Conversion therapy refers to the use of systemic therapy, locoregional therapy, or combined approaches to render initially unresectable hepatocellular carcinoma (HCC) amenable to curative treatment. With advances in targeted therapy and immunotherapy, an increasing number of patients achieve successful conversion; however, the optimal post-conversion treatment strategy—surgical resection, locoregional curative therapy, continued systemic therapy, or active surveillance—remains controversial. Emerging evidence indicates that different conversion strategies lead to heterogeneous tumor response depth and biological behavior, subsequently influencing post-conversion treatment selection and long-term outcomes. This review summarizes current evidence regarding post-conversion treatment options for HCC and their appropriate patient populations, and discusses future individualized decision-making strategies integrating tumor biology and conversion response depth, aiming to inform clinical practice.