In both univariate and multivariate analyses, elevated ATX level (≥ 1.323 mg/L) consistently showed a significant predictive capability for HCC recurrence (univariate HR: 6.49; 95% CI: 1.90–22.13; p = 0.003; multivariate HR: 6.38–10.50) independently of conventional tumor markers and liver fibrosis markers. The gene discussed is ENPP2; the disease is hepatocellular carcinoma.