Hepatocellular carcinoma (HCC) is the third leading cause of worldwide cancer mortality. HCC almost exclusively develops in patients with chronic liver disease, driven by a vicious cycle of liver injury, inflammation and regeneration that typically spans decades. Increasing evidence points towards a key role of the bacterial microbiome in promoting the progression of liver disease and the development of HCC. Here, we will review mechanisms by which the gut microbiota promotes hepatocarcinogenesis, focusing on the leaky gut, bacterial dysbiosis, microbe-associated molecular patterns and bacterial metabolites as key pathways that drive cancer-promoting liver inflammation, fibrosis and genotoxicity. On the basis of accumulating evidence from preclinical studies, we propose the intestinal-microbiota–liver axis as a promising target for the simultaneous prevention of chronic liver disease progression and HCC development in patients with advanced liver disease. We will review in detail therapeutic modalities and discuss clinical settings in which targeting the gut-microbiota–liver axis for the prevention of disease progression and HCC development seems promising.

肝细胞癌（HCC）是全球癌症死亡的第三大原因。HCC 几乎全部发生在慢性肝病患者中，其驱动因素是肝损伤、炎症和再生的恶性循环，通常持续数十年。越来越多的证据表明细菌微生物组在促进肝病进展和肝癌发展中发挥着关键作用。在这里，我们将回顾肠道微生物群促进肝癌发生的机制，重点关注肠漏、细菌生态失调、微生物相关分子模式和细菌代谢物作为驱动癌症促进肝脏炎症、纤维化和基因毒性的关键途径。在临床前研究积累的证据的基础上，我们提出肠道-微生物群-肝脏轴作为同时预防晚期肝病患者慢性肝病进展和肝癌发展的有希望的目标。我们将详细回顾治疗方式并讨论临床环境，其中针对肠道-微生物群-肝脏轴来预防疾病进展和肝癌发展似乎很有希望。