Another study evaluating the potential value of cathepsins (cathepsin D, B, and L) as markers for malignant progression in patients found that the serum levels of all cathepsins (D, B, and L) were increased in patients with HCC and elevated levels of two cathepsins (cathepsin D and B) were seen in patients with cirrhosis [109]. This evidence concerns the gene CTSD and hepatocellular carcinoma.