Since hypoxia is a key trigger enhancing the expression of the H19 gene [25], the fact that more than half of HCC recurrence patients in this study were treated with transarterial chemoembolization (TACE, 86/240) and/or radiofrequency ablation (RFA, 38/240) might be an explanation for this. In vitro, a publication strongly suggested that H19 could act as a tumor suppressor [26], while other authors assumed that H19 acts as an oncogenic marker in humans [25, 27]. The gene discussed is H19; the disease is neoplasm.