Objective To observe the efficacy and safety of apatinib in the treatment of the elderly patients with advanced hepatocellular cancer (HCC). Methods From January 2018 to June 2018, a total of 49 elderly patients were retrieved for the study, who were treated with apatinib for advanced hepatocellular cancer. Clinical efficacy was evaluated by RECIST 1.1 and side effects by NCI-CTCAE 3.0. Progression-free survival (PFS) was also observed. Kaplan-Meier survival analysis and Cox multivariate regression analysis were performed. Results The sum of maximum diameters of the lesion and alpha-fetoprotein levels were significantly reduced at 4 weeks of treatment as compared with those before the treatment (P<0.05). At 12 weeks of the treatment, the objective response rate, complete remission (CR) and partial remission (PR), was 8.16%(4/49), and disease control rate [CR, PR, and stable disease (SD)] was 77.55%(38/49). The median PFS of 49 patients was 7.75 months (P<0.05). Cox multivariate analysis showed that the sum of maximum diameters was an independent influencing factor [HR:1.866,95%CI(2.470-16.916), P=0.000]. The incidence of adverse reactions was 100%, mainly of grade 1-2. Conclusion Apatinib is effective for advanced HCC among the elderly patients with controllable adverse reactions and may serve as an option for those who have failed with multi-line treatment.