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.
Peng Cui, Ji-tao Wang, Siyan Xue et al.· 0 citations
Multi-turn jailbreak attacks demonstrate that harmful intent can be distributed across dialogue, yet existing methods obscure what conversational mechanisms drive vulnerability. We introduce BLUEPRINT, a safety-evaluation framework separating a factorized social-influence strategy space from WORLDVIEWSIM, a cross-turn situational context module. Monte Carlo Tree Search optimizes turn-level combinations of 18 theory-grounded influence factors across a four-turn trajectory. Across six frontier models, BLUEPRINT achieves near-ceiling ASR on major open-weight and proprietary models, while requiring the fewest average queries (2.46). The resulting trajectories further reveal model-specific vulnerability among resistant targets: each responds to distinct influence factors and strategy transitions, yet all share a common recovery pathway-shifting toward concrete, executable task framing consistently escapes hard-refusal states. Ablations confirm operational cues matter most: making requests actionable has the largest impact, gain framing is unusually potent, and some legitimacy appeals can backfire. These findings suggest robust multi-turn safety requires monitoring not only harmful content, but also how dialogue state makes unsafe requests appear concrete and locally executable.
Si-Yu Chen, Hao-Ran Wang, Xiaojian Li et al.· 0 citations
Multi-agent systems (MAS) decompose long-horizon tasks across supervisors and subagents, but delegated goals do not necessarily carry their original authorization boundaries. Existing safety benchmarks mainly study adversarial compromise, while work on constraint drift lacks controlled architecture-level evaluation. We introduce MasDrift, a benchmark of 600 benign productivity tasks across eight domains. Each task pairs required work with reserved actions. MasDrift compares single-agent, centralized, and decentralized coordination while varying hierarchy depth and peer width, measuring task completion and authorization preservation. Across generic multi-agent conditions, centralized hierarchies achieve 93.9--98.6% task completion versus 85.7--87.0% for peer networks, while unauthorized actions occur in 2.7--19.8% of tasks versus 0.6--0.8%, a gap that widens with hierarchy depth. We further compare two defenses that differ in where authorization evidence resides. One re-anchors every pending call to the original user request. The other carries an attenuated policy along the delegation chain. Re-anchoring reduces unauthorized actions in every model configuration we evaluate, at a cost of 1.6 points of pooled completion. Chain propagation blocks required work instead, forfeiting up to 36.3 points. A heterogeneous case study confirms that the failure follows from coordination rather than model strength. MasDrift exposes a centralization tradeoff and makes authorization preservation a measurable property of MAS design.
Zhuoning Xu, Xiucheng Zhang, Hanjun Luo et al.· 1 citation
Musculoskeletal diseases are among the leading causes of disability and drive the greatest global need for rehabilitation. Because recovery, remodelling and degeneration of bones, joints and related tissues unfold over months to years, care requires longitudinal management rather than isolated decisions. Clinicians must repeatedly integrate evolving patient evidence, medical knowledge and stage-specific functional goals, yet evidence is often fragmented across visits, departments and hospital systems, disrupting continuous, individualised management. Here we report OrthoPilot, a clinical artificial intelligence (AI) system powered by a large language model (LLM) that integrates hospital data streams with authoritative external knowledge for continuous musculoskeletal care. It autonomously retrieves real-time imaging, laboratory, pathology and order data and translates evolving patient states into evidence-based decisions from admission diagnosis through rehabilitation planning. We established a specialist-validated benchmark from real-world electronic health records (EHRs) spanning 1,000 disease codes. In a full-pathway reader study against 81 orthopaedic physicians, OrthoPilot outperformed experts with 25 years of experience in diagnostic reasoning, clinical decision-making and management planning. This advantage generalised across 60 external clinical centres, where OrthoPilot surpassed all evaluated intelligent systems. In a prospective physician decision-making study of 1,870 complex cases, OrthoPilot improved full-chain management success by 10.6%. In a randomised deployment involving 8,240 inpatients, integration into routine care increased cumulative cases per bed by 9.7% and improved patient-reported access to health information. These results move clinical AI from predicting isolated events toward executing longitudinal management across complete musculoskeletal care pathways.
Wenjie Li, Yu-Jie Zhang, Fanrui Zhang et al.· 0 citations
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