360 Ch 359. Hepatocellular Carcinoma, Cholangiocarcinoma, and Other Hepatobiliary/GI Tumors

HCC (hepatocellular carcinoma) — 6th most common cancer worldwide, 3rd leading cause of cancer death；~ 90% arise in cirrhotic liver；risk factors: HBV (top globally, esp Asia/Africa), HCV (declining with DAAs), ALD, MASLD/MASH (rising), aflatoxin, hemochromatosis；台灣 — HBV-related historically (declining with vaccination + treatment), MASLD/MASH rising；surveillance: HBV cirrhosis OR cirrhosis any cause OR HBV high-risk non-cirrhotic — abdominal ultrasound ± AFP every 6 months；diagnosis: imaging-based (LI-RADS) — multiphase CT/MRI with arterial enhancement + washout + capsule appearance；biopsy reserved for atypical；staging: BCLC (Barcelona Clinic Liver Cancer) integrates tumor + liver function + performance status；treatment: BCLC 0/A — resection, ablation, transplant; BCLC B (intermediate) — TACE; BCLC C (advanced) — atezolizumab + bevacizumab (IMbrave150, FDA 2020 first-line), durvalumab + tremelimumab (HIMALAYA, STRIDE), lenvatinib, sorafenib, regorafenib, cabozantinib, ramucirumab；Cholangiocarcinoma (CCA) — intrahepatic + perihilar + distal；rising incidence；TOPAZ-1 (2022) durvalumab + cis/gem first-line；pemigatinib (FGFR2 fusion), futibatinib (FGFR2), ivosidenib (IDH1) targeted；other tumors: gallbladder, ampullary, GIST。