Although there are several staging system used for hepatocellular carcinoma (HCC), the Barcelona Clinic Liver Cancer (BCLC) staging system are usually used to define advanced stage HCC (BCLC-C).1 This stage includes patients presenting with vascular invasion or extrahepatic spread who are still relatively fit, as reflected by a performance status ≤2 at staging work-up, and who have preserved liver function.1 The first-line recommendation with high-level of scientific evidence is systemic therapy. Currently, several systemic agents has show scientific efficacy in randomized controlled trials, which are atezolizumab with bevacizumab combination therapy,2 lenvatinib,3 and sorafenib.4, 5 Tremelimumab with durvalumab has also shown promising result as a first-line for advanced stage HCC.1 Cabozantinib and atezolizumab has also shown promising results in early analysis.1 However, advanced HCC includes heterogeneous population. If mUICC staging is used, advanced HCC by BCLC staging system (BCLC-C) include mUICC II, mUICC III and mUICC stage IV.6 The Korean Liver Cancer Association-National Cancer Center practice guidelines for the management of HCC suggested resection can be an alternative option for mUICC II or mUICC III HCC with vascular invasion. Herein, we’ll discuss treatment option for advanced HCC, from the viewpoint of hepatologist. References 1. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol 2021. 2. Finn RS, Qin S, Ikeda M, et al. Atezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma. N Engl J Med 2020;382:1894-1905. 3. Kudo M, Finn RS, Qin S, et al. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet 2018;391:1163-1173. 4. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 2009;10:25-34. 5. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 2008;359:378-90. 6. 2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol 2019;20:1042-1113.