Tumor-resident microorganisms as clinical biomarkers in primary liver cancer: A systematic review of current evidence

Figure 3 Possible mechanisms by which intratumoral microbes affect tumor development and drug sensitivity in hepatic malignancies. The figure illustrates four key mechanisms: Chronic inflammation through immune cell infiltration and inflammatory mediator release; metabolic network modulation affecting glucose metabolism, TCA cycle, and biosynthetic pathways; microbial drug inactivation through enzymatic degradation; and inhibition of tumor cell apoptosis promoting tumor survival. These interconnected pathways demonstrate the multifaceted role of tumor-resident microbiota in hepatocarcinogenesis and therapeutic resistance.