Elevated neutrophil-to-lymphocyte ratio (NLR) and MPO-DNA markers have been identified as markers of advanced HCC, poor prognosis, and inadequate treatment response.15,16 Although studies have confirmed that gut microbiota can activate excessive formation of NETs,17,18 the potential interrelation among gut microbiota, excessive NETs activation, and intrahepatic metastasis of HCC remains unknown. Here, MPO is linked to hepatocellular carcinoma.