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Original Article | Open Access

Diagnostic performance comparisons of two commonly used multi-biomarker-based scores for detection of hepatocellular carcinoma in non-alcoholic fatty liver disease

Wei Ouyanga,b,c,1, Ming-Da Wangb,1, Ming-Cheng Guanc,1, Yong-Kang Diaob, Li-Yang Sune, Nan-Ya Wangd, Feng Shenb, Hong Zhuc( ), Tian Yangb( )
Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, China
Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai 200438, China
Department of Medical Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
Cancer Center, First Hospital of Jilin University, Changchun 130015, China
Department of Graduate, Bengbu Medical College, Bengbu 233099, China

1 These authors contributed equally to this work.

Show Author Information

Graphical Abstract

ROC curves comparing the overall performance of the ASAP with the GALAD score and individual biomarkers in the (A) overall cohort (N = 147 for NAFLD related HCC, N = 460 for NAFLD control), (B) early-stage HCC (BCLC stage 0+A) vs. NAFLD (N = 83 for NAFLD related HCC, N = 460 for NAFLD control), (C) early-stage HCC (TNM staging I) (8th) vs. NAFLD (N = 84 for NAFLD related HCC, N = 460 for NAFLD control), (D) Early-stage HCC (within Milan criteria) vs. NAFLD (N = 72 for NAFLD related HCC, N = 460 for NAFLD control).

Abstract

Background and aims

The ASAP and GALAD scores are widely used diagnostic models for detecting hepatocellular carcinoma (HCC), incorporating factors such as sex, age, alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ), and lens culinaris agglutinin-reactive fraction of AFP (AFP-L3%). This study compares the diagnostic efficacy of the ASAP and GALAD scores in the early detection of HCC in patients with non-alcoholic fatty liver disease (NAFLD).

Methods

NAFLD patients with and without HCC were recruited from 12 Chinese tertiary hospitals. Serum levels of AFP, PIVKA-Ⅱ, and AFP-L3% were measured. The diagnostic accuracy of individual biomarkers, the ASAP score, and the GALAD score in detecting NAFLD-HCC at various stages was evaluated using receiver operating characteristic (ROC) curves and area under the curve (AUC) values.

Results

In a cohort of 147 NAFLD-HCC cases and 460 NAFLD controls, both the ASAP and GALAD scores outperformed individual biomarkers in detecting NAFLD-HCC. The ASAP score demonstrated a high AUC of 0.910 (sensitivity: 80.3%, specificity: 92.8%) for identifying NAFLD-HCC at all stages, surpassing AFP (AUC: 0.716, P < 0.001), PIVKA-Ⅱ (AUC: 0.849, P < 0.001), AFP-L3% (AUC: 0.663, P < 0.001), and the GALAD score (AUC: 0.882, P = 0.014). Comparable results were observed for early-stage NAFLD-HCC and for detecting HCC in NAFLD patients with or without cirrhosis.

Conclusion

The ASAP score, which excludes the AFP-L3% indicator, demonstrated superior performance in differentiating NAFLD-HCC compared to the GALAD score, suggesting its potential for early screening of HCC in NAFLD patients.

Keywords

Early diagnosisHepatocellular carcinomaNonalcoholic fatty liver diseaseAlpha-fetoproteinLens culinaris agglutinin-reactive alpha-fetoproteinProtein induced by vitamin K absence or antagonist-ⅡASAP scoreGALAD score

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iLIVER
Volume 3 Issue 2,
June 2024
Article number: 100098
DOI: 10.1016/j.iliver.2024.100098
Cite this article:
Ouyang W, Wang M-D, Guan M-C, et al. Diagnostic performance comparisons of two commonly used multi-biomarker-based scores for detection of hepatocellular carcinoma in non-alcoholic fatty liver disease. iLIVER, 2024, 3(2): 100098. https://doi.org/10.1016/j.iliver.2024.100098

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Received: 20 April 2024
Revised: 14 May 2024
Accepted: 14 May 2024
Published: 21 May 2024
© 2024 The Authors. Tsinghua University Press.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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