AFP and hepatocellular carcinoma: The relationship between HBV and HCC is well-established, with hepatitis B-associated HCC exhibiting higher levels of AFP compared to other etiologies.[26] Zhang et al concluded that the hepatitis B virus X protein triggers AFP transcription, leading to increased AFP expression in HBV-associated HCC.[27] In our study, we observed that HBV-related HCC patients are more likely to have elevated AFP and PIVKA-II levels than those with nonviral and non-alcohol-related HCC.