients with major depressive disorder (MDD) compared to control individuals. This breakdown of spatial correlations was most prominent in the left fronto - temporal network, specifically in patients with current MDD rather than in those with past MDD. We also found that the amplitude fluctuations of alpha oscillations during eye-open rest exhibited lower levels of spatial correlation in patients with past MDD compared to control individuals or patients with current MDD. Discussion: Our results suggest that breakdown of long-range spatial correlations may offer a biomarker for the diagnosis of depression (current MDD), as well as the tracking of the recovery from depression (past MDD).
RESUMEN
As online news increasingly include data journalism, there is a corresponding increase in the incorporation of visualization in article thumbnail images. However, little research exists on the design rationale for visualization thumbnails, such as resizing, cropping, simplifying, and embellishing charts that appear within the body of the associated article. Therefore, in this paper we aim to understand these design choices and determine what makes a visualization thumbnail inviting and interpretable. To this end, we first survey visualization thumbnails collected online and discuss visualization thumbnail practices with data journalists and news graphics designers. Based on the survey and discussion results, we then define a design space for visualization thumbnails and conduct a user study with four types of visualization thumbnails derived from the design space. The study results indicate that different chart components play different roles in attracting reader attention and enhancing reader understandability of the visualization thumbnails. We also find various thumbnail design strategies for effectively combining the charts' components, such as a data summary with highlights and data labels, and a visual legend with text labels and Human Recognizable Objects (HROs), into thumbnails. Ultimately, we distill our findings into design implications that allow effective visualization thumbnail designs for data-rich news articles. Our work can thus be seen as a first step toward providing structured guidance on how to design compelling thumbnails for data stories.
RESUMEN
Scientific understanding of how the mind generates bodily actions remains opaque. In the early 19th century, the ideomotor theory proposed that humans generate voluntary actions by imagining the sensory consequence of those actions, implying that the idea of an action's consequence mediates between the intention to act and motor control. Despite its long history and theoretical importance, existing empirical evidence for the ideomotor theory is not strong enough to rule out alternative hypotheses. In this study, we devised a categorization-action task to evaluate ideomotor theory by testing whether an idea, distinguished from a stimulus, can modulate task-irrelevant movements. In Experiment 1, participants categorized a stimulus duration as long or short by pressing an assigned key. The results show that participants pressed the key longer when categorizing the stimulus as long than they did when characterizing it as short. In Experiment 2, we showed that the keypressing durations were not modulated by the decision category when the property of the decision category, the brightness of a stimulus, was not easily transferable to the action. In summary, our results suggest that while the perceived stimulus features have a marginal effect on response duration linearly, the decision category is the main factor affecting the response duration. Our results indicate that an abstract category attribute can strongly modulate action execution, constraining theoretical conjectures about the ideomotor account of how people voluntarily generate action.
RESUMEN
Brain-computer interfaces (BCIs) can restore impaired cognitive functions in people with neurological disorders such as stroke. Musical ability is a cognitive function that is correlated with non-musical cognitive functions, and restoring it can enhance other cognitive functions. Pitch sense is the most relevant function to musical ability according to previous studies of amusia, and thus decoding pitch information is crucial for BCIs to be able to restore musical ability. This study evaluated the feasibility of decoding pitch imagery information directly from human electroencephalography (EEG). Twenty participants performed a random imagery task with seven musical pitches (C4-B4). We used two approaches to explore EEG features of pitch imagery: multiband spectral power at individual channels (IC) and differences between bilaterally symmetric channels (DC). The selected spectral power features revealed remarkable contrasts between left and right hemispheres, low- (< 13 Hz) and high-frequency ( 13 Hz) bands, and frontal and parietal areas. We classified two EEG feature sets, IC and DC, into seven pitch classes using five types of classifiers. The best classification performance for seven pitches was obtained using IC and multiclass Support Vector Machine with an average accuracy of 35.68±7.47% (max. 50%) and an information transfer rate (ITR) of 0.37±0.22 bits/sec. When grouping the pitches to vary the number of classes (K = 2-6), the ITR was similar across K and feature sets, suggesting the efficiency of DC. This study demonstrates for the first time the feasibility of decoding imagined musical pitch directly from human EEG.
Asunto(s)
Interfaces Cerebro-Computador , Cuero Cabelludo , Humanos , Electroencefalografía , Cognición , ImaginaciónRESUMEN
Epithelial-mesenchymal transition (EMT) has been implicated in cancer progression, invasion, and metastasis. We aimed to evaluate the correlations between clinicopathological characteristics and EMT markers in patients with hepatocellular carcinoma (HCC) who underwent surgical resection and to identify the key regulator in EMT process. Fresh-frozen HCC tissues and adjacent nontumor liver tissues from 30 patients who underwent surgical resection were provided by the Gachon University Gil Medical Center Bio Bank. Human HCC cell lines, Hep3B, SNU449, and Huh7 cells were transfected with Rac1 siRNA and exposed to hypoxic conditions. The combined EMT markers expression (down-expression of E-cadherin and overexpression of p21-activated kinases 1 (PAK1)/Snail) by Western blot in HCC tissues when compared to adjacent nontumor liver tissues was significantly associated with macrovascular invasion (p = 0.021), microvascular invasion (p = 0.001), large tumor size (p = 0.021), and advanced tumor stage (p = 0.015). Patients with combined EMT markers expression showed early recurrence and poor overall survival. In vitro studies showed that Rac1 knockdown decreased the expression of EMT markers including PAK1 and Snail in hypoxia-induced Hep3B cells and suppressed the migration and invasion of hypoxia-induced HCC cells. Rac1 may be a potential therapeutic target for inhibition of EMT process through the inhibition of PAK1 and Snail in HCC.
Asunto(s)
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/metabolismo , Neoplasias Hepáticas/metabolismo , Transición Epitelial-Mesenquimal/genética , Relevancia Clínica , Transducción de Señal , Hipoxia/genética , Línea Celular Tumoral , Movimiento Celular/genética , Regulación Neoplásica de la Expresión Génica , Proteína de Unión al GTP rac1/genética , Proteína de Unión al GTP rac1/metabolismoRESUMEN
Despite the fundamental importance of visual motion processing, our understanding of how the brain represents basic aspects of motion is incomplete. While it is generally believed that direction is the main representational feature of motion, motion processing is also influenced by nondirectional orientation signals that are present in most motion stimuli. Here, we aimed to test whether this nondirectional motion axis contributes motion perception even when orientation is completely absent from the stimulus. Using stimuli with and without orientation signals, we found that serial dependence in a simple motion direction estimation task was predominantly determined by the orientation of the previous motion stimulus. Moreover, the observed attraction profiles closely matched the characteristic pattern of serial attraction found in orientation perception. Evidently, the sequential integration of motion signals strongly depends on the orientation of motion, indicating a fundamental role of nondirectional orientation in the coding of visual motion direction.
Asunto(s)
Percepción de Movimiento , Orientación , Humanos , Percepción Visual , Movimiento (Física) , Estimulación LuminosaRESUMEN
Predicting the development of hepatocellular carcinoma (HCC) is a key clinical issue in patients with chronic hepatitis B (CHB). The aim of this study was to develop a precise and simple HCC risk score for up to 10 years. A total of 1895 CHB patients treated with entecavir or tenofovir disoproxil fumarate were retrospectively recruited and randomized into derivation (n = 1239) and validation cohorts (n = 656). Variables proven to be independent risk factors for HCC in the derivation cohort were used to develop the prediction model. The ACCESS-HCC model included five variables (age, cirrhosis, consumption of ethanol, liver stiffness, and serum alanine aminotransferase). Areas under curves were 0.798, 0.762, and 0.883 for HCC risk at 3, 5, and 10 years, respectively, which were higher than those of other prediction models. The scores were categorized according to significantly different HCC incidences: 0-4, low; 5-8, intermediate; and 9-14, high-risk. The annual incidence rates were 0.5%, 3.2%, and 11.3%, respectively. The performance of this model was validated in an independent cohort. The ACCESS-HCC model shows improved long-term prediction and provides three distinct risk categories for HCC in CHB patients receiving antiviral therapy. Further research is needed for external validation using larger cohorts.
RESUMEN
BACKGROUND: Sequential effects of environmental stimuli are ubiquitous in most behavioral tasks involving magnitude estimation, memory, decision making, and emotion. The human visual system exploits continuity in the visual environment, which induces two contrasting perceptual phenomena shaping visual perception. Previous work reported that perceptual estimation of a stimulus may be influenced either by attractive serial dependencies or repulsive aftereffects, with a number of experimental variables suggested as factors determining the direction and magnitude of sequential effects. Recent studies have theorized that these two effects concurrently arise in perceptual processing, but empirical evidence that directly supports this hypothesis is lacking, and it remains unclear whether and how attractive and repulsive sequential effects interact in a trial. Here we show that the two effects concurrently modulate estimation behavior in a typical sequence of perceptual tasks. RESULTS: We first demonstrate that observers' estimation error as a function of both the previous stimulus and response cannot be fully described by either attractive or repulsive bias but is instead well captured by a summation of repulsion from the previous stimulus and attraction toward the previous response. We then reveal that the repulsive bias is centered on the observer's sensory encoding of the previous stimulus, which is again repelled away from its own preceding trial, whereas the attractive bias is centered precisely on the previous response, which is the observer's best prediction about the incoming stimuli. CONCLUSIONS: Our findings provide strong evidence that sensory encoding is shaped by dynamic tuning of the system to the past stimuli, inducing repulsive aftereffects, and followed by inference incorporating the prediction from the past estimation, leading to attractive serial dependence.
Asunto(s)
Toma de Decisiones , Percepción Visual , Humanos , Toma de Decisiones/fisiología , Percepción Visual/fisiología , Visión OcularRESUMEN
BACKGROUND: Tenofovir disoproxil fumarate (TDF, Viread®) had been used as a standard treatment option of chronic hepatitis B (CHB). This clinical trial was conducted to evaluate the efficacy and safety of DA-2802 (tenofovir disoproxil orotate) compared to TDF. METHODS: The present study was a double blind randomized controlled trial. Patients with CHB were recruited from 25 hospitals in Korea and given DA-2802 at a dose of 319 mg once daily or Viread® at a dose of 300 mg once daily for 48 weeks from March 2017 to January 2019. Change in hepatitis B virus (HBV) DNA level at week 48 after dosing compared to baseline was the primary efficacy endpoint. Secondary efficacy endpoints were proportions of subjects with undetectable HBV DNA, those with normal alanine aminotransferase (ALT) levels, and those with loss of hepatitis B envelop antigen (HBeAg), those with loss of hepatitis B surface antigen (HBsAg). Adverse events (AEs) were also investigated. RESULTS: A total of 122 patients (DA-2802 group: n = 61, Viread® group: n = 61) were used as full analysis set for efficacy analysis. Mean age, proportion of males, laboratory results and virologic characteristics were not different between the two groups. The change in HBV DNA level at week 48 from baseline was -5.13 ± 1.40 in the DA-2802 group and -4.97 ± 1.40 log10 copies/mL in the Viread® group. The analysis of primary endpoint using the nonparametric analysis of covariance showed statistically significant results (P < 0.001), which confirmed non-inferiority of DA-2802 to Viread® by a prespecified noninferiority margin of 1. The proportion of undetectable HBV DNA was 78.7% in the DA-2802 group and 75.4% in the Viread® group (P = 0.698). The proportion of subjects who had normal ALT levels was 75.4% in the DA-2802 group and 73.3% in the Viread® group (P = 0.795). The proportion of those with HBeAg loss was 8.1% in the DA-2802 group and 10.8% in the Viread® group (P = 1.000). No subject showed HBsAg loss. The frequency of AEs during treatment was similar between the two groups. Most AEs were mild to moderate in severity. CONCLUSION: DA-2802 is considered an effective and safe treatment for patients with CHB. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02967939.
Asunto(s)
Antivirales/uso terapéutico , Hepatitis B Crónica/tratamiento farmacológico , Ácido Orótico/uso terapéutico , Tenofovir/uso terapéutico , Adulto , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , República de Corea , Resultado del TratamientoRESUMEN
PURPOSE: Current evidence demonstrates the effectiveness of vision training for presbyopia. We developed and examined a training program to test the effectiveness of alternating focal distances as a training method. METHODS: We devised a sharpness discrimination task, in which participants judged whether the stimulus was a sine- or square-wave grating, and tested in two training groups and one control group. In the alternating-distance training group (N = 8, age 49-64), participants had to alternate the fixation between a near- and far-screen. In the fixed-distance training group (N=8, age 47-65), participants fixated on the same-distance target for the whole block. Before and after the 20 training sessions, we measured the near- and far-visual acuity (VA) using the Landolt C and Early Treatment Diabetic Retinopathy Study (ETDRS) tasks and contrast sensitivity using the qCSF procedure. The control group (N=8, age 49-65) participated only in the pre- and post-tests. RESULTS: Both training groups showed a significant improvement between the pre- and post-tests in the Landolt C task, and the improvement sizes were not significantly different between the groups. In the ETDRS task, only the fixed-distance training group showed significant improvement, although there was no significant difference between the two groups. Neither group showed improvement in the contrast sensitivity task compared to the control group. CONCLUSION: The novel sharpness discrimination task can be an effective training method for presbyopia to prevent the deterioration of VA; however, contrary to popular belief, the effect of alternating-distance training was comparable to or even weaker than that of fixed-distance training.
Asunto(s)
Presbiopía , Baja Visión , Anciano , Sensibilidad de Contraste , Humanos , Persona de Mediana Edad , Presbiopía/terapia , Visión Ocular , Agudeza VisualRESUMEN
We prospectively investigated the changes of liver stiffness (LS) and the occurrence of hepatocellular carcinoma (HCC) after hepatitis C virus (HCV) eradication using direct antiviral agents (DAA) over three years. LS measurement using transient elastography and serum fibrosis surrogate markers before treatment and at 48, 96, 144 weeks after starting direct-acting antivirals (DAA) according to the protocol were evaluated. Patients were also compared with historical cohort treated with pegylated interferon (peg-IFN). Sustained viral response (SVR) was observed in 95.8%. LS value in the patients achieving SVR significantly decreased over time (19.4 ± 12.9 kPa [baseline], 13.9 ± 9.1 kPa [48 weeks], 11.7 ± 8.2 kPa [96 weeks], 10.09 ± 6.23 [144 weeks], all p < 0.001). With matched analysis, the decrease in LS value was significantly larger in DAA group than peg-IFN group at both 48 weeks (29% vs. 9%) and 96 weeks (39% vs. 17%). The incidence of HCC was not significantly different between DAA and peg-IFN groups (5.5% vs. 5.4%) at 144 weeks. HCV eradication with DAA can lead to improvement of liver stiffness over time. The regression of fibrosis was greater in the group with DAA than peg-IFN.Clinical trials registration: ClinicalTrials.gov (NCT02865369).
Asunto(s)
Antivirales/administración & dosificación , Carcinoma Hepatocelular/prevención & control , Hepatitis C Crónica/tratamiento farmacológico , Cirrosis Hepática/tratamiento farmacológico , Neoplasias Hepáticas/prevención & control , Administración Oral , Anciano , Antivirales/efectos adversos , Carbamatos/administración & dosificación , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/virología , Quimioterapia Combinada , Diagnóstico por Imagen de Elasticidad , Femenino , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/epidemiología , Hepatitis C Crónica/virología , Humanos , Imidazoles/administración & dosificación , Incidencia , Interferones/administración & dosificación , Isoquinolinas/administración & dosificación , Cirrosis Hepática/diagnóstico por imagen , Cirrosis Hepática/epidemiología , Cirrosis Hepática/virología , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/virología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Pirrolidinas/administración & dosificación , Estudios Retrospectivos , Ribavirina/administración & dosificación , Seúl , Sulfonamidas/administración & dosificación , Respuesta Virológica Sostenida , Factores de Tiempo , Resultado del Tratamiento , Valina/administración & dosificación , Valina/análogos & derivadosRESUMEN
BACKGROUND/AIMS: We compared the post-treatment overall survival (OS) and recurrence-free survival (RFS) between patients with Child-Turcotte-Pugh (CTP) class-A and single small (≤3 cm) hepatocellular carcinoma (HCC) treated by surgical resection (SR) and radiofrequency ablation (RFA). METHODS: We retrospectively analyzed 391 HCC patients with CTP class-A who underwent SR (n=232) or RFA (n=159) as first-line therapy for single small (≤3 cm) HCC. Survival was compared according to the tumor size (≤2 cm/2-3 cm) and the presence of cirrhosis. Inverse probability of treatment weighting (IPW) method was used to estimate the average causal effect of treatment. RESULTS: The median follow-up period was 64.8 months (interquartile range, 0.1-162.6). After IPW, the estimated OS was similar in the SR and RFA groups (P=0.215), and even in patients with HCC of ≤2 cm (P=0.816) and without cirrhosis (P=0.195). The estimated RFS was better in the SR group than in the RFA groups (P=0.005), also in patients without cirrhosis (P<0.001), but not in those with HCC of ≤2 cm (P=0.234). The weighted Cox proportional hazards model with IPW provided adjusted hazard ratios (95% confidence interval) for OS, and the RFS after RFA versus SR were 0.698 (0.396-1.232) (P=0.215) and 1.698 (1.777-2.448) (P=0.005), respectively. CONCLUSION: SR was similar for OS compared to RFA, but was better for RFS in patients with CTP class-A and single small (≤3 cm) HCC. The RFS was determined by the presence or absence of cirrhosis. Hence, SR rather than RFA should be considered in patients without cirrhosis to prolong the RFS, although there is no OS difference.