Previous studies reported high TS expression in HCC specimens compared with matched normal liver.[19, 20] The effects of high TS expression in a cohort of Japanese patients with HCC were inconclusive.[21] More recent studies reported the significance of TS expression and gene polymorphisms to 5-FU based therapies and prognosis of Asian patients.[22–24] However, similar studies of patients in non-Asian countries have yet to appear. Here, TYMS is linked to hepatocellular carcinoma.