**Abbreviations**

*Aflatoxin B1 Occurrence, Detection and Toxicological Effects*

PHCC risk and outcome.

**Acknowledgements**

associated with poor OS and RFS of patients with PHCC [6].

more actual predictive role of blood AFB1-DNA adducts.

proved by larger clinic samples and functional analyses.

**Conflict of interests and source of funding**

Following epidemiological studies on based clinical samples further prove that the amount of AFB1-DNA adducts is higher in the tumor tissues than in the peritumor tissues [6]. This increasing tissular AFB1-DNA adducts are significantly

In this study, we designed and finished a hospital-based case-control study in the southwestern of Guangxi, a knowledge-high AFB1 exposure area. Our data exhibited that increasing the amount of AFB1-DNA adducts in peripheral white blood cells not only increased PHCC risk, but also modified the OS and RFS of patients with PHCC. Supporting our findings through several studies from high AFB1 exposure areas, the amount of blood AFB1-DNA adducts can reflect the levels of AFB1 exposure information and may be related to PHCC risk and prognosis [11, 12, 14, 15, 17, 38]. Taken together, these results suggest that AFB1-DNA adducts in the blood as well as in the tumor tissues may be potential biomarkers for

This study has several strengthens. We accomplished the predictive value analyses using these individuals only with AFB1 exposure but without HBV or HCV. This is done mainly because both HBV and HCV infection will alter effects of AFB1-DNA adducts predicting the risk and outcome of PHCC. Additionally, to control potential confounders such as age, gender, and race, the individually matched design was finished in this study. Therefore, our study may represent a relatively

To conclude, this study explored the association between blood AFB1-DNA adducts and the risk and prognosis of PHCC using a retrospective clinic-sample research approach and displayed that blood AFB1-DNA adduct may be a potential biomarker for HCC risk and outcome. Several limitations should be focused for our study. First, relatively small-size samples may underestimate the effects of blood AFB1-DNA adducts on PHCC risk and outcome. Second, selective bias may happen because of this hospital-based retrospective investigative design. Finally, the mechanical analyses for AFB1-DNA adducts predicting PHCC risk and prognosis were not finished. Thus, the blood AFB1-DNA adducts may be valuable biomarkers for predicting the risk and prognosis of PHCC once the present findings were

We thank Dr Yuan-Feng Zhou for sample collection and management.

in part by the National Natural Science Foundation of China (Nos. 81860489, 81760502, 81572353, and 81660495), the Natural Science Foundation of Guangxi (Nos. 2018GXNSFAA281043, 2017GXNSFAA198002, and 2017GXNSFGA198002), Research Program of Guangxi "Zhouyue Scholar" (No. 2017-38), Research Program of Guangxi Specially invited Expert (No. 2017-6th), the "12th Five" Planning Program of Guangxi Education Science (No. 2015C397), the Innovative Program of Guangxi Graduate Education (No. JGY2015139), Research Program of Guangxi Clinic Research Center of Hepatobiliary Diseases (No. AD17129025), and Open Research Program from Molecular Immunity Study Room Involving in Acute and Severe Diseases in Guangxi Colleges and Universities (Nos. kfkt20160062 and

The authors declare no competing financial interests. This study was supported

**112**

kfkt20160063).

