The immunosuppressive activity of PIWIL1 influenced MDSCs in the HCC tumor microenvironment is diminished by an inhibition of IL-10 secretion which leads to a promotion of hepatocellular carcinoma (HCC) initiation, development and progression (28).The imbalance of the complement system, with excessive activation and consumption, can change the microenvironment of the tumor of hepatocellular carcinoma cells causing development and progression of the tumor (29).The present study determined that the hazard ratio (HR) for complement C3 with values below one indicates a protective factor. This evidence concerns the gene PIWIL1 and hepatocellular carcinoma.