In the past few decades, many promising candidate biomarkers for HCC had been found, but most of them were not applied to clinical diagnosis due to their limited practicability and high cost [15–19]. Nevertheless, these new markers have potential to be applied in clinical diagnosis for their higher sensitivity and specificity. So far, α-fetoprotein (AFP) and imaging technology (e.g., ultrasound or computed tomography) are two primary methods to diagnose HCC in hospitals. AFP has been used as a serum marker for HCC for many years, but its sensitivity was only about 39%–65% . AFP-L3, which is the main glycoform of AFP in the serum of HCC, was proven to be an excellent biomarker with sensitivity 75% to 96.90%. High percentage of AFP-L3 has been shown to be associated with poor differentiation and biologically malignant characteristics, worse liver function, and larger tumor mass; some experts thought that the AFP-L3/AFP ratio is more helpful in diagnosis and prognosis of HCC [21, 22]. However, Miura and his coworkers showed that AFP-L3 could not provide an entirely satisfactory solution to detect HCC at the early stage . Our study showed that patients with higher levels of AFP, AFP-L3, AFP-L3/AFP ratio, and ALT have higher risk of developing HCC than those with normal levels of these markers, suggesting that these four markers are potential precursors of HCC in hepatic cirrhosis patients and that serum AFP, AFP-L3, AFP-L3/AFP ratio, and ALT may be useful markers for indicating the development of HCC.