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