Case Report: Tumor lysis syndrome in advanced, massive hepatocellular carcinoma with main portal vein invasion following atezolizumab plus bevacizumab therapy

This case underscores that advanced HCC with extensive vascular invasion is at risk of severe TLS shortly after potent immuno-antiangiogenic therapy. Clinicians should incorporate thorough baseline risk assessments, prompt laboratory monitoring, and timely intervention into standard care algorithms for high-risk HCC. The rapid metabolic collapse observed here serves as a reminder that while combination therapy holds promise for improving survival in advanced HCC, it can also lead to life-threatening complications in specific subgroups. Careful selection of therapeutic options and shared decision-making with patients are critical to balancing potential benefits against severe adverse events, such as TLS.