**Abstract**

Aflatoxin B1 (AFB1) is an important carcinogen for primary hepatocellular carcinoma (PHCC). However, the values of blood AFB1-DNA adducts predicting HCC risk and prognosis have not still been clear. We conducted a hospital-based case-control study, consisting of 380 patients with pathologically diagnosed PHCC and 588 controls without any evidence of liver diseases, to elucidate the associations between the amount of AFB1-DNA adducts in the peripheral blood and the risk and outcome of HCC. All subjects had not the history of hepatitis B and C virus infection. AFB1-DNA adducts were tested using enzyme-linked immunosorbent assay. Cases with PHCC featured an increasing blood amount of AFB1-DNA adducts compared with controls (2.01 ± 0.71 vs. 0.98 ± 0.63 μmol/DNA). Increasing adduct amount significantly grew the risk of PHCC [risk values, 1.82 (1.34–2.48) and 3.82 (2.71–5.40) for medium and high adduct level, respectively]. Furthermore, compared with patients with low adduct level, these with medium or high adduct level faced a higher death and tumor-recurrence risk. These results suggest that the blood AFB1-DNA adducts may act as a potential biomarker for predicting the risk and prognosis of PHCC.

**Keywords:** AFB1, DNA adduct, primary hepatocellular carcinoma, biomarker, risk, prognosis
