Although AFP measurements are considered a tumor marker in the recommendations (Proposal 5), PIVKA-II had a higher positive rate than AFP in the data of the NASH research group of the Ministry of Health, Labor, and Welfare [46] and in the data in the Japan Study Group of NAFLD (JSG-NAFLD) from a multi-center Japanese study [51]. Here, AFP is linked to metabolic dysfunction-associated steatotic liver disease.