Aggressive HCC biology: macrovascular invasion (portal vein tumor thrombus segmental or m...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-HCC-HIGH-RISK-BIOLOGY`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HCC-2023` `SRC-NCCN-HCC-2025`

Red Flag Origin

Definition	Aggressive HCC biology: macrovascular invasion (portal vein tumor thrombus segmental or main), AFP >1000 ng/mL at baseline (high tumor burden marker), tumor doubling-time <3 months, OR poorly differentiated histology on biopsy. Predicts worse OS regardless of BCLC stage; favors more-active 1L choice (atezo+bev > sorafenib).
Clinical direction	intensify
Category	high-risk-biology

Trigger Logic

{
  "any_of": [
    {
      "finding": "portal_vein_tumor_thrombus",
      "value": true
    },
    {
      "comparator": ">=",
      "finding": "afp_baseline_ng_ml",
      "threshold": 1000
    },
    {
      "comparator": "<",
      "finding": "tumor_doubling_time_months",
      "threshold": 3
    },
    {
      "finding": "poorly_differentiated_histology",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

IMbrave150 subgroup analysis: AFP >400 derives larger benefit from atezo+bev vs sorafenib (HR 0.55 vs 0.85 overall). Macrovascular invasion (Vp1-4) traditionally precluded surgical / loco-regional options, but doesn't preclude systemic ICI-combination.

Used By

No reverse references found in the YAML corpus.