OBJECTIVE To evaluate the efficacy and safety of camrelizumab combined with apatinib in first-line treatment of unresectable advanced hepatocellular carcinoma. METHODS Based on real-world data， 67 patients with unresectable advanced hepatocellular carcinoma admitted to our hospital from January 2020 to January 2023 were retrospectively selected as the subjects. According to their different medication regimens， they were divided into two groups： camrelizumab combined with apatinib group （32 cases） and camrelizumab combined with oxaliplatin group （35 cases）. Both groups of patients were treated for more than 12 months， with a follow-up period of 12 months from the start of treatment. The therapeutic effects of two groups， as well as the levels of tumor markers， liver and kidney function indicators， and blood routine indicators before and after treatment were compared； Kaplan-Meier method was used to draw survival curves， and Log-rank test was used to analyze the differences in survival between two groups. Multivariate Cox regression analysis was used to identify factors that affect patient survival. RESULTS After treatment， the disease control rate of patients in camrelizumab combined with apatinib group was 68.8%， significantly higher than 45.7% in camrelizumab combined with oxaliplatin group （P＜0.05）； the levels of alpha-fetoprotein， carbohydrate antigen 19-9 （except for camrelizumab combined with oxaliplatin group） and carbohydrate antigen 15-3 in both groups were significantly reduced， and the decrease in alpha-fetoprotein， carcinoembryonic antigen and carbohydrate antigen 15-3 was more significant in camrelizumab combined with apatinib group （P＜0.05）； the levels of aspartate transaminase were significantly increased in camrelizumab combined with apatinib group （P＜0.05）. Compared with camrelizumab combined with oxaliplatin group， camrelizumab combined with apatinib group had significantly prolonged overall survival （hazard ratio of 2.97， 95% confidence interval of 1.305-6.749， P value of Log-rank test of 0.006）； the treatment plan and stage of hepatocellular carcinoma at the time of diagnosis were important factors affecting patient survival （hazard ratios of 2.97 and 5.16， 95% confidence intervals of 1.305-6.749 and 2.261-11.780， respectively， P＜ 0.05）. CONCLUSIONS Camrelizumab combined with apatinib as first-line treatment for unresectable advanced hepatocellular carcinoma has good clinical efficacy and overall controllable safety， but attention should be paid to monitoring patients’ liver function indicators during medication.