Abstract:Primary liver cancer, specifically referring to hepatocellular carcinoma (hereafter referred to as HCC) in this article, is one of the malignant tumors with relatively high incidence and mortality in China. Because most patients are diagnosed at an intermediate or advanced stage, or present with impaired hepatic reserve due to underlying liver cirrhosis, opportunities for curative surgical resection are limited. In recent years, drawing on therapeutic experience from colorectal cancer, conversion therapy has attracted considerable attention in the field of liver cancer as a comprehensive treatment strategy aimed at achieving radical resection. Through systemic therapy, locoregional treatment, or their combination, this approach seeks to convert initially unresectable HCC into tumors amenable to radical resection, thereby improving long-term survival outcomes. With the rapid development of targeted therapies, immunotherapy, and locoregional treatment modalities, conversion therapy has become a major research focus in liver cancer management in China and has achieved encouraging progress in clinical practice. Nevertheless, substantial controversies remain regarding patient selection, the value of surgery after conversion, optimal timing of resection, and postoperative management. In this article, recent advances in oncological conversion therapy are systematically reviewed and critically appraised, with the aim of promoting conceptual consensus and standardized clinical implementation of conversion therapy, ultimately improving the overall treatment outcomes of patients with intermediate to advanced hepatocellular carcinoma.