Surgery Plus Systemic Therapy for Liver Cancer With Extrahepatic Metastases

Inclusion Criteria: * Age 18 to 75 years * Hepatocellular carcinoma confirmed by imaging and/or histology according to AASLD or EASL criteria * Resectable primary intrahepatic tumor with expected R0 resection * ECOG performance status 0 to 1 * At least one measurable extrahepatic metastatic lesion according to RECIST version 1.1 * Child-Pugh class A or stable Child-Pugh B7 * Written informed consent and willingness to comply with study follow-up and data collection Exclusion Criteria: * Prior systemic therapy for hepatocellular carcinoma, including immunotherapy, targeted therapy, or chemotherapy * Decompensated or clinically unstable liver disease, including refractory ascites, recurrent hepatic encephalopathy, active gastrointestinal bleeding, or - Child-Pugh class greater than B7 * Major bleeding risk or clinically significant coagulation abnormality, including recent gastrointestinal bleeding or untreated/high-risk gastroesophageal varices * Active autoimmune disease or long-term systemic immunosuppressive therapy * Active severe infection, including uncontrolled bacterial or fungal infection, uncontrolled hepatitis B virus replication without appropriate antiviral treatment, or active tuberculosis * Uncontrolled central nervous system metastases * Uncontrolled cardiovascular disease, including poorly controlled hypertension, recent myocardial infarction, unstable angina, stroke, or major thrombotic event * Significant proteinuria or renal dysfunction considered unsuit…