肝细胞癌（HCC）是最常见的原发性肝癌和全球癌症相关死亡的第四大原因。HCC通常发生在慢性肝病或肝硬化的背景下。最近的证据突出了免疫微环境在HCC的发展和进展中的重要性，以及其在潜在治疗反应中的作用。病毒性肝炎、酒精性肝病和非酒精性脂肪肝等肝脏疾病是HCC发展的主要风险因素，已被证明会改变免疫微环境。免疫微环境的改变可能显著影响不同治疗策略的反应。因此，研究集中于理解肿瘤细胞、免疫细胞和周围肝实质之间的复杂关系，以更有效地治疗HCC。在本文中，我们回顾了免疫微环境，以及肝病对免疫微环境的相对影响。此外，我们回顾了免疫微环境的变化如何导致治疗耐药，并强调了旨在开发下一代HCC治疗的未来策略。 版权©2023 Brown、Ruff和Pawlik。

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth leading cause of cancer-related death worldwide. HCC often occurs in the setting of chronic liver disease or cirrhosis. Recent evidence has highlighted the importance of the immune microenvironment in the development and progression of HCC, as well as its role in the potential response to therapy. Liver disease such as viral hepatitis, alcohol induced liver disease, and non-alcoholic fatty liver disease is a major risk factor for the development of HCC and has been demonstrated to alter the immune microenvironment. Alterations in the immune microenvironment may markedly influence the response to different therapeutic strategies. As such, research has focused on understanding the complex relationship among tumor cells, immune cells, and the surrounding liver parenchyma to treat HCC more effectively. We herein review the immune microenvironment, as well as the relative effect of liver disease on the immune microenvironment. In addition, we review how changes in the immune microenvironment can lead to therapeutic resistance, as well as highlight future strategies aimed at developing the next-generation of therapies for HCC.Copyright © 2023 Brown, Ruff and Pawlik.