AFP and Cirrhosis: Most cases of HCC are associated with chronic liver diseases and cirrhosis, often caused by metabolic-associated steatotic liver disease (MASLD)/metabolic-associated steatohepatitis (MASH), alcohol-related cirrhosis, hepatitis B, and hepatitis C. According to AASLD guidelines, patients with cirrhosis should undergo HCC surveillance with liver ultrasound and serum alpha-fetoprotein (AFP) every six months.