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World J Gastrointest Oncol. Oct 15, 2025; 17(10): 110503
Published online Oct 15, 2025. doi: 10.4251/wjgo.v17.i10.110503
Sleep disorders in hepatocellular carcinoma
Jin Qian, Ming-Hao Ruan, Zhi-Jie Wang, Wei Dong, Jin-Yong Jia, Xiao-Chen Feng, Hui Liu
Jin Qian, Ming-Hao Ruan, Xiao-Chen Feng, Hui Liu, The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai 200082, China
Zhi-Jie Wang, Clinical Cancer Institute Center for Translational Medicine, Naval Medical University, Shanghai 200082, China
Wei Dong, Department of Pathology, The Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, Shanghai 200082, China
Wei Dong, Vincent Mary School of Science and Technology, Assumption University of Thailand, Bangkok 10240, Thailand
Jin-Yong Jia, Department of Naval Nutrition and Food Hygiene, Naval Medical University, Shanghai 200082, China
Co-first authors: Jin Qian and Ming-Hao Ruan.
Co-corresponding authors: Xiao-Chen Feng and Hui Liu.
Author contributions: Qian J and Ruan MH contributed equally to this work; Liu H conceived and designed the overall scope, structure, and central hypothesis of this review article; provided continuous scientific oversight and guidance throughout all stages of the project (conception, literature search strategy, drafting, and revision); secured and administered the financial support for the work; performed critical revisions of multiple drafts of the manuscript, focusing on the coherence of the narrative, the integration of key findings on sleep disorders (e.g., sleep apnea, insomnia) and their mechanistic links to hepatocellular carcinoma, and the clinical implications; provided final approval of the version to be published; serves as a primary contact for communication with the journal. Feng XC conceived and designed the overall scope, structure, and central hypothesis of this review article; provided continuous scientific oversight and guidance throughout all stages of the project (conception, literature search strategy, drafting, and revision); performed critical revisions of multiple drafts of the manuscript, with a focus on the methodological rigor of the literature review, the accuracy of the pathophysiological mechanisms linking sleep disturbances to hepatocarcinogenesis (e.g., circadian disruption, inflammation, metabolic dysregulation), and the strength of the epidemiological evidence; provided final approval of the version to be published; serves as a primary contact for communication with the journal and handles post-submission inquiries and revisions; Qian J and Ruan MH conducted the literature review and drafted the original manuscript; Jia JY and Ruan MH created the artwork; Feng XC Wang ZJ, Dong W, made critical revisions; all authors prepared the draft and approved the submitted version.
Supported by National Natural Science Foundation of China, No. 82270634.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui Liu, MD, Professor, The Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, No. 225 Changhai Road, Shanghai 200082, China. liuhuigg@hotmail.com
Received: June 9, 2025
Revised: July 2, 2025
Accepted: September 16, 2025
Published online: October 15, 2025
Processing time: 128 Days and 22.8 Hours
Abstract

As one of the most prevalent malignant tumors, hepatocellular carcinoma (HCC) represents a major global public health burden. Traditionally, HCC pathogenesis has been attributed to chronic liver diseases (viral hepatitis, cirrhosis) and aflatoxin exposure. However, with evolving lifestyles and environmental changes, sleep disorders have become increasingly prevalent. Emerging evidence suggest that sleep disorders may contribute to hepatocarcinogenesis through multiple mechanisms, including immunity environment disorder, oxidative stress, metabolic dysregulation, disruption of gut microbiota, and circadian rhythm disruption, thereby influencing disease progression and patient prognosis. This review summarizes epidemiological evidence on the relationship between sleep disorders and HCC incidence, explores the underlying mechanisms through which sleep disorders contribute to HCC, and discusses clinical challenges and potential intervention strategies. Our objective is to provide novel insights into HCC prevention and therapeutic approaches.

Keywords: Sleep disorders; Circadian rhythm; Clock gene; Hepatocellular carcinoma; Risk factors; Prevention strategies

Core Tip: Hepatocellular carcinoma (HCC) remains a globally prevalent malignancy, traditionally attributed to etiological factors such as viral hepatitis, alcohol-related liver disease, and metabolic dysfunction-associated fatty liver disease. Alarmingly, the global incidence of HCC continues to rise, with more than 900000 new cases reported in 2020, a trend not fully explained by these established risk factors. Emerging evidence highlights sleep disorders as a novel contributor to hepatocarcinogenesis. This review systematically explores the association between sleep disturbances and HCC pathogenesis, focusing on the underlying pathological mechanisms through which disrupted sleep patterns may drive HCC progression.