Liver Function Laboratory Tests: Conventional Markers and Hepatocellular Carcinoma Biomarkers

Liver function tests represent a cornerstone in the evaluation of hepatobiliary disease, providing a non-invasive assessment of hepatic injury, synthetic capacity, and excretory function, offering valuable insight into hepatocellular integrity, cholestasis, and hepatic synthetic capacity. Despite their widespread use, many of these parameters reflect liver injury rather than true hepatic function, requiring careful clinical interpretation. This narrative review summarizes the physiological basis, diagnostic significance, and limitations of conventional liver biochemical markers, including aminotransferases, alkaline phosphatase, bilirubin, gamma-glutamyl transferase, albumin, total protein, platelet count, and prothrombin time. Particular emphasis is placed on the interpretation of laboratory patterns that distinguish hepatocellular from cholestatic injury. In addition, the review highlights emerging biomarkers for hepatocellular carcinoma (HCC), a leading cause of cancer-related mortality worldwide. Current evidence regarding alpha-fetoprotein, microRNA-122, and inflammatory mediators such as tumor necrosis factor-alpha is discussed, with attention to their diagnostic performance, clinical applications, and limitations in HCC surveillance. Understanding the strengths and shortcomings of both conventional and emerging biomarkers is essential for improving early detection of liver disease and optimizing surveillance strategies for hepatocellular carcinoma. Future approaches integrating multi-marker panels with imaging and clinical risk stratification may enhance diagnostic accuracy and patient outcomes.