Environmental factors related to pathogenesis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with high morbidity and mortality worldwide. Its etiology is complex, involving multiple aspects such as viral infection, dietary exposure, chemical pollution, lifestyle and endogenous factors. This review conducted a comprehensive search in databases such as PubMed and Scopus using keywords including "hepatocellular carcinoma", "environmental factors", "epidemiological trends", and "prevention and treatment strategies". Relevant papers, including clinical case reports, reviews, and basic research, were included. This study systematically reviewed the mechanisms and epidemiological characteristics of external environmental factors such as viral infection, aflatoxin, arsenic, vinyl chloride, per- and polyfluoroalkyl substances, microplastics, oral contraceptives, nitrite, and microcystin-leucine arginine in the occurrence of HCC; internal environmental factors such as genetic susceptibility, diabetes, obesity, metabolic dysfunction-associated steatotic liver disease, metabolic syndrome, gut microbiota, and sex hormones; other factors such as alcohol consumption, smoking, insufficient sleep, lack of exercise and aging. A variety of preventive and intervention measures have been proposed, including hepatitis B vaccination, reduction of aflatoxin and alcohol exposure, tobacco control, antioxidant supplementation, regular rest and exercise. The prevention and control of HCC should range from infectious disease prevention and control to metabolic disease management and environmental governance, combined with individualized risk assessment and precise prevention strategies.