Patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) often have a poor prognosis, and there is currently no suitable treatment for these patients, despite multiple efforts to improve prognosis. At the 63rd Annual Meeting of the American Association for the Study of Liver Diseases (AASLD), a study from Italy showed that treatment for PVTT can improve survival in patients with advanced HCC. The investigators included 60 patients with advanced HCC combined with PVTT (patients seen between May 2008 and April 2012, 51 men and 9 women, mean age 66 ± 5.6 years) in a retrospective study to assess their epidemiological data, tumor and underlying liver disease characteristics, overall survival, and treatment-related survival. Variables associated with PVTT progression and worsening were also assessed, as well as the impact of tumor embolization on survival in patients with advanced HCC. Included cases included patients with the presence of main portal vein tumor thrombus and branch portal vein tumor thrombus, diagnosed on the basis of a typical hemodynamic model on imaging. Overall survival was calculated from the time when both tumor and PVTT diagnoses were established. In addition, survival analysis was applied to assess the possible prognostic impact of the implemented treatment. It was found that 33/60 (55%) patients had received systemic antiangiogenic therapy; 6/60 (10%) had received external radiation therapy targeting the tumor thrombus; and 21/60 (35%) had not received any treatment. All patients received optimal treatment for HCC lesions. Multivariate analysis showed that time to tumor thrombus after diagnosis of HCC was significantly associated with viral etiology and BCLC stage at the time of diagnosis of HCC, whereas tumor thrombus spread was significantly associated with portal hypertension. At the end of the observation period (47 months), survival rates were 18%, 50%, and 23% in each group, respectively. Overall survival calculated from the time of diagnosis of HCC was 753 ± 88 days, which was significantly associated with young age at diagnosis, BCLC grade A, and treatment targeting HCC lesions, but not with treatment targeting PVTT. Overall survival calculated from the time of diagnosis of PVTT was 397±77 days. The mean survival per group was 408±86 days (antiangiogenic therapy group), 855±273 days (external radiation therapy group), and 140±29 days (no treatment group) (p<0.001), without taking into account factors such as age and severity of underlying liver disease. The study concludes that treatment targeting PVTT improves survival in patients with advanced HCC when age is not taken into account. External radiation therapy seems to be the best treatment option for such patients. However, PVTT treatment could not affect overall survival calculated from the time of HCC diagnosis. Moreover, further in-depth work needs to be performed to patient characteristics and tumor characteristics on treatment? evaluative studies on whether there is any influence on the efficacy of treatment.