Research progress on the role of cholesterol in hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is often diagnosed at advanced stages with no effective treatment options. Mechanistically, it is a complex biological process. Recently, the main cause of its incidence is changing from viral to non-viral. It has been shown that high cholesterol levels can cause the further transformation of non-alcoholic fatty liver disease (NAFLD) to HCC, but some investigations have found that serum cholesterol levels are negatively correlated with morbidity and mortality. Conflicting experimental results and epidemiological investigations illustrate the complex mechanisms of HCC. Cholesterol is essential for the survival of the body and tumors, although research on the function of cholesterol in tumors is evolving, the use of lowering cholesterol drugs in treating HCC remains limited. In this review, the cholesterol-involved mechanisms that cause the development of HCC or reduce the mortality and the latest progress in the use of cholesterol in the treatment of HCC and prospects for prevention and diagnosis have been summarized. •Cholesterol is an important component of the cell membranes, and plays an important role in HCC.•Cholesterol affects liver metabolism, gut microbiome homeostasis and immune function in HCC.•Regulation of cholesterol levels has great potential for the treatment of HCC, especially in immunotherapy.