• HCC pathogenesis involves complex genetic and epigenetic alterations, with key pathways including Wnt/β-catenin, PI3K/AKT/mTOR, and VEGF signaling.
• Multikinase inhibitors (e.g., sorafenib, lenvatinib) and immune checkpoint inhibitors (e.g., nivolumab, pembrolizumab) have improved survival in advanced HCC, but resistance remains a challenge.
• Combination therapies, such as atezolizumab plus bevacizumab, have shown superior efficacy and are now first-line options for advanced HCC.
• Biomarker-driven patient selection and personalized treatment strategies are critical for optimizing therapeutic outcomes and minimizing adverse effects.