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Disclosures: David Martinus: Nothing to Disclose, David Fuentes: Nothing to Disclose, Michelle Luster: Nothing to Disclose, Uma Ramamurthy: Nothing to Disclose, Fasiha Kanwal: Nothing to Disclose, Saira Khaderi: AstraZeneca: Advisor, Hashem El-Serag: Nothing to Disclose, Eugene Koay: Nothing to Disclose 1908 MULTISTEP ACCUMULATION OF MISMATCH REPAIR DEFICIENCY-ASSOCIATED MUTATIONAL SIGNATURE DURING THE HEPATOCARCINOGENESIS REVEALED BY WHOLE-GENOME SEQUENCING ANALYSIS Haruhiko Takeda 1 Atsushi Takai 1 Masayuki Ueno 1 Yosuke Fujii 1 Masako Mishima 1 Tadashi Inuzuka 1 Hiroshi Seno 1 , 1 Kyoto University Graduate School of Medicine Background: Mismatch repair deficiency (dMMR) is one of the established biomarkers predicting the efficacy of immune checkpoint inhibitors