Abstract:Hepatocellular carcinoma (HCC) is characterized by a high propensity for vascular invasion, frequently leading to the formation of tumor thrombi, which significantly affect prognosis and therapeutic decision-making. Microvascular invasion (MVI) is a key predictor of postoperative recurrence, whereas the presence of macrovascular tumor thrombus indicates advanced disease. In recent years, notable progress has been made in the standardized diagnosis, preoperative prediction, and individualized treatment strategies for vascular tumor thrombi. The integration of radiomics and biomarkers has markedly improved the accuracy of preoperative MVI prediction, while various neoadjuvant and adjuvant treatment approaches have shown potential in controlling postoperative recurrence. Despite continuous optimization of diagnostic and therapeutic systems, challenges remain, including tumor heterogeneity, the lack of dynamic monitoring tools, and the difficulty in improving survival rates in high-risk patients. This review summarizes recent advances in the field of vascular tumor thrombi in HCC, aiming to provide theoretical support for clinical practice and to promote the development of individualized precision therapy.