AFP and Cirrhosis: NAFLD patients also represent a distinct high-risk population due to the challenges of ultrasound-based HCC screening related to increased subcutaneous, visceral, and intrahepatic adiposity[5]; the potential absence of elevated tumor markers, such as alpha-fetoprotein (AFP)[6]; and the observation that 20%-30% of all HCCs occur in the absence of underlying cirrhosis[7].