The Efficacy of Sequential Treatment With Bevacizumab Combined With Atezolizumab in Advanced Liver Cancer With MASLD

Eligibility Criteria Inclusion Criteria

* Age ≥ 18 years old (gender not limited)
* ECOG performance status of 0-1
* Preoperative imaging diagnosis of advanced hepatocellular carcinoma (BCLC stage C or D, unsuitable for surgery)
* Ultrasound or MRI indicating moderate to severe fatty liver (Fibroscan CAP \> 268 dB/m or MR fat score \> 10%)
* Willing to use contraceptive measures during the trial period
* Expected survival time ≥ 3 months
* At least one measurable lesion (per RECIST 1.1) that has not been irradiated
* Organ function levels (within 7 days before first study medication) must meet the following:
* Hematopoietic function: ANC ≥ 1.5×10⁹/L, PLT ≥ 100×10⁹/L, Hb ≥ 90 g/L, no transfusion within 14 days
* Liver function: TBIL ≤ 1.5×ULN, AST/ALT/ALP ≤ 2.5×ULN, serum creatinine ≤ 1.5×ULN, CrCl ≥ 50 mL/min, ALB ≥ 30 g/L, Child-Pugh A
* Coagulation function: INR and APTT ≤ 1.5×ULN or within therapeutic range if on anticoagulants
* Renal function: urinary protein ≤ 1+ (or ≤1 g/24h if \>1+)
* Cardiac function: ECG normal or clinically insignificant, LVEF \> 50%
* Women of childbearing potential must have a negative serum pregnancy test within 7 days prior to first dosing
* Men and women of reproductive potential must use effective contraception during and for 12 months after treatment
* Participants must voluntarily provide informed consent and have good compliance

Exclusion Criteria

* Excessive alcohol consumption (weekly ethanol intake: males \< 210 g, females \< 140 g)
* Tumor lesions previously treated with targeted therapy, immunotherapy, TACE, or radiotherapy
* Pregnant or breastfeeding women, or positive pregnancy test at baseline
* Central nervous system metastases diagnosed by CT, MRI, or PET-CT
* Participation in another clinical drug or therapy trial within 4 weeks before first study dose
* Major surgery within 4 weeks prior to first study dose, or incomplete recovery from surgery
* Radiotherapy within 2 weeks before first study dose
* History or presence of primary immunodeficiency or active autoimmune disease
* History of organ transplantation or hematopoietic stem cell transplantation
* Current use of immunosuppressants or corticosteroids (\>10 mg/day prednisone or equivalent) within 2 weeks
* Positive for HIV antibody or Treponema pallidum antibody, or active hepatitis B/C infection
* Allergy to recombinant humanized PD-1 monoclonal antibody, VEGF monoclonal antibody, or components
* Symptomatic pleural effusion, pericardial effusion, or ascites requiring clinical intervention
* Severe cardiovascular disease within 12 months (e.g., CAD, CHF ≥ II, arrhythmias, MI)
* Events within 6 months before first dose (e.g., DVT, PE, MI, PCI, ACS, CABG, stroke, TIA, embolism)
* History of GI surgery, obstruction, bleeding, dysfunction, or malabsorption affecting drug absorption
* Severe uncontrolled infection or comorbidity, or moderate/severe renal impairment
* Active pulmonary disease (interstitial pneumonia, COPD, asthma, tuberculosis history)
* Abnormal coagulation (INR \> 2.0, PT \> 16 s), bleeding tendency, or thrombolytic/anticoagulant therapy (except prophylaxis)
* Significant bleeding within 3 months (e.g., hemoptysis ≥ 2.5 mL, GI bleeding, varices, ulcers, vasculitis)
* Known hereditary/acquired bleeding or thrombotic disorders (e.g., hemophilia, thrombocytopenia)
* History of substance abuse or mental disorders affecting compliance
* Use of warfarin or coumarin derivatives within 14 days before or during treatment
* Other severe acute/chronic conditions increasing risk or confounding results
* Poor compliance or other conditions deemed unsuitable for trial participation