Among patients with early-stage HCC (BCLC stage 0+A, n = 91), PIVKA-II demonstrated better diagnostic performance (AUC 0.828, 0.779-0.870) compared with AFP (AUC 0.755, 0.701-0.804) alone or AFP-L3% (AUC 0.684, 0.627-0.738) alone. Here, AFP is linked to hepatocellular carcinoma.