AFP and hepatocellular carcinoma: Enjoji et al. reported the sensitivity of DiAcSpm (65.5%) was neither superior nor inferior to alpha-fetoprotein (AFP) (63.8%) and protein induced by vitamin K absence or antagonist II (PIVKA-II) (60.3%), illustrating that the polyamine, either alone or in conjunction with AFP and PIVKA-II, could be a reliable non-invasive index in HCC detection, especially in patients without elevation of other serum markers [20].