TNF and hepatocellular carcinoma: Smoking is cytotoxic and associated with increased inflammation and fibrosis in the liver through toxic (ie, iron overload and purine catabolism), immunological (ie, proinflammatory cytokines interleukin 1, interleukin 6, and tumor necrosis factor), and oncogenic (ie, p53 and T-cell suppression) properties.28 Thus, the potential role of smoking cessation in HCC risk reduction in patients with low FIB-4 scores should not be underestimated.