TP53 mutation detected in circulating exosomal DNA is associated with prognosis of patients with hepatocellular carcinoma

Cancer Biol Ther. 2022 Dec 31;23(1):439-445. doi: 10.1080/15384047.2022.2094666.


Exosome DNA (exoDNA) can be used for liquid biopsy. This study was the first to use droplet digital PCR (ddPCR) to detect tumor-specific mutations in exoDNA and to evaluate the prognosis of hepatocellular carcinoma (HCC) patients. 60 HCC patients were enrolled in the study. We used ddPCR to detect c.747 G > T mutation in TP53 gene. We analyzed the correlation between detectable mutation in exoDNA and clinicopathologic characteristics using Multivariate logistics regression analysis. We performed Cox regression to assess the correlation between mutation frequency (mutant droplets/total droplets, MD/TD) and prognostic. We found that 48 of 60 patients had c.747 G > T mutation in TP53 gene in exoDNA (80.0%). We found that detectable mutation in exoDNA and age were associated with microvascular invasion (MVI) (P < .01). The ROC curve analysis revealed that the best cutoff value of mutation frequency to predict MVI was 67% (sensitivity 48.15%, specificity 93.94%,), the corresponding AUC was 0.761 (95%CI, 0.640-0.866; P < .01). Furthermore, we found that patients suffered high-frequency mutation (>67%) had shorted median recurrence-free survival (RFS) with 63 days (range, 53-202 days), compared with 368 days (range, 51-576 days) for patients with low-frequency mutation (<67%) (HR:4.61; 95% CI, 1.70-12.48; P = 0 .003). We also found that high-frequency mutation was associated with poor prognosis though patients had better pathological characteristics, such as AFP (<400 ng/mL), Liver cirrhosis (Negative), Tumor thrombus (Negative), Tumor numbers (Single) and Post-operation TACE (Executed). We provided evidence that the mutations in exoDNA might be used to predict patients with poor RFS.Abbreviations: TP53: Tumor protein p53; ExoDNA: Exosomal DNA; HCC: Hepatocellular carcinoma; ddPCR: Droplet digital Polymerase Chain Reaction (PCR); MD/TD: The ratio of mutant droplets/total droplets; AFP: Alpha-fetoprotein; MVI: Microvascular invasion; RFS: Recurrence-free survival.

Keywords: Liquid biopsy; TP53 mutation; droplet digital PCR; exosomal DNA; hepatocellular carcinoma.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Carcinoma, Hepatocellular* / pathology
  • Cell-Free Nucleic Acids*
  • Humans
  • Liver Neoplasms* / pathology
  • Mutation
  • Prognosis
  • Retrospective Studies
  • Tumor Suppressor Protein p53 / genetics
  • alpha-Fetoproteins / genetics
  • alpha-Fetoproteins / metabolism


  • Cell-Free Nucleic Acids
  • TP53 protein, human
  • Tumor Suppressor Protein p53
  • alpha-Fetoproteins

Grant support

This study was supported by grant from the key research projects of Jiangxi Province, China (20181BBG70010), Chen-Xiao-Ping Foundation For The Development Of Science And Technology Of HuBei Province, China (CXPJJH12000001-2020341) and Clinical Research Program for The Second Affiliated Hospital of Nanchang University (2021efyB04). It contributed to study design and data collection, analysis and interpretation, and it also contributed to authorization of software and paper written.