However, in about one-third of all HCC case with small lesions (<3cm), AFP level does not reach such value at an early HCC stage, leading to missed diagnosis in their early tumor stage.38 Nevertheless, considering the thresholds of PLR > 10 and NLR < 0.1 indicating high accuracy, the values for PLR (4.098) and NLR (0.187) in the present meta-analysis suggested caution regarding the diagnostic power of miR-21 for HCC screening alone. This evidence concerns the gene AFP and neoplasm.