AFP and hepatocellular carcinoma: Furthermore, higher PIVKA-II levels in nonviral HCC patients may result from more rigorous ultrasound surveillance, leading to the detection of more advanced disease at the time of initial diagnosis.[28] Previous studies have indicated a positive correlation between both AFP and PIVKA-II levels and tumor size.[29–31] Consistent with these findings, our study identified tumor size as an independent factor associated with abnormally elevated levels of PIVKA-II and AFP in HCC patients.