KEAP1 and hepatocellular carcinoma: Patients with higher nrf2 and lower keap1 expression were found to have a significantly reduced overall survival(OS) and disease-free survival(DFS) [156], Accordingly, Zhang et al. found an increased Nrf2 protein expression in a series of 65 HCC samples, where Nrf2 expression positively correlated with metastasis at distal sites and lower OS and DFS.