Evaluating serum extra spindle pole bodies-like 1 protein vs p53 antibody for hepatitis B virus-related hepatocellular carcinoma diagnosis

Abstract

Background: Hepatitis B virus (HBV) infection is a leading cause of global hepatocellular carcinoma (HCC). Conventional biomarkers such as alpha-fetoprotein (AFP) demonstrate suboptimal sensitivity and specificity. Emerging evidence suggests that serum extra spindle pole bodies like 1 (ESPL1) protein and p53 antibody may improve diagnostic accuracy.

Aim: To assess and compare the diagnostic performance of serum ESPL1 protein and p53 antibody in HBV-related HCC (HBV-HCC).

Methods: This case-control study from the First Affiliated Hospital of Guangxi Medical University enrolled 30 patients with chronic hepatitis B (CHB), 30 with HBV-related liver cirrhosis (HBV-LC), 55 with HBV-HCC, and 30 healthy controls. Serum ESPL1 protein and p53 antibody levels were quantified via ELISA. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis, including sensitivity, specificity, and correlation with AFP.

Results: Serum ESPL1 protein levels progressively increased across disease stages (CHB: 89.9 ng/L; HBV-LC: 188.83 ng/L; HBV-HCC: 317.63 ng/L), with a significantly higher area under the ROC curve (AUC = 0.917) than either p53 antibody (AUC = 0.725) or AFP (AUC = 0.678). p53 antibody levels were significantly elevated only in the HBV-HCC group. ESPL1 demonstrated superior sensitivity and concordance with histopathological findings. A significant correlation between ESPL1 and p53 antibody levels was observed exclusively in the HBV-HCC group (r = 0.320, P = 0.017), suggesting potential interplay in malignant transformation.

Conclusion: Serum ESPL1 protein, a promising biomarker for early HBV-HCC detection, outperforms p53 antibody in diagnostic reliability. Higher ESPL1 levels correlate with increased HCC risk in chronic HBV patients.

Keywords: Case-control study; Diagnostic biomarker; Extra spindle pole bodies-like 1; Hepatitis B virus; Hepatocellular carcinoma; p53 antibody.

Figure 1

Research flowchart outlining participant enrollment, group allocation, and biomarker analysis. CHB: Chronic hepatitis B; HBV-LC: Hepatitis B virus-related liver cirrhosis; HBV-HCC: Hepatitis B virus-related hepatocellular carcinoma; ESPL1: Extra spindle pole bodies-like 1; AFP: Alpha-fetoprotein; IHC: Immunohistochemistry; ROC: Receiver operating characteristic.

Figure 2

Comparison of serum biomarker levels among study groups assessed by Kruskal-Wallis test. A: The level of serum extra spindle pole bodies-like 1 (ESPL1) protein; B: The level of serum p53 antibody. ESPL1: Extra spindle pole bodies-like 1 CHB: Chronic hepatitis B; HBV-LC: Hepatitis B virus-related liver cirrhosis; HBV-HCC: Hepatitis B virus-related hepatocellular carcinoma; ns: Not significant.

Figure 3

Scatter plots illustrating the correlation between serum extra spindle pole bodies-like 1 protein and p53 antibody levels. A: In chronic hepatitis B group; B: In hepatitis B virus (HBV)-related liver cirrhosis group; C: In HBV-related hepatocellular carcinoma group. ESPL1: Extra spindle pole bodies-like 1.

Figure 4

Expression patterns of serum extra spindle pole bodies-like 1 protein, p53 antibody, and alpha-fetoprotein with hepatitis B virus-related hepatocellular carcinoma. In the 55 patients diagnosed with hepatitis B virus hepatitis B virus-hepatocellular carcinoma, 49 (89.1%) were extra spindle pole bodies-like 1-positive, 35 (63.6%) were p53 antibody-positive, and 26 (47.3%) were alpha-fetoprotein-positive. A: In the 26 alpha-fetoprotein (AFP)-positive patients, 25 (96.2%) were extra spindle pole bodies-like 1 (ESPL1)-positive and 19 (73.1%) were p53 antibody-positive; B: In the 35 p53 antibody-positive patients, 32 (91.4%) were ESPL1-positive and 19 (54.5%) AFP-positive; C: In the 49 ESPL1-positive patients, 32 (65.3%) were p53 antibody-positive and 25 (51.0%) were AFP-positive. D: In the 29 AFP-negative patients, 24 (82.8%) were ESPL1-positive and 16 (55.2%) were p53 antibody-positive; E: In the 20 p53 antibody-negative patients, 17 (85.0%) tested positive for ESPL1, whereas 7 (35.0%) were AFP-positive; F: In the 6 ESPL1-negative patients, 3 (50.0%) were p53 antibody-positive, and 1 (16.7%) was AFP-positive. ESPL1: Extra spindle pole bodies-like 1; AFP: Alpha-fetoprotein.

Figure 5

Receiver operating characteristic curves of serum extra spindle pole bodies-like 1, p53 antibody and alpha-fetoprotein for diagnosing hepatitis B virus-related hepatocellular carcinoma. ^aP < 0.05 vs p53 antibody; ^bP < 0.05 vs alpha-fetoprotein. ESPL1: Extra spindle pole bodies-like 1; AFP: Alpha-fetoprotein; AUC: Area under the receiver operating characteristic curve.

Figure 6

Proposed mechanism of accumulative effects involving extra spindle pole bodies-like 1 gene integration and mutated p53 protein overexpression in the progression to hepatitis B virus-related hepatocellular carcinoma.