Гепатоцелюлярна карцинома
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DIS-HCC |
|---|---|
| Тип | Хвороба |
| Синоніми | Hepatocellular carcinomaLiver cell carcinomaPrimary liver cancer (parenchymal)Гепатоцелюлярна карцинома |
| Статус | переглянуто 2026-04-26 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-AASLD-HCC-2023 SRC-NCCN-HCC-2025 |
Інформаційна підтримка. Усі рекомендації має перевірити кваліфікований онколог. Технічні перевірки не є клінічною валідацією чи схваленням лікування.
| icd_o_3_morphology | 8170/3 |
|---|---|
| icd_o_3_topography | ["C22.0"] |
| icd_10 | C22.0 |
| who_classification | WHO Digestive System Tumours 5th ed (2019): Hepatocellular carcinoma NOS |
Нотатки
HCC є канонічним прикладом "гібридного" архетипу: стадія за BCLC визначає модальний каскад (резекція / трансплантація / абляція для 0-A; TACE / TARE для B; системна терапія для C; паліативна допомога для D), а етіологічні фактори керують паралельними рішеннями (профілактика реактивації HBV при ICI / хіміоемболізації; лікування HCV із досягненням SVR; модифікація способу життя при MASH; припинення вживання алкоголю). Клас за Child-Pugh є універсальним модифікатором — кожна стадія BCLC має підрозділ CP-A, CP-B та CP-C, причому CP-C загалом виключає системну терапію. Цей комміт постачає лише логіку системної терапії (BCLC C, CP-A); курабельні модальності (хірургія, трансплантація, абляція) очікують ратифікації PROPOSAL §17, тому нозологія позначена як `partial`.
Де використовується
Algorithms
ALGO-HCC-SYSTEMIC-1L- ALGO-HCC-SYSTEMIC-1LALGO-HCC-SYSTEMIC-2L- ALGO-HCC-SYSTEMIC-2L
Questionnaires
QUEST-HCC-1L-STUB- Hepatocellular carcinoma — first line
Sources
SRC-AASLD-HCC-2023- AASLD Practice Guidance on HCCSRC-NCCN-HCC-2025- NCCN Hepatocellular Carcinoma
Клінічна застосовність
BMA-AFP-HCC-AASLD-SURVEILLANCE- Serum AFP is used in combination with ultrasound every 6 months for HCC surveillance in c...BMA-BRAF-V600E-HCC- BRAF V600E in HCC is exceptional (<1%). Tissue-agnostic dabrafenib + trametinib could be...BMA-HBV-DNA-MONITORING-ANTIVIRAL-RESPONSE- Quantitative HBV DNA tracks response during nucleos(t)ide-analogue (NA) therapy with ente...BMA-HNF1A-HCC- HNF1A somatic inactivating mutations occur in ~10% of HCC and ~35–40% of hepatocellular a...BMA-KRAS-G12C-HCC- KRAS G12C in HCC is rare. Sotorasib not approved in HCC; trial-only.BMA-MET-AMP-HCC- MET amplification / overexpression in HCC has biological rationale (HGF/MET autocrine loo...BMA-PIK3CA-HOTSPOT-HCC- PIK3CA in HCC — no targeted approval; atezolizumab + bevacizumab / lenvatinib per usual a...BMA-TP53-MUT-HCC- TP53 mutations in HCC (~30%) — adverse prognostic; not directly targeted.
Показання
IND-A1AT-DEFICIENCY-HCC-LUNG-PREVENTION-OBSERVATION- IND-A1AT-DEFICIENCY-HCC-LUNG-PREVENTION-OBSERVATIONIND-A1AT-DEFICIENCY-HCC-LUNG-PREVENTION-SURVEILLANCE- IND-A1AT-DEFICIENCY-HCC-LUNG-PREVENTION-SURVEILLANCEIND-CHRONIC-HBV-PREVENTION-ANTIVIRAL- IND-CHRONIC-HBV-PREVENTION-ANTIVIRALIND-CHRONIC-HBV-PREVENTION-OBSERVATION- IND-CHRONIC-HBV-PREVENTION-OBSERVATIONIND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-COMBINATION-ANTIVIRAL- IND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-COMBINATION-ANTIVIRALIND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-OBSERVATION- IND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-OBSERVATIONIND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-OBSERVATION- IND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-OBSERVATIONIND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-TENOFOVIR-ART- IND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-TENOFOVIR-ARTIND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-OBSERVATION- IND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-OBSERVATIONIND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-SURVEILLANCE- IND-CHRONIC-NAFLD-MASLD-HCC-PREVENTION-SURVEILLANCEIND-CIRRHOSIS-HCC-OBSERVATION- IND-CIRRHOSIS-HCC-OBSERVATIONIND-CIRRHOSIS-HCC-SURVEILLANCE- IND-CIRRHOSIS-HCC-SURVEILLANCEIND-HCC-SYSTEMIC-1L-ATEZO-BEV- IND-HCC-SYSTEMIC-1L-ATEZO-BEVIND-HCC-SYSTEMIC-1L-DURVA-TREME- IND-HCC-SYSTEMIC-1L-DURVA-TREMEIND-HCC-SYSTEMIC-1L-SORAFENIB- IND-HCC-SYSTEMIC-1L-SORAFENIBIND-HCC-SYSTEMIC-2L-CABOZANTINIB- IND-HCC-SYSTEMIC-2L-CABOZANTINIBIND-HCC-SYSTEMIC-2L-RAMUCIRUMAB- IND-HCC-SYSTEMIC-2L-RAMUCIRUMABIND-HCC-SYSTEMIC-2L-REGORAFENIB- IND-HCC-SYSTEMIC-2L-REGORAFENIBIND-HEMOCHROMATOSIS-HCC-PREVENTION-OBSERVATION- IND-HEMOCHROMATOSIS-HCC-PREVENTION-OBSERVATIONIND-HEMOCHROMATOSIS-HCC-PREVENTION-SURVEILLANCE- IND-HEMOCHROMATOSIS-HCC-PREVENTION-SURVEILLANCEIND-LIFESTYLE-ALCOHOL-PREVENTION-CESSATION- IND-LIFESTYLE-ALCOHOL-PREVENTION-CESSATIONIND-LIFESTYLE-ALCOHOL-PREVENTION-OBSERVATION- IND-LIFESTYLE-ALCOHOL-PREVENTION-OBSERVATIONIND-OCC-VINYL-CHLORIDE-PREVENTION-OBSERVATION- IND-OCC-VINYL-CHLORIDE-PREVENTION-OBSERVATIONIND-OCC-VINYL-CHLORIDE-PREVENTION-SURVEILLANCE- IND-OCC-VINYL-CHLORIDE-PREVENTION-SURVEILLANCEIND-PSC-CHOLANGIOCARCINOMA-PREVENTION-OBSERVATION- IND-PSC-CHOLANGIOCARCINOMA-PREVENTION-OBSERVATIONIND-PSC-CHOLANGIOCARCINOMA-PREVENTION-SURVEILLANCE- IND-PSC-CHOLANGIOCARCINOMA-PREVENTION-SURVEILLANCEIND-UNIVERSAL-HEAVY-ALCOHOL-PREVENTION-BRIEF-INTERVENTION- IND-UNIVERSAL-HEAVY-ALCOHOL-PREVENTION-BRIEF-INTERVENTIONIND-UNIVERSAL-HEAVY-ALCOHOL-PREVENTION-CESSATION-SCREENING- IND-UNIVERSAL-HEAVY-ALCOHOL-PREVENTION-CESSATION-SCREENINGIND-VHL-CARRIER-INTENSIFIED- IND-VHL-CARRIER-INTENSIFIEDIND-VHL-CARRIER-SURVEILLANCE- IND-VHL-CARRIER-SURVEILLANCEIND-WILSONS-DISEASE-HCC-PREVENTION-OBSERVATION- IND-WILSONS-DISEASE-HCC-PREVENTION-OBSERVATIONIND-WILSONS-DISEASE-HCC-PREVENTION-SURVEILLANCE- IND-WILSONS-DISEASE-HCC-PREVENTION-SURVEILLANCE
Схема лікування
REG-CABOZANTINIB-HCC- Cabozantinib (HCC, 2L)REG-RAMUCIRUMAB-HCC- Ramucirumab (HCC, 2L high AFP)REG-REGORAFENIB-HCC- Regorafenib (HCC, 2L)
Тривожна ознака
RF-A1AT-DEFICIENCY-HCC-LUNG-PREVENTION- Alpha-1 antitrypsin (A1AT) deficiency, particularly homozygous PiZZ genotype (severe defi...RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK- Patient with active or incompletely controlled pre-existing autoimmune or inflammatory di...RF-CASCADE-VHL-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CHRONIC-CIRRHOSIS-ETIOLOGY-AGNOSTIC-HCC-PREVENTION- Established cirrhosis of any etiology (Child-Pugh A, B, or C) when the specific cause is...RF-CHRONIC-HBV-MALIGNANCY-PREVENTION- Chronic Hepatitis B infection (HBsAg+ ≥6 months OR HBV-DNA detectable ≥6 months) in an in...RF-CHRONIC-HCV-HBV-COINFECTION-PREVENTION- Concurrent chronic HCV + HBV coinfection (HCV-RNA detectable ≥6 months AND HBsAg positive...RF-CHRONIC-HIV-HBV-COINFECTION-PREVENTION- Concurrent HIV + HBV coinfection (HIV-positive AND HBsAg positive ≥6 months OR HBV-DNA de...RF-CHRONIC-NAFLD-MASLD-HCC-PREVENTION- Non-alcoholic fatty liver disease (NAFLD) / metabolic-dysfunction- associated steatotic l...RF-CHRONIC-T2DM-CANCER-RISK-PREVENTION- Established type-2 diabetes mellitus (HbA1c ≥6.5% on two occasions, or established T2DM d...RF-HCC-AFP-RAPID-RISE- Rapid AFP rise (>50% increase in 4-8 weeks) during systemic HCC therapy suggests progress...RF-HCC-CHILD-PUGH-B-C- Child-Pugh B or C cirrhosis in HCC patient. CP-A is the only fully- studied class for ICI...RF-HCC-FRAILTY-AGE- Frailty profile precluding intensified 1L systemic in HCC: ECOG ≥3, OR (age ≥75 + Child-P...RF-HCC-HBV-REACTIVATION-RISK- HBV-positive HCC patient (any HBsAg+ OR anti-HBc+ status). Anti-tumor therapy — especiall...RF-HCC-HIGH-RISK-BIOLOGY- Aggressive HCC biology: macrovascular invasion (portal vein tumor thrombus segmental or m...RF-HCC-VARICEAL-BLEED- Active or recent (≤6 months) variceal hemorrhage in HCC patient with cirrhosis. Mandates...RF-HEMOCHROMATOSIS-HCC-PREVENTION- Hereditary hemochromatosis (HFE-related; C282Y homozygous genotype primarily, compound C2...RF-LIFESTYLE-ALCOHOL-CANCER-PREVENTION- Heavy alcohol consumption — defined as >14 drinks/week (women) or >21 drinks/week (men) p...RF-LIFESTYLE-OBESITY-CANCER-PREVENTION- Obesity — BMI ≥30 kg/m² (per WHO definition) — OR class 2/3 obesity with BMI ≥35 / ≥40. I...RF-LIFESTYLE-TOBACCO-CANCER-PREVENTION- Active tobacco smoking (current smoker OR cessation <15 years) OR smokeless tobacco use O...RF-OCC-AROMATIC-AMINES-MALIGNANCY-PREVENTION- Documented occupational aromatic-amine exposure — benzidine, 2-naphthylamine, 4-aminobiph...RF-OCC-VINYL-CHLORIDE-MALIGNANCY-PREVENTION- Documented occupational vinyl chloride monomer (VCM) exposure — historically in PVC manuf...RF-PSC-CHOLANGIOCARCINOMA-PREVENTION- Primary sclerosing cholangitis (PSC) — confirmed by characteristic cholangiographic findi...RF-UNIVERSAL-HEAVY-ALCOHOL-MULTI-CANCER- Heavy alcohol use — ≥3 standard drinks per day in men, ≥2 standard drinks per day in wome...RF-VHL-CONFIRMED-CARRIER- Patient has a confirmed germline VHL pathogenic variant (positive germline test result, d...RF-WILSONS-DISEASE-HCC-PREVENTION- Wilson's disease (autosomal recessive ATP7B-mutated copper-transport disorder with hepati...
Хвороба
DIS-CHOLANGIOCARCINOMA- Cholangiocarcinoma (bile duct cancer)DIS-HEPATOBLASTOMA- Hepatoblastoma