Psychological Stress in Hepatocellular Carcinoma: Clinical Outcomes and Biological Mechanisms.
- 1Department of Geriatrics, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, People's Republic of China.
Abstract
Psychological stress is common among patients with hepatocellular carcinoma (HCC) and may influence the disease course beyond its effects on quality of life. However, whether stress contributes to tumor recurrence and survival, and through which biological pathways, remains uncertain. In this Review, we summarize clinical evidence linking anxiety, depression, and chronic stress with peri-treatment recovery and oncologic outcomes in HCC. We then examine how activation of the hypothalamic pituitary adrenal axis and sympathetic nervous system reshapes tumor and liver biology through neuroendocrine signaling, immune suppression, stromal remodeling, and metabolic reprogramming. We also review emerging mechanisms involving kynurenine metabolism, gut microbial metabolites, bile acids, mitochondrial dysfunction, and ferroptosis resistance. Finally, we discuss psychological and pharmacological interventions, ongoing clinical studies, and the methodological challenges that currently limit causal inference. Integrating longitudinal psychological assessment with circulating and tissue-based biomarkers will be essential to determine whether stress reduction can improve liver-related and oncologic outcomes in HCC.
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BibTeX
@article{you2026psychological,
title = {{Psychological Stress in Hepatocellular Carcinoma: Clinical Outcomes and Biological Mechanisms.}},
author = {Chaojun You},
journal = {Journal of hepatocellular carcinoma},
year = {2026},
month = oct,
doi = {10.2147/jhc.s649100},
url = {https://europepmc.org/article/MED/42953582},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Psychological Stress in Hepatocellular Carcinoma: Clinical Outcomes and Biological Mechanisms.
AU - Chaojun You
PY - 2026
DA - 2026/10/23
JO - Journal of hepatocellular carcinoma
DO - 10.2147/jhc.s649100
UR - https://europepmc.org/article/MED/42953582
AB - Psychological stress is common among patients with hepatocellular carcinoma (HCC) and may influence the disease course beyond its effects on quality of life. However, whether stress contributes to tumor recurrence and survival, and through which biological pathways, remains uncertain. In this Review, we summarize clinical evidence linking anxiety, depression, and chronic stress with peri-treatment recovery and oncologic outcomes in HCC. We then examine how activation of the hypothalamic pituitary adrenal axis and sympathetic nervous system reshapes tumor and liver biology through neuroendocrine signaling, immune suppression, stromal remodeling, and metabolic reprogramming. We also review emerging mechanisms involving kynurenine metabolism, gut microbial metabolites, bile acids, mitochondrial dysfunction, and ferroptosis resistance. Finally, we discuss psychological and pharmacological interventions, ongoing clinical studies, and the methodological challenges that currently limit causal inference. Integrating longitudinal psychological assessment with circulating and tissue-based biomarkers will be essential to determine whether stress reduction can improve liver-related and oncologic outcomes in HCC.
SN - 2253-5969
ER -