Abstract
BACKGROUND: Astragaloside IV (AS-IV), a key monomeric compound extracted from the traditional Chinese medicine Astragalus membranaceus, has demonstrated significant therapeutic potential in cancer treatment. Hepatocellular carcinoma (HCC), as a malignant tumor posing severe threats to global health, is characterized by high incidence and mortality rates, imposing substantial burdens on patients, families, and society. Numerous studies have demonstrated that AS-IV exhibits significant inhibitory effects on HCC. However, the precise underlying mechanisms remain unclear. Therefore, this systematic review provides a comprehensive summary of current research findings. METHODS: This systematic review comprehensively evaluates the molecular mechanisms of AS-IV in HCC through extensive literature retrieval from five authoritative databases, encompassing studies published from their inception to March 2025. RESULTS: A total of 172 potentially relevant articles were retrieved through database search. After screening, a total of 16 articles finally met the qualification criteria. CONCLUSION: Current evidence indicates that AS-IV exerts crucial therapeutic effects in HCC through multiple pathways: inhibiting tumor cell proliferation, migration, and invasion; inducing apoptosis; modulating immune responses; reducing drug resistance while enhancing chemosensitivity; and suppressing angiogenesis. However, large-scale, well-designed multicenter randomized controlled trials are warranted to establish more robust clinical evidence, thereby solidifying the foundation for AS-IV's broader application in HCC therapeutics.