Abstract: Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) have a short survival time and an extremely poor prognosis,with more than half of all HCC cases complicated by PVTT.In the past,various local therapies or direct surgical strategies were often adopted for HCC patients with PVTT,but ideal outcomes were difficult to achieve.Currently,there is a general consensus on the efficacy and safety of immune checkpoint inhibitors combined with tyrosine kinase inhibitors as a conversion therapy regimen for advanced HCC.Our team has explored and developed a sequential surgical treatment protocol combining immune targeting and conversion.We believe that compared to existing treatment approaches,this strategy significantly prolongs the overall survival of HCC patients with PVTT and has the potential to become a new treatment paradigm.This article details the efficacy of the sequential surgical treatment protocol combining immune targeting and conversion for HCC patients with PVTT,as well as key surgical considerations,with the aim of sharing relevant experience.

Key words: hepatocellular carcinoma, portal vein tumor thrombus, immune checkpoint inhibitors, tyrosine kinase inhibitors, treatment paradigm