Autophagy-apoptosis crosstalk in hepatocellular carcinoma: Therapeutic implications of traditional Chinese medicine: A narrative minireview

Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality, and primary or acquired resistance to systemic therapy is common.Autophagy is context-dependent in HCC and is intimately connected with apoptosis through shared regulatory nodes.Traditional Chinese medicine (TCM)-derived compounds and formulae have been reported to modulate autophagy and apoptosis in preclinical HCC models.This narrative minireview summarizes the core autophagic machinery, the molecular interface between autophagy and apoptosis, and representative TCM agents.In this revision, compound-specific claims are retained only when supported by verifiable primary HCC studies that reported both autophagy-related and apoptosisrelated readouts; unsupported agent-specific statements have been removed.We critically appraise the evidence rather than merely listing compounds.Most included studies measured static markers such as LC3-II, p62, or autophagosome accumulation without lysosomal blockade or tandem fluorescent reporters; therefore, claims of autophagy induction, protective autophagy, cytotoxic autophagy, or autophagydependent apoptosis remain provisional.We classify agents according to the direction of crosstalk suggested by available functional evidence and explicitly separate demonstrated from hypothetical mechanisms.No clinical evidence supports TCMmediated reversal of HCC drug resistance.Flux-validated experiments, genetic perturbations, standardized reporting, and clinically relevant resistant models are required before therapeutic recommendations can be made.