Li J, Tao H, Zhang E, et al. - Among patients with alpha-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC), the diagnostic value of gamma-glutamyl transpeptidase to alkaline phosphatase ratio (GAPR) combined with gamma-glutamyl transpeptidase to aspartate aminotransferase ratio (GAR) and alanine aminotransferase to aspartate aminotransferase ratio (AAR) was assessed in this study. Participants were 925 AFP-negative patients, including 235 HCC cases, 213 chronic hepatitis (CH) cases, and 218 liver cirrhosis (LC) cases, as well as 259 healthy controls. GAPR, GAR, and AAR were revealed as essential parameters closely associated with AFP-negative HCC (AFP-NHCC). The combination of GAPR, GAR, and AAR showed the highest effectiveness in distinguishing AFP-NHCC group from control group (AUC = 0.875), AFP-negative CH group (AUC = 0.733), and AFP-negative LC group (AUC = 0.713). Overall, findings demonstrate the effectiveness of GAPR combined with GAR and AAR as diagnostic markers of AFP-NHCC, particularly in cases with good liver function, early stage or small size.