Progress of intestinal flora and intratumoral flora imbalance in immune escape of hepatocellular carcinoma
In recent years,immunotherapy plays an important role in the systematic treatment of unresectable hepatocellular carcinoma(HCC)and gradually becomes one of the first-line treatments.However,the objective remission rate of patients and other indicators still have a large room for improvement even for the most preferred regimen recommended by many guidelines,atezolizumab plus bevacizumab.It is speculated that a large number of HCC patients are in a state of primary immunotherapy resistance,leading to tumor immune escape,which is closely related to tumor microenvironment and tumor internal factors.Recent studies have found that HCC patients have a wide range of microbial dysregulation,including intestinal flora and the intratumoral flora.The former may interact with immune cells in the tumor microenvironment through their lipopolysaccharide(LPS),bacterial metabolites(such as secondary bile acids and short-chain fatty acids)or their own structural proteins.The latter may change the biological characteristics of HCC cells and immune cells by regulating gene expressions at the epigenetic level and substance metabolites,thereby inducing immunosuppressive microenvironment and leading to immune escape of HCC.Here the characteristics of microbial dysregulation in HCC patients were summarized,and the potential mechanisms of HCC immune escape induced by intestinal flora and intratumoral flora were reviewed,in order to provide reference for the relationship between intestinal flora and immunotherapy resistance of HCC.
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