Hepatocellular carcinoma (HCC) has aggressive biological characteristics and can invade the portal vein. The prognosis of patients with HCC with portal vein invasion is poor; if untreated, the median overall survival is only 2.7-4 months. 1 According to subgroup analyses of the Sorafenib Hepatocellular Carcinoma Assessment Randomized Protocol (SHARP) trials, when treated with sorafenib-the first-line therapy in patients with HCC with portal vein tumor thrombus (PVTT)-the median overall survival has been shown to be approximately 8 months. 2,3 Treatment with regorafenib as second-line treatment has been demonstrated to extend survival by approximately 3 months. 4 However, even with the same BCLC C stage, the extent of the PVTT may also affect the patient prognosis. 5 Recently, HCC treatment approaches, such as hepatic resection, transarterial chemoembolization, radiation therapy, transarterial radioembolization (TARE) with yttrium-90, hepatic arterial infusion chemotherapy (HAIC), molecular targeted therapy, and immune therapy, have greatly advanced.Based on various retrospective clinical studies, it has been demonstrated that combination treatment or multidisciplinary management using the aforementioned treatments can improve the survival of patients with advanced HCC. 6