HCC was either confirmed histologically or diagnosed using the noninvasive criteria stipulated by the European Association for the Study of the Liver.24 Intrahepatic lesions and vascular invasion were diagnosed using a combination of contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and ultrasonography (US). Additionally, alpha-fetoprotein (AFP) and des-gamma-carboxy prothrombin (DCP) serum levels were measured up to 1 month before treatment. Intra-abdominal metastases were concurrently assessed during an abdominal CT, MRI, and US for the evaluation of intrahepatic lesions. Pulmonary lesions were detected using chest radiography or CT, which was carried out up to 1 month before treatment. Additional examinations, such as positron emission tomography and brain CT or MRI, were indicated when symptoms attributable to extrahepatic metastasis developed. These examinations were also conducted in cases in which the AFP or DCP levels increased in a manner that could not be explained by the status of the intrahepatic lesions. Liver function was evaluated using both the Child–Pugh class score and albumin-bilirubin (ALBI) grade.25 Tumor staging was according to the Barcelona Clinic Liver Cancer (BCLC) classification.26,27

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