Published online Sep 15, 2021. doi: 10.4251/wjgo.v13.i9.1132
Peer-review started: February 28, 2021
First decision: April 19, 2021
Revised: May 2, 2021
Accepted: July 5, 2021
Article in press: July 5, 2021
Published online: September 15, 2021
Processing time: 193 Days and 20.7 Hours
Hepatocellular carcinoma (HCC) is one of the most prevalent cancers and one of the main causes of cancer-related deaths worldwide. Most HCCs develop in an inflammatory microenvironment, and mounting evidence emphasizes the importance of immune aspects in hepatocarcinogenesis. In normal physiology, both innate and adaptive immune responses are responsible for eliminating malignantly transformed cells, thus preventing the development of liver cancer. However, in the setting of impaired natural killer cells and exhaustion of T cells, HCC can develop. The immunogenic features of HCC have relevant clinical implications. There is a large number of immune markers currently being studied for the early detection of liver cancer, which would be critical in order to improve surveillance programs. Moreover, novel immunotherapies have recently been proven to be effective, and the combination of atezolizumab and bevacizumab is currently the most effective treatment for advanced HCC. It is expected that in the near future different subgroups of patients will benefit from specific immunotherapy. The better we understand the immune aspects of HCC, the greater the benefit to patients through surveillance aiming for early detection of liver cancer, which allows for curative treatments, and, in cases of advanced disease, through the selection of the best possible therapy for each individual.
Core Tip: Recent developments in the field of hepatocellular carcinoma have drawn attention to the immune aspects of this neoplasm. Understanding the immune features of hepatocarcinogenesis is instrumental in order to comprehend current advances in immune markers and immunotherapy. Intensifying research on immune markers may improve surveillance and allow for precision medicine. Immunotherapy is already first-line treatment for advanced hepatocellular carcinoma.