AIMS: The aims of the study were to compare the efficacy and safety between transcatheter arterial chemoembolization (TACE) combined with I seed implantation (TACE-I) or with apatinib (TACE-Apatinib) in HCC-portal vein tumor thrombosis (PVTT) patients. SETTING AND DESIGN: We retrospectively evaluated the medical records of consecutive patients with HCC-PVTT who had undergone treatment with either TACE-I or TACE-Apatinib between January 2018 and June 2019. MATERIALS AND METHODS: The response was assessed at the last follow-up, and the outcomes were compared between the two groups. Progression-free survival (PFS), overall survival (OS), and treatment-related complications were evaluated. Statistical analysis used the 2-sample Student's t-test and Fisher's exact test. RESULTS: This study enrolled 48 patients; 21 were treated with TACE-Apatinib and 27 with TACE-I. For PVTT, the disease control rate (DCR) was 23.81% in the TACE-Apatinib group and 77.78% in the TACE-I group. The objective response rate (ORR) in the TACE-Apatinib group was remarkably lower. The DCR of intrahepatic lesions was 85.71% in the TACE-Apatinib group and 81.48% in the TACE-I group. There was no statistically significant difference in the ORR of intrahepatic lesions. Median OS was significantly longer in the TACE-I group (13.3 vs. 10.8 months). Similarly, the median PFS was significantly longer in the TACE-I group (9.7. vs. 6.6 months). Multivariate and univariate analyses showed that TACE-I was an independent prognostic factor for OS. CONCLUSIONS: Compared with TACE-Apatinib, TACE-I seed implantation can effectively prolong PVTT progression, PFS, and OS in HCC patients with PVTT.