Immunoediting characteristics and immunotherapy strategy optimization in HBV-related hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a globally prevalent malignant tumor with high mortality, and chronic hepatitis B virus (HBV) infection is its most important risk factor. The occurrence and progression of HBV-related HCC (HBV-HCC) are closely associated with the dynamic immunoediting process (elimination, equilibrium, escape) modulated by chronic HBV infection, which reshapes the tumor immune microenvironment (TIME) and regulates immune cell function, thereby affecting tumor fate. Although immune checkpoint inhibitors (ICIs) and related combination therapies have achieved breakthroughs in HBV-HCC treatment, the highly immunosuppressive TIME and tumor heterogeneity lead to significant therapeutic response differences and limitations, especially in special populations. This review systematically outlines the immunoediting process of HBV-HCC, evaluates current immunotherapy limitations, and proposes optimized strategies for clinical translation.