AFP and cancer: Research has demonstrated that the tumor microenvironment is critical in HCC progression, with AFP driving carcinogenesis through mechanisms such as proliferation, angiogenesis, and invasion.25 AFP also has immunosuppressive effects that allow early malignant cells to evade immune surveillance, promoting cancer cell growth by activating survival pathways and inhibiting apoptosis, preventing cell death.29–31 Incorporating postoperative AFP into a predictive model offers a more detailed view of recurrence risk over time than static preoperative factors.