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Liu W, Cai S, Pu R, Li Z, Liu D, Zhou X, Yin J, Chen X, Chen L, Wu J, Tan X, Wang X, Cao G. HBV preS Mutations Promote Hepatocarcinogenesis by Inducing Endoplasmic Reticulum Stress and Upregulating Inflammatory Signaling. Cancers (Basel) 2022; 14:cancers14133274. [PMID: 35805045 PMCID: PMC9265300 DOI: 10.3390/cancers14133274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/13/2022] [Accepted: 06/27/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Viral mutations at the preS region of hepatitis B virus (HBV) significantly increase the risk of developing hepatocellular carcinoma (HCC). Compared to HBV preS deletion, the oncogenic effect of preS combo mutation has rarely been investigated. With a cohort including 2114 subjects, we demonstrated that preS combo mutations G2950A/G2951A/A2962G/C2964A and C3116T/T31C significantly increased the risk of HCC in patients without antiviral treatment, whereas preS2 deletion significantly increased the risk of HCC in patients with antiviral treatment. The prevalence of C3116T/T31C (43.61%) was higher than preS2 deletion (7.16%). By using Sleeping Beauty mouse models and in vitro experiments, we found G2950A/G2951A/A2962G/C2964A, C3116T/T31C, and preS2 deletion promoted hepatocarcinogenesis by increasing levels of inflammatory cytokines, activating STAT3 pathway, enhancing endoplasmic reticulum stress, and altering gene expression profiles in inflammation- and metabolism-related pathways. These results suggest that preS combo mutations G2950A/G2951A/A2962G/C2964A and C3116T/T31C had similar oncogenic effects of preS2 deletion and should also be monitored. Abstract This study aimed to elucidate the effects and underlying mechanisms of hepatitis B virus (HBV) preS mutations on hepatocarcinogenesis. The effect of the preS mutations on hepatocellular carcinoma (HCC) occurrence was evaluated using a prospective cohort study with 2114 HBV-infected patients, of whom 612 received antiviral treatments. The oncogenic functions of HBV preS mutations were investigated using cancer cell lines and Sleeping Beauty (SB) mouse models. RNA-sequencing and microarray were applied to identify key molecules involved in the mutant-induced carcinogenesis. Combo mutations G2950A/G2951A/A2962G/C2964A and C3116T/T31C significantly increased HCC risk in patients without antiviral treatment, whereas the preS2 deletion significantly increased HCC risk in patients with antiviral treatment. In SB mice, the preS1/preS2/S mutants induced a higher rate of tumor and higher serum levels of inflammatory cytokines than did wild-type counterpart. The preS1/preS2/S mutants induced altered gene expression profiles in the inflammation- and metabolism-related pathways, activated pathways of endoplasmic reticulum (ER) stress, affected the response to hypoxia, and upregulated the protein level of STAT3. Inhibiting the STAT3 pathway attenuated the effects of the preS1/preS2/S mutants on cell proliferation. G2950A/G2951A/A2962G/C2964A, C3116T/T31C, and preS2 deletion promote hepatocarcinogenesis via inducing ER stress, metabolism alteration, and STAT3 pathways, which might be translated into HCC prophylaxis.
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Affiliation(s)
- Wenbin Liu
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Shiliang Cai
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Rui Pu
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Zixiong Li
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Donghong Liu
- Department of Liver Cancer Surgery, Third Affiliated Hospital, Second Military Medical University, Shanghai 200433, China;
| | - Xinyu Zhou
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Jianhua Yin
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Xi Chen
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Liping Chen
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Jianfeng Wu
- Department of Pathology, Xijing Hospital, Xi’an 710032, China;
| | - Xiaojie Tan
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
| | - Xin Wang
- Laboratory of Molecular Cell Biology, Institute of Biochemistry and Cell Biology, Chinese Academy of Sciences, Shanghai 200433, China;
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University, 800 Xiangyin Rd., Shanghai 200433, China; (W.L.); (S.C.); (R.P.); (Z.L.); (X.Z.); (J.Y.); (X.C.); (L.C.); (X.T.)
- Correspondence: ; Tel.: +86-21-8187-1060
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Lin J, Zhang H, Yu H, Bi X, Zhang W, Yin J, Zhao P, Liang X, Qu C, Wang M, Hu M, Liu K, Wang Y, Zhou Z, Wang J, Tan X, Liu W, Shao Z, Cai J, Tang W, Cao G. Epidemiological Characteristics of Primary Liver Cancer in Mainland China From 2003 to 2020: A Representative Multicenter Study. Front Oncol 2022; 12:906778. [PMID: 35800051 PMCID: PMC9253580 DOI: 10.3389/fonc.2022.906778] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/11/2022] [Indexed: 01/27/2023] Open
Abstract
Background The contribution of hepatitis B virus (HBV) and hepatitis C virus (HCV) to primary liver cancer (PLC) and their association with cancer aggressiveness remains uncertain in China, a country with half of global PLC. We aimed to characterize this using data from four representative medical centers. Methods In total, 15,801 PLC patients were enrolled from the centers distributed in Easter5n, Southern, Northern, and Western China from 2003 to 2020. Of those, 7585 with curative surgery were involved in survival analysis. A nomogram was constructed using preoperative parameters to predict postoperative survival. Results Hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, and combined hepatocellular cholangiocarcinoma accounted for 93.0%, 4.3%, and 1.6% in PLC, respectively. The seropositivities of HBV and HCV were 84.4% and 3.2% in HCC, respectively. The seropositivity of anti-HCV antibody was significantly higher in HBV-negative than in HBV-positive HCC patients (13.2% vs. 1.1%). Compared to HCV-positive HCC (HCV-HCC), HBV-positive HCC (HBV-HCC) was associated with 12-year earlier onset, higher proportions of males, high α-fetoprotein, large tumor size, advanced Barcelona Clinic Liver Cancer (BCLC) stage, and vascular tumor thrombus. The proportions of HCC and HBV seropositivity increased, whereas that of anti-HCV decreased, from 2003 to 2020. Postoperative five-year survival rate was 73.5%, 64.1%, 34.9%, and 19.7% in HCC at BCLC stage 0, A, B, and C, respectively. The multivariate Cox regression analysis showed that HBV seropositivity, incomplete tumor capsule, vascular tumor thrombus, tumor diameter (≥3 cm), advanced BCLC stage (B+C), α-fetoprotein (≥20ng/ml), and direct bilirubin (>8µmol/L) contributed independently to shorter overall survival (OS); whereas post-operative radiofrequency ablation and second resection independently improved OS in HCC. HCV-HCC had a more favorable prognosis than did HBV-HCC (Log-rank test, P<0.001). A nomogram composed of age, gender, and the preoperative independent risk factors was accurate in predicting postoperative survival in HCC (C-index: 0.735; 95% confidence interval: 0.727–0.743). Conclusion HBV contributes to 84.4% of HCC in China, and actively promotes hepatocarcinogenesis and HCC progression. A favorable postoperative survival obtained in patients at the early BCLC stage highlights the importance of screening for early HCC in high-risk populations. Our preoperative prognosis prediction model is important in clinical decision-making.
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Affiliation(s)
- Jiansheng Lin
- Department of Epidemiology, Second Military Medical University, Shanghai, China
- Department of Epidemiology, School of Medicine, Jinan University, Guangzhou, China
| | - Hongwei Zhang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Hongping Yu
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xinyu Bi
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weilu Zhang
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi’an, China
| | - Jianhua Yin
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Pei Zhao
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xiumei Liang
- Office for Disease Process Management, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Chunfeng Qu
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Wang
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Hu
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Kun Liu
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi’an, China
| | - Yuting Wang
- State Key Lab of Molecular Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zihan Zhou
- Guangxi Office for Cancer Prevention and Control, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Junqi Wang
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Xiaojie Tan
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Wenbin Liu
- Department of Epidemiology, Second Military Medical University, Shanghai, China
| | - Zhongjun Shao
- Department of Epidemiology, School of Public Health, Fourth Military Medical University, Xi’an, China
- *Correspondence: Zhongjun Shao, ; Jianqiang Cai, ; Weizhong Tang, ; Guangwen Cao,
| | - Jianqiang Cai
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Zhongjun Shao, ; Jianqiang Cai, ; Weizhong Tang, ; Guangwen Cao,
| | - Weizhong Tang
- Department of Gastrointestinal Surgery and Guangxi Clinical Research Center for Colorectal Cancer, Guangxi Medical University Cancer Hospital, Nanning, China
- *Correspondence: Zhongjun Shao, ; Jianqiang Cai, ; Weizhong Tang, ; Guangwen Cao,
| | - Guangwen Cao
- Department of Epidemiology, Second Military Medical University, Shanghai, China
- *Correspondence: Zhongjun Shao, ; Jianqiang Cai, ; Weizhong Tang, ; Guangwen Cao,
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