Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229–263

PubMed  Google Scholar 

Dong G, Fan F, He Y, Luo Y, Yu J, Liang P. T-Lymphocyte gene-regulated CCL5 and its association with extrahepatic metastasis in hepatocellular carcinoma. J Hepatocell Carcinoma. 2023;10:1267–1279

Article  CAS  PubMed  PubMed Central  Google Scholar 

Llovet JM, Kelley RK, Villanueva A, Singal AG, Pikarsky E, Roayaie S, et al. Hepatocellular carcinoma. Nat Rev Dis Primers. 2021;7(1):6

Article  PubMed  Google Scholar 

Uka K, Aikata H, Takaki S, Shirakawa H, Jeong SC, Yamashina K, et al. Clinical features and prognosis of patients with extrahepatic metastases from hepatocellular carcinoma. World J Gastroenterol. 2007;13(3):414–420

Article  PubMed  PubMed Central  Google Scholar 

Xiang ZL, Zeng ZC, Fan J, Tang ZY, Zeng HY, Gao DM. Gene expression profiling of fixed tissues identified hypoxia-inducible factor-1alpha, VEGF, and matrix metalloproteinase-2 as biomarkers of lymph node metastasis in hepatocellular carcinoma. Clin Cancer Res. 2011;17(16):5463–5472

Article  CAS  PubMed  Google Scholar 

Yang A, Xiao W, Ju W, Liao Y, Chen M, Zhu X, et al. Prevalence and clinical significance of regional lymphadenectomy in patients with hepatocellular carcinoma. ANZ J Surg. 2019;89(4):393–398

Article  PubMed  PubMed Central  Google Scholar 

Chen X, Lu Y, Shi X, Han G, Zhao J, Gao Y, et al. Development and validation of a novel model to predict regional lymph node metastasis in patients with hepatocellular carcinoma. Front Oncol. 2022;12:835957

Article  PubMed  PubMed Central  Google Scholar 

Moris D, Martinino A, Schiltz S, Allen PJ, Barbas A, Sudan D, et al. Advances in the treatment of hepatocellular carcinoma: an overview of the current and evolving therapeutic landscape for clinicians. CA Cancer J Clin. 2025;75(6):498–527

PubMed  PubMed Central  Google Scholar 

Llovet JM, De Baere T, Kulik L, Haber PK, Greten TF, Meyer T, et al. Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol. 2021;18(5):293–313

Article  CAS  PubMed  Google Scholar 

Bejjani A, Finn RS. Evolution of systemic therapy in advanced hepatocellular carcinoma. Surg Oncol Clin N Am. 2024;33(1):73–85

Article  PubMed  Google Scholar 

Su K, Guo L, Ma W, Wang J, Xie Y, Rao M, et al. PD-1 inhibitors plus anti-angiogenic therapy with or without intensity-modulated radiotherapy for advanced hepatocellular carcinoma: a propensity score matching study. Front Immunol. 2022;13:972503

Article  CAS  PubMed  PubMed Central  Google Scholar 

Lee YH, Tai D, Yip C, Choo SP, Chew V. Combinational immunotherapy for hepatocellular carcinoma: radiotherapy, immune checkpoint blockade and beyond. Front Immunol. 2020;11:568759

Article  CAS  PubMed  PubMed Central  Google Scholar 

Liu Z, Zhao Q, Zheng Z, Liu S, Meng L, Dong L, et al. Vascular normalization in immunotherapy: a promising mechanisms combined with radiotherapy. Biomed Pharmacother. 2021;139:111607

Article  CAS  PubMed  Google Scholar 

Zeng ZC, Tang ZY, Fan J, Qin LX, Ye SL, Zhou J, et al. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factors from 125 patients. Int J Radiat Oncol Biol Phys. 2005;63(4):1067–1076

Article  PubMed  Google Scholar 

Zeng ZC, Tang ZY, Yang BH, Fan J, Qin LX, Jiang GL, et al. Radiation therapy for the locoregional lymph node metastases from hepatocellular carcinoma, phase I clinical trial. Hepatogastroenterology. 2004;51(55):201–207

PubMed  Google Scholar 

Yoon SM, Kim JH, Choi EK, Ahn SD, Lee SW, Yi BY, et al. Radioresponse of hepatocellular carcinoma-treatment of lymph node metastasis. Cancer Res Treat. 2004;36(1):79–84

Article  PubMed  PubMed Central  Google Scholar 

Lee BM, Choi J, Seong J. Efficacy of local treatment in lymph node metastasis from hepatocellular carcinoma. Liver Cancer. 2023;12(3):218–228

Article  CAS  PubMed  PubMed Central  Google Scholar 

Chen YX, Zeng ZC, Fan J, Tang ZY, Zhou J, Zeng MS, et al. Defining prognostic factors of survival after external beam radiotherapy treatment of hepatocellular carcinoma with lymph node metastases. Clin Transl Oncol. 2013;15(9):732–740

Article  CAS  PubMed  Google Scholar 

Gordan JD, Kennedy EB, Abou-Alfa GK, Beal E, Finn RS, Gade TP, et al. Systemic therapy for advanced hepatocellular carcinoma: ASCO guideline update. J Clin Oncol. 2024;42(15):1830–1850

Article  CAS  PubMed  Google Scholar 

Wee CW, Kim K, Chie EK, Yu SJ, Kim YJ, Yoon JH. Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis. Br J Radiol. 2016;89(1065):20160383

Article  PubMed  PubMed Central  Google Scholar 

Kim Y, Park HC, Yoon SM, Kim TH, Lee J, Choi J, et al. Prognostic group stratification and nomogram for predicting overall survival in patients who received radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma: a multi-institutional retrospective study (KROG 15–02). Oncotarget. 2017;8(55):94450–94461

Article  PubMed  PubMed Central  Google Scholar 

Zhang H, Chen Y, Hu Y, Yang P, Wang B, Zhang J, et al. Image-guided intensity-modulated radiotherapy improves short-term survival for abdominal lymph node metastases from hepatocellular carcinoma. Ann Palliat Med. 2019;8(5):717–727

Article  PubMed  Google Scholar 

Ricke J, Klumpen HJ, Amthauer H, Bargellini I, Bartenstein P, de Toni EN, et al. Impact of combined selective internal radiation therapy and sorafenib on survival in advanced hepatocellular carcinoma. J Hepatol. 2019;71(6):1164–1174

Article  CAS  PubMed  Google Scholar 

Chen G, Zheng D, Zhou Y, Du S, Zeng Z. Olaparib enhances radiation-induced systemic anti-tumor effects via activating STING-chemokine signaling in hepatocellular carcinoma. Cancer Lett. 2024;582:216507

Article  CAS  PubMed  Google Scholar 

Zhong L, Wu D, Peng W, Sheng H, Xiao Y, Zhang X, et al. Safety of PD-1/PD-L1 inhibitors combined with palliative radiotherapy and anti-angiogenic therapy in advanced hepatocellular carcinoma. Front Oncol. 2021;11:686621

Article  CAS  PubMed  PubMed Central  Google Scholar 

Zhu M, Liu Z, Chen S, Luo Z, Tu J, Qiao L, et al. Sintilimab plus bevacizumab combined with radiotherapy as first-line treatment for hepatocellular carcinoma with portal vein tumor thrombus: a multicenter, single-arm, phase 2 study. Hepatology. 2024;80(4):807–815

Article  PubMed  Google Scholar 

Liu S, Wang W, Hu S, Jia B, Tuo B, Sun H, et al. Radiotherapy remodels the tumor microenvironment for enhancing immunotherapeutic sensitivity. Cell Death Dis. 2023;14(10):679

Article  PubMed  PubMed Central  Google Scholar 

Galluzzi L, Aryankalayil MJ, Coleman CN, Formenti SC. Emerging evidence for adapting radiotherapy to immunotherapy. Nat Rev Clin Oncol. 2023;20(8):543–557

Article  PubMed  Google Scholar 

Du SS, Chen GW, Yang P, Chen YX, Hu Y, Zhao QQ, et al. Radiation therapy promotes hepatocellular carcinoma immune cloaking via PD-L1 upregulation induced by cGAS-STING activation. Int J Radiat Oncol Biol Phys. 2022;112(5):1243–1255

Article  PubMed  Google Scholar 

Wang Y, Li Q, Zhang L, Liu S, Zhu J, Yang Y, et al. Efficacy and dose-response relationship of stereotactic body radiotherapy for abdominal lymph node metastases from hepatocellular carcinoma. Oncologist. 2023;28(6):e369–e378

Article  CAS  PubMed  PubMed Central  Google Scholar 

Lee DY, Park JW, Kim TH, Lee JH, Kim BH, Woo SM, et al. Prognostic indicators for radiotherapy of abdominal lymph node metastases from hepatocellular carcinoma. Strahlenther Onkol. 2015;191(11):835–844

Ar