肠–肝轴：肠道菌群调控肝癌发生发展 与治疗响应

Gut-Liver Axis: The Regulation of Liver Cancer Occurrence and Development as Well as Treatment Response by the Gut Microbiota

摘要: 肝细胞癌(Hepatocellular Carcinoma, HCC)作为全球癌症相关死亡的主要病因之一，其发生发展机制复杂且治疗挑战突出。近年来，连接肠道与肝脏的“肠–肝轴”(Gut-Liver Axis, GLA)在HCC的病理过程中扮演重要角色。本综述系统阐述在HCC发展及治疗响应中，肠道菌群通过GLA发挥的重要作用。肠道菌群失调(Intestinal Dysbacteriosis, ID)是驱动HCC的核心环境因素，其代谢产物破坏肠道屏障、诱发肝脏持续炎症、塑造免疫抑制微环境，驱动肿瘤发生。研究证实，HCC患者具有特征性肠道菌群谱，该“微生物指纹”兼具诊断与预后预测潜力。同时，菌群组成显著影响免疫检查点抑制剂的疗效，使得靶向菌群调控成为增强免疫治疗、改善预后的前沿策略。尽管在机制研究深度与个体化干预方面仍存挑战，但靶向GLA无疑为HCC精准防治开辟全新视角。

Abstract: Hepatocellular Carcinoma (HCC) is one of the major causes of cancer-related deaths worldwide, and its occurrence and development mechanisms are complex with significant treatment challenges. In recent years, the “Gut-Liver Axis” (GLA), which connects the gut and the liver, plays an important role in the pathological process of HCC. This review systematically elaborates on the significant role of the gut microbiota through the GLA in the development of HCC and the response to treatment. Intestinal Dysbacteriosis (ID) is a core environmental factor driving HCC, and its metabolites damage the intestinal barrier, induce persistent liver inflammation, and shape an immunosuppressive microenvironment, driving tumor occurrence. Studies have confirmed that HCC patients have characteristic gut microbiota profiles, and this “microbial fingerprint” has both diagnostic and prognostic predictive potential. At the same time, the composition of the microbiota significantly affects the efficacy of immune checkpoint inhibitors, making targeting the regulation of the microbiota a promising strategy for enhancing immunotherapy and improving prognosis. Although there are still challenges in the depth of mechanism research and individualized intervention, targeting the GLA undoubtedly opens up a new perspective for the precise prevention and treatment of HCC.