Published online Feb 27, 2022. doi: 10.4254/wjh.v14.i2.372
Peer-review started: May 27, 2021
First decision: July 6, 2021
Revised: July 21, 2021
Accepted: January 25, 2022
Article in press: January 25, 2022
Published online: February 27, 2022
Hepatocellular carcinoma (HCC) is the most prevalent primary malignancy in patients suffering from chronic liver diseases and cirrhosis. Recent attention has been paid to the involvement of the gut-liver axis (GLA) in HCC pathogenesis. This axis results from a bidirectional, anatomical and functional relationship between the gastrointestinal system and the liver. Moreover, the complex network of interactions between the intestinal microbiome and the liver plays a crucial role in modulation of the HCC-tumor microenvironment, contributing to the pathogenesis of HCC by exposing the liver to pathogen-associated molecular patterns, such as bacterial lipopolysaccharides, DNA, peptidoglycans and flagellin. Indeed, the alteration of gut microflora may disturb the intestinal barrier, bringing several toll-like receptor ligands to the liver thus activating the inflammatory response. This review explores the new therapeutic opportunities that may arise from novel insights into the mechanisms by which microbiota immunomodulation, represented by probiotics, and prebiotics, affects HCC through the GLA.
Core Tip: In patients with chronic liver disease and cirrhosis, hepatocellular carcinoma (HCC) is the most common primary malignancy. Recent attention has been paid to the involvement of the gut-liver axis (GLA) in HCC pathogenesis. This review explores the potential for new treatment options as a result of novel insights into the processes by which microbiota immunomodulation, represented by probiotics and prebiotics, affects HCC through the GLA.