To provide evidence-based medical evidence for the optimized combination strategy of local and systemic therapies.

Inclusion Criteria

1. Age 18-80 years.
2. Diagnosed with hepatocellular carcinoma (HCC) in accordance with the Standardization for Diagnosis and Treatment of Primary Hepatic Carcinoma (2024 Edition) issued by the National Health Commission of the People's Republic of China.
3. BCLC stage B or C, with no indication or refusal of surgical treatment, and measurable lesions meeting the mRECIST (Modified Response Evaluation Criteria in Solid Tumors) criteria on baseline imaging.
4. Child-Pugh liver function grade A or well-compensated grade B (score ≤7).
5. ECOG Performance Status (PS) score 0-1.
6. Expected survival time ≥12 weeks.

Exclusion Criteria

1. Prior transarterial chemoembolization (TACE) or other local therapies for HCC (except bridging liver transplantation).
2. Active viral hepatitis (hepatitis B or C) with pre-treatment viral load >100 IU/mL (positive for HCV RNA or HBV DNA) or without consistent antiviral therapy.
3. Alcohol abuse or pregnancy.
4. Concurrent other malignancies or history of other malignancies within the past 3 years.
5. Renal dysfunction (creatinine [Cr] >2 mg/dL or creatinine clearance [CCr] <30 mL/min) or severe organic diseases of vital organs (heart, lung, brain, etc.).
6. Inability to cooperate with interventional procedures.
7. Presence of distant metastasis.
8. Main portal vein tumor thrombus accompanied by impaired portal venous blood flow and collateral circulation.

Withdrawal Criteria

1. Identification of non-compliance with the study protocol during the trial.
2. Administration of radiotherapy or other interventions during the trial that prevent efficacy evaluation.
3. Discontinuation of treatment due to severe adverse reactions (excluded from efficacy analysis but included in adverse reaction statistics).
4. Patient or representative withdraws informed consent or requests to stop treatment.
5. Loss to follow-up or death of the patient.

Key Terminology Notes

• National Health Commission of the People's Republic of China: Official English name of the Chinese health authority, consistent with government documentation.
• Standardization for Diagnosis and Treatment of Primary Hepatic Carcinoma (2024 Edition) : Translated title of the 2024 national guideline for HCC diagnosis and treatment, aligning with the 2022 edition's official English translation published in Cancer Research on Prevention and Treatment.
• mRECIST: Abbreviation for Modified Response Evaluation Criteria in Solid Tumors, the standard for assessing treatment response in HCC, widely used in clinical trials.
• BCLC Staging: Barcelona Clinic Liver Cancer staging system, a globally recognized framework for HCC prognosis and treatment decision-making.
• Child-Pugh Score: A widely used tool to assess liver function in patients with cirrhosis, with grades A (5-6 points), B (7-9 points), and C (10-15 points).
• ECOG PS Score: Eastern Cooperative Oncology Group Performance Status, a scale from 0 (fully active) to 5 (dead) used to evaluate a patient's ability to perform daily activities.

This study adopts a single-blind design, where subjects and staff responsible for subject recruitment and management are aware of the study group assignments and arrange corresponding screening interventions, while physicians conducting clinical examinations for subjects are unaware of the subjects' group allocations.