Serum DKK-1 had shown diagnostic value in diagnosing HCC in many studies,[22–31] and majority of them concluded that DKK-1 could commendably detect HCC, except Mao et al to differentiate AFP (−) HCC from liver cirrhosis.[24] In another study published in 2012, serum DKK-1 showed a moderate diagnostic value in distinguishing AFP (−) HCC from high-risk patients.[23] However, it is difficult to predict whether DKK-1 could display a good diagnostic accuracy in AFP (−) HCC as there was insufficient data to analyze in the current meta-analysis. This evidence concerns the gene AFP and hepatocellular carcinoma.