Previous studies have shown that chromobox 4 (CBX4) expression may involve in the progression of liver cancer, however, it is unclear whether it affects the prognosis of hepatocellular carcinoma (HCC) related to aflatoxin B1 (AFB1). Methods: A retrospective study was conducted in the high AFB1 exposure areas and a total of 428 patients with HCC were included in the final survival analyses. AFB1 exposure levels and CBX4 expression in the tumor tissues were tested using enzyme-linked

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... assay and immunohistochemistry, respectively. The effects of AFB1 and CBX4 on HCC outcome were elucidated by Kaplan-Meier survival method and Cox regression model. Results: We found that the levels of AFB1 exposure and CBX4 expression in tumor tissues were significantly associated with some clinicopathological features such as microvessel density and tumor stage. Furthermore, both AFB1 and CBX4 significantly modified overall survival and tumor reoccurrence-free survival status of HCC. Additionally, some evidence of CBX4-AFB1 interaction affecting HCC prognosis was observed, with an interactive value of 1.98 for overall survival and 1.94 for tumor reoccurrence-free survival, respectively. Conclusion: These results suggest that CBX4 expression might be a useful marker for AFB1related HCC prognosis.