Some clinical findings have suggested that DCP/PIVKA-II should not be used alone [63]; however, many studies suggest that it improves diagnostic accuracy when combined with AFP and AFP-L3% [64,65,66], particularly in distinguishing HCC patients from those with cirrhosis [67] and NAFLD (non-alcoholic fatty liver disease) [68], the latter which is a fast-growing cause of HCC. This evidence concerns the gene ACE and hepatocellular carcinoma.