360.2 🩺 國考版

360.2.1 高頻考點

360.2.1.1 HCC Risk Factors

  • HBV (top globally)
  • HCV (declining with DAAs)
  • ALD
  • MASLD/MASH (rising)
  • Aflatoxin

360.2.1.2 Surveillance

  • US ± AFP every 6 months
  • Cirrhotic any cause
  • HBV high-risk

360.2.1.3 LI-RADS LR-5 Criteria

  • ≥ 1 cm tumor + cirrhosis
  • Arterial hyperenhancement
  • Washout
  • Capsule
  • Growth

360.2.1.4 BCLC Stages

  • 0: very early
  • A: early
  • B: intermediate
  • C: advanced
  • D: terminal

360.2.1.5 Milan Criteria (HCC Transplant)

  • Single ≀ 5 cm OR
  • ≀ 3 nodules each ≀ 3 cm
  • No vascular invasion
  • No EHD

360.2.1.6 HCC First-Line Advanced

  • Atezolizumab + bevacizumab (IMbrave150) preferred
  • Durvalumab + tremelimumab (HIMALAYA — STRIDE)
  • Sorafenib (SHARP — original)
  • Lenvatinib (REFLECT)

360.2.1.7 HCC Second-Line

  • Regorafenib (RESORCE)
  • Cabozantinib (CELESTIAL)
  • Ramucirumab (REACH-2 if AFP > 400)
  • Nivolumab/pembrolizumab

360.2.1.8 CCA Subtypes

  • Intrahepatic (iCCA) — rising
  • Perihilar (Klatskin) — most common
  • Distal (dCCA)

360.2.1.9 CCA Risk Factors

  • PSC
  • Hepatolithiasis
  • Liver flukes
  • Biliary cysts
  • Viral hepatitis

360.2.1.10 CCA First-Line Advanced

  • Cisplatin + gemcitabine + durvalumab (TOPAZ-1, 2022)
  • Cisplatin + gemcitabine (ABC-02 historical)

360.2.1.11 CCA Targeted Therapy

  • Pemigatinib (FGFR2 fusion)
  • Futibatinib (FGFR2)
  • Ivosidenib (IDH1)
  • Dabrafenib + trametinib (BRAF V600E)
  • Trastuzumab (HER2)

360.2.1.12 Mayo Protocol Hilar CCA

  • Early stage I, II
  • Neoadjuvant chemoradiation
  • LT after staging
  • 5-yr 65%

360.2.1.13 GIST

  • KIT or PDGFRA mutations
  • Imatinib TKI
  • Sunitinib, regorafenib, ripretinib, avapritinib

360.2.1.14 NET

  • Octreotide, lanreotide
  • Everolimus, sunitinib
  • PRRT (177Lu-DOTATATE)

360.2.2 Trial Quick Reference

Trial Drug Setting
IMbrave150 Atezo + Bev HCC first-line
HIMALAYA Durva + Treme (STRIDE) HCC first-line
SHARP Sorafenib HCC first-line (original)
REFLECT Lenvatinib HCC first-line
RESORCE Regorafenib HCC second-line
CELESTIAL Cabozantinib HCC second-line
REACH-2 Ramucirumab HCC second-line if AFP > 400
TOPAZ-1 Durva + cis/gem CCA first-line
KEYNOTE-966 Pembro + cis/gem CCA first-line
BILCAP Capecitabine Adjuvant CCA