摘要Lactic acidosis is a hallmark of the tumor microenvironment(TME)and a critical impediment to the efficacy of transarterial chemoembolization(TACE)in hepatocellular carcinoma(HCC).Incomplete embolization preserves viable tumor cells that amplify hypoxia-driven glycolysis,generating a lactic acid-rich milieu that drives treatment resistance,skews immune populations toward immunosup-pressive phenotypes,and impairs cytotoxic T lymphocyte function.In this review,we elucidate the pathways through which lactic acidosis compromises TACE efficacy and propose novel strategies for its mitigation.We examine emerging approaches,including systemic or intra-arterial alkalization,targeted inhibition of lactate production and export,and calcium carbonate nanoparticles,and evaluate their respective merits and limitations.Finally,we propose a combination regimen of calcium carbonate nanoparticles,lactate-targeting agents,and TACE to achieve precise drug delivery,synergistic lactic acid depletion,and enhanced antitumor immunity.These integrated strategies have the potential to convert immunologically"cold"HCC lesions into"hot"ones,thereby improving TACE outcomes and disease control.