Safety and Efficacy of LVD + C-TACE + Tis/Len for Unresectable Right-Liver HCC

A Prospective, Single-Center, Single-Arm Trial to Validate the Safety and Efficacy of "Dual-Conversion" Therapy With Liver Venous Deprivation (LVD), Conventional Transarterial Chemoembolization (cTACE), Tislelizumab, and Lenvatinib for Initially Unresectable Hepatocellular Carcinoma in the Right Liver.

This study evaluates a novel "Dual-Conversion" strategy (mechanical volume conversion via LVD plus biological conversion via cTACE, Tislelizumab, and Lenvatinib) for patients with initially unresectable right-sided hepatocellular carcinoma (HCC). The primary goal is to assess the rate of successful conversion to R0 resection and the safety profile of this multi-modal approach.

For patients with large right-sided HCC, resection is often precluded by insufficient future liver remnant (FLR) or high biological aggressiveness. This trial utilizes:

1. Mechanical Conversion: LVD (simultaneous portal and hepatic vein embolization) to trigger rapid FLR hypertrophy.
2. Biological Conversion: cTACE combined with systemic therapy (Tislelizumab + Lenvatinib) to control tumor growth and reduce tumor stage.

Patients will undergo "Dual-Conversion" therapy and be assessed for surgical resectability every 3-6 weeks. Success is defined as achieving R0 resection with a safe FLR-to-body weight ratio.

Inclusion Criteria:

• Age 18-75 years.
• Confirmed HCC (histologically or by AASLD clinical criteria).
• Initially unresectable HCC limited to the right liver (due to insufficient FLR or tumor characteristics).
• Child-Pugh score ≤ 7 (Class A or early B).
• ECOG Performance Status of 0 or 1.
• Adequate organ function (marrow, hepatic, and renal).

Exclusion Criteria:

• Extrahepatic metastasis.
• Portal vein tumor thrombus involving the main trunk (Vp4).
• Previous systemic therapy for HCC.
• Active autoimmune disease or history of organ transplantation.
• Contraindications to LVD, TACE, or the study drugs