A variety of etiologic factors can implicate the development of HCC without underlying cirrhosis, such as alcoholic, non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), autoimmune liver disease, genetic haemochromatosis, alpha-1-antitrypsin deficiency, Wilson’s disease, etc. [3]. Here, SERPINA1 is linked to metabolic dysfunction-associated steatotic liver disease.