# Towards Precision Therapy in Hepatocellular Carcinoma: A Clinical-Reasoning LLM for Risk Stratification and Treatment Guidance

arXiv: https://arxiv.org/abs/2607.08602 · HTML: https://mlsanity.com/paper/2607.08602/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 65 references that are in the map.
- First posted on arXiv 9 Jul 2026.

## Builds on (most cited first, 22 of 22)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
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- [Training language models to follow instructions with human feedback](https://mlsanity.com/paper/2203.02155/) (2022)
- [Proximal Policy Optimization Algorithms](https://mlsanity.com/paper/1707.06347/) (2017)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Mixed Precision Training](https://mlsanity.com/paper/1710.03740/) (2017)
- [Training Deep Nets with Sublinear Memory Cost](https://mlsanity.com/paper/1604.06174/) (2016)
- [SFT Memorizes, RL Generalizes: A Comparative Study of Foundation Model Post-training](https://mlsanity.com/paper/2501.17161/) (2025)
- [WizardMath: Empowering Mathematical Reasoning for Large Language Models via Reinforced Evol-Instruct](https://mlsanity.com/paper/2308.09583/) (2023)
- [BioGPT: Generative Pre-trained Transformer for Biomedical Text Generation and Mining](https://mlsanity.com/paper/2210.10341/) (2022)
- [Logic-RL: Unleashing LLM Reasoning with Rule-Based Reinforcement Learning](https://mlsanity.com/paper/2502.14768/) (2025)
- [STAIR: Improving Safety Alignment with Introspective Reasoning](https://mlsanity.com/paper/2502.02384/) (2025)
- [NFT: Bridging Supervised Learning and Reinforcement Learning in Math Reasoning](https://mlsanity.com/paper/2505.18116/) (2025)
- [Towards Efficient Exact Optimization of Language Model Alignment](https://mlsanity.com/paper/2402.00856/) (2024)
- [What Do Learning Dynamics Reveal About Generalization in LLM Reasoning?](https://mlsanity.com/paper/2411.07681/) (2024)
- [Disentangling Logic: The Role of Context in Large Language Model Reasoning Capabilities](https://mlsanity.com/paper/2406.02787/) (2024)
- [HiDe-PET: Continual Learning via Hierarchical Decomposition of Parameter-Efficient Tuning](https://mlsanity.com/paper/2407.05229/) (2024)

## Abstract (arXiv)

Hepatocellular carcinoma (HCC) is a common malignancy and a leading cause of cancer-related mortality. Current guidelines and staging systems provide coarse categories, but often miss within-stage heterogeneity and the clinical context in electronic medical records (EMRs). We present HCC-STAR (Hepatocellular Carcinoma Staging, Treatment And pRognosis), a clinically aligned large language model that reads routine EMR narratives and jointly outputs risk score-based staging, ranked guideline-consistent treatments with evidence-based rationales, and individualized survival estimates. We curated about 30,000 HCC cases from SEER and expanded them into EMR-style narrative training data using a clinician-validated, prompt-based augmentation workflow. On this corpus, we developed a knowledge-aligned reasoning framework optimized with a step-verifiable composite reward, moving beyond text-level memorization of clinical guidelines. In a multi-center cohort of 6,668 patients from 12 hospitals in China, HCC-STAR achieved state-of-the-art performance in treatment recommendation and risk stratification compared with clinical guidelines and competitive models, including GPT-5 and Gemini-2.5 Pro. Hypothetical overall-survival analysis showed a median survival of 51 months under adherence to HCC-STAR recommendations, compared with 29 and 32 months under BCLC and CNLC. In clinician-centric evaluations, blinded hepatobiliary specialists rated HCC-STAR's reasoning and evidence-based justifications as trustworthy. The model surpassed resident and attending physicians in treatment accuracy and helped physicians make more accurate decisions faster when used as an assistant. These findings support HCC-STAR as a reliable and verifiable decision-support system for risk stratification and precision therapy in HCC.