Objective To Evaluate The Value Of Peripheral Blood In The Diagnosis Of Hepatocellular Carcinoma And Prediction Of Recurrence

Background: Hepatitis B virus(HBV)infection is a major health and health problem worldwide and a major cause of hepatitis,cirrhosis and hepatocellular carcinoma(HCC).Hepatocellular carcinoma is the fifth most common cancer worldwide and the second most common cause of cancer deaths worldwide.Liver cirrhosis,diabetes mellitus,liver cancer in the immediate family,high serum HBs Ag level,exposure to aflatoxin and so on are all related to the high incidence of liver cancer.Despite the antiviral effect of NAs in treating HBV infection,a proportion of HBV-infected patients still develop HCC after long-term effective NAs treatment.Our previous series of studies showed that 80%(8/10)of HBV S gene and host gene were detected in the liver cancer tissues of patients with HBV infection,and 75%(6/8)of these patients had HBV S gene and human ESPL1 gene fusion.The fusion gene HBV S-human ESPL1 was formed.The level of serum ESPL1 in chronic hepatitis group,non-HBV S gene integration group,hepatitis B cirrhosis group,liver cancer group and HBV S gene integration group increased successively,and the level of serum ESPL1 in the group before liver cancer resection was higher than that after liver cancer resection group.It suggests that ESPL1 expression may be more active in tumor tissues.After tumor resection,ESPL1 gene expression gradually decreases,and serum ESPL1 level also decreases,which is related to the progression of the disease.However,there is a lack of observational studies on the dynamic level of peripheral serum ESPL1 in patients with HBV-associated hepatocellular carcinoma,as well as the prediction of prognosis and recurrence in patients with HBV-associated hepatocellular carcinoma.Objective: To study the level of serum ESPL1 in hepatitis B liver cancer patients during the course of disease,and to explore the feasibility of monitoring the clinical diagnosis,prognosis and recurrence of HCC by the level of peripheral blood ESPL1.Methods: In this study,119 patients who met the inclusion criteria were selected from the cohort of long-term antiviral treatment for chronic HBV infection in the First Affiliated Hospital of Guangxi Medical University,and the subjects were divided into the group with primary liver cancer,the group with no recurrence 5 years after operation,the group with recurrence after operation,and the group with repeated recurrence after operation.In addition,CHB and LC were selected as the control group in this study.The level of serum ESPL1 in each group was determined by enzyme-linked immunosorbent assay(ELISA).1.The ROC curve was drawn to evaluate the levels of ESPL1 and AFP in peripheral blood,which were used as the indicators for predicting the first occurrence of hepatitis B liver cancer.2.Scatter plots were drawn to dynamically analyze the rise and fall of peripheral blood ESPL1 level before and after hepatocellular carcinoma resection;3.One-way ANOVA was used to compare the relationship between the pathological diagnosis of liver cancer and the level of ESPL1 in peripheral blood.Results: 1.Comparison between ESPL1 level in peripheral blood and AFP in the diagnostic evaluation of HCC: When the cut-off value of ESPL1 level in peripheral blood is 212.62ng/ml and the value of AFP is 11.33 ng/ml,the comparison between ESPL1 level and AFP for HCC diagnostic evaluation: area under the curve(0.89 vs 0.78),sensitivity(89.8% vs 55.9%),specificity(90.0%vs 93.3%),agreement rate(89.8% vs 74.8%).2.(1)In the preoperative group of first-onset HCC,the level of peripheral blood ESPL1 gradually increased from 5years before the first onset of HCC to more than the cut-off value 3 years before the occurrence of HCC;As the disease progressed until the first occurrence of HCC,peripheral blood serum ESPL1 was associated with a higher R2 than AFP level(0.91 vs 0.62).(2)In the group without recurrence after hepatocellular carcinoma resection,the level of peripheral blood ESPL1 gradually decreased from the postoperative level of hepatocellular carcinoma to below the cut-off value 4 years after the operation;The correlation between postoperative peripheral serum ESPL1 and time was higher than that of AFP(R2 0.86 vs 0.30).(3)The fluctuation of ESPL1 in peripheral blood of recurrent hepatocellular carcinoma group after operation was as follows: "persistently high-level type" accounted for 76.9%,"V-type" 19.2%,and "persistently declining type" accounted for 4.0%;(4)The fluctuation of ESPL1 in peripheral blood of the group with multiple recurrence after liver cancer surgery was as follows: "persistently high-level type" 57.1%,"wavy type" 42.9%.3.HCC grade I vs HCC grade II(218.0±104.2 vs 301.2±76.5,P=0.041);HCC grade I vs HCC grade III(218.0±104.2 vs 340.8±76.7,P=0.005);HCC grade II vs HCC grade III(301.2±76.5 vs 340.8±76.7,P=0.045).Analysis of variance pairwise comparison,the differences are statistically significant.Conclusions: 1.The reliability of ESPL1ESPL1 in peripheral blood was higher than AFP in the diagnosis of HCC;2.The fluctuation of ESPL1 level before and after hepatocellular carcinoma is helpful to predict the occurrence and recurrence of hepatocellular carcinoma;3.The level of ESPL1 was highly correlated with the degree of malignancy of HCC.