Hepatocellular carcinoma (HCC) is a rapidly rising global health concern, ranking as the third-leading cause of cancer-related mortality. Despite medical advancements, the five-year survival rate remains a dismal 18%, with a daunting 70% recurrence rate within a five-year period. Current systematic treatments, including first-line sorafenib, yield an overall response rate (ORR) below 10%. In contrast, immunotherapies have shown promise by improving ORR to approximately 30%. The IMbravel150 clinical trial demonstrates that combining atezolizumab and bevacizumab surpasses sorafenib in terms of median progression-free survival (PFS) and overall survival (OS). However, the therapeutic efficacy for HCC patients remains unsatisfactory, highlighting the urgent need for a comprehensive understanding of antitumor responses and immune evasion mechanisms in HCC. In this context, understanding the immune landscape of HCC is of paramount importance. Tumor-infiltrating T cells, including cytotoxic T cells, regulatory T cells, and natural killer T cells, are key components in the antitumor immune response. This review aims to shed light on their intricate interactions within the immunosuppressive tumor microenvironment and explores potential strategies for revitalizing dysfunctional T cells. Additionally, current immune checkpoint inhibitor (ICI)-based trials, ICI-based combination therapies, and CAR-T- or TCR-T-cell therapies for HCC are summarized, which might further improve OS and transform the management of HCC in the future.
肝细胞癌（HCC）已成为全球范围内快速增长的公共卫生问题，是癌症相关死亡的第三大主要原因。尽管医学不断进步，其五年生存率仍低至18%，且五年内复发率高达70%。当前系统性治疗方案（包括一线药物索拉非尼）的总体缓解率（ORR）低于10%。相比之下，免疫疗法展现出潜力，能将ORR提升至约30%。IMbravel150临床试验表明，阿特珠单抗联合贝伐珠单抗在中位无进展生存期（PFS）和总生存期（OS）方面均优于索拉非尼。然而，肝细胞癌患者的治疗效果仍不理想，这凸显了全面理解HCC抗肿瘤反应及免疫逃逸机制的迫切性。在此背景下，解析HCC的免疫微环境特征至关重要。肿瘤浸润T细胞（包括细胞毒性T细胞、调节性T细胞和自然杀伤T细胞）是抗肿瘤免疫应答的核心组分。本综述旨在阐明这些细胞在免疫抑制性肿瘤微环境中的复杂相互作用，并探索重振功能失调T细胞的潜在策略。此外，本文系统总结了当前基于免疫检查点抑制剂（ICI）的临床试验、ICI联合疗法以及CAR-T/TCR-T细胞疗法在HCC领域的应用进展，这些新兴策略有望进一步提升患者总生存期，并可能在未来改变HCC的治疗格局。
肿瘤(癌症)患者之家