Another retrospective study showed that the detection rate of the combined PIVKAII and AFP-L3 assay in patients with AFP-negative HCC was only 68.4%(39), which was lower than that of the combined GPR and GAR assay, and the sensitivity was only 40% when the results of the combined AFP-L3 and GP73 assay were used, which was inferior to the combined GPR and GAR. This evidence concerns the gene ALDH18A1 and hepatocellular carcinoma.