HAIC vs. TACE Combined With Sintilimab and Bevacizumab for Intermediate HCC (Beyond Up-To-Seven)

Inclusion Criteria: * Diagnosis: Histologically or cytologically confirmed hepatocellular carcinoma (HCC), or patients with cirrhosis meeting the American Association for the Study of Liver Diseases (AASLD) clinical diagnostic criteria for HCC. * Age: ≥ 18 years old. * Performance Status: ECOG performance status score of 0. * Prior Treatment: No prior systemic anti-tumor therapy or transarterial interventional therapy for HCC. * Tumor Stage and Burden: Barcelona Clinic Liver Cancer (BCLC) Stage B, unsuitable for radical surgery and/or local therapy (such as ablation). * Up-To-Seven Criteria: Tumor burden exceeding the Up-To-Seven criteria, defined as the sum of the size of the largest intrahepatic tumor (in cm) and the number of tumors being greater than 7. * Tumor Distribution: Bilobar multifocal tumors. * Measurable Disease: At least one measurable lesion with arterial phase enhancement on CT/MRI. * Vascular Status: Patent portal vein with no evidence of portal vein tumor thrombus. * Extrahepatic Status: No extrahepatic metastasis. * Variceal Risk: No risk of variceal bleeding; esophagogastroduodenoscopy (EGD) within 6 months shows no gastroesophageal varices or active ulcers. * Liver Function: Child-Pugh Grade A. * Hematology: Platelets \> 75 × 10⁹/L; White Blood Cells \> 3.0 × 10⁹/L; Neutrophils \> 1.5 × 10⁹/L. * Biochemistry: Serum bilirubin ≤ 1.5 × upper limit of normal (ULN); Transaminases ≤ 3 × ULN; Serum creatinine \< 1.5 × ULN. * Physical Findings: No ascites * Albumin ≥ 30 g/L. * Coagulation: Normal coagulation function. * Expectancy: Expected survival \> 3 months. * Consent: Signed written informed consent and willingness/ability to comply with follow-up until death, study completion, or termination. Exclusion Criteria: * Histology: Known histology/cytology of fibrolamellar HCC, sarcomatoid HCC, or components of cholangiocarcinoma. * Medical History: History of hepatic encephalopathy or liver transplantation. * Effusions: Clinically symptomatic pleural effusion, ascites, or pericardial effusion requiring drainage. * Viral Hepatitis: Active Hepatitis B (HBV DNA \> 2000 IU/ml or 10⁴ copies/ml) or Hepatitis C (HCV RNA \> 10³ copies/ml); co-infection with both HBsAg and anti-HCV positive. (Eligible if levels drop below these criteria after nucleoside antiviral therapy) . * Cardiovascular (Past 12 Months): Myocardial infarction, severe/unstable angina, coronary artery bypass grafting, congestive heart failure, cerebrovascular accident (including transient ischemic attack), or pulmonary embolism. * Ongoing Cardiac Issues: Arrhythmia ≥ Grade 2 (NCI-CTCAE); QTc prolongation (Male \> 450 ms, Female \> 470 ms). * Bleeding Risk: History of gastrointestinal bleeding within 6 months or clear bleeding tendency (e.g., high-risk varices, active GI ulcer, persistent positive fecal occult blood). * Hypertension: Uncontrollable hypertension (SBP \> 140 mmHg or DBP \> 90 mmHg despite optimal treatment); history of hypertensive crisis or hypertensive encephalopathy. * Organ Failure: Renal failure requiring hemodialysis or peritoneal dialysis; severe dysfunction of other major organs. * Second Malignancy: History of other malignancies within 3 years prior to screening (except those with negligible risk of metastasis/death such as treated cervical cancer in situ, non-melanoma skin cancer, or localized prostate cancer). * CNS Involvement: Known or new evidence of brain or leptomeningeal lesions. Coagulation Disorders: Hemophilia or bleeding tendency; currently taking therapeutic doses of coumarin derivatives (e.g., warfarin). * Pregnancy/Lactation: Pregnant or breastfeeding females; women of childbearing potential must have a negative pregnancy test within 7 days prior to enrollment. * Other History: Prior organ transplant; known HIV infection; active tuberculosis; allergy to chemotherapy drugs. * Autoimmune Diseases: Active or history of autoimmune diseases (e.g., myasthenia gravis, myositis, autoimmune hepatitis, SLE, rheumatoid arthritis, IBD, etc.). * General Compliance: Any serious acute/chronic physical or mental illness, or laboratory abnormalities that increase study risk or interfere with interpretation of results. * Non-compliance: History of significant non-compliance with medical protocols or inability to provide reliable informed consent.