GALAD 评分系统在肝细胞癌检测中的应用与肝脏超声比较及 GALADUS 评分的提出。
GALAD Score for Hepatocellular Carcinoma Detection in Comparison with Liver Ultrasound and Proposal of GALADUS Score.
机构信息
Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
Division of Biomedical Statistics and Informatics, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.
出版信息
Cancer Epidemiol Biomarkers Prev. 2019 Mar;28(3):531-538. doi: 10.1158/1055-9965.EPI-18-0281. Epub 2018 Nov 21.
BACKGROUND
The GALAD score is a serum biomarker-based model that predicts the probability of having hepatocellular carcinoma (HCC) in patients with chronic liver disease. We aimed to assess the performance of the GALAD score in comparison with liver ultrasound for detection of HCC.
METHODS
A single-center cohort of 111 HCC patients and 180 controls with cirrhosis or chronic hepatitis B and a multicenter cohort of 233 early HCC and 412 cirrhosis patients from the Early Detection Research Network (EDRN) phase II HCC Study were analyzed.
RESULTS
The area under the ROC curve (AUC) of the GALAD score for HCC detection was 0.95 [95% confidence interval (CI), 0.93-97], which was higher than the AUC of ultrasound (0.82, <0.01). At a cutoff of -0.76, the GALAD score had a sensitivity of 91% and a specificity of 85% for HCC detection. The AUC of the GALAD score for early-stage HCC detection remained high at 0.92 (95% CI, 0.88-0.96; cutoff -1.18, sensitivity 92%, specificity 79%). The AUC of the GALAD score for HCC detection was 0.88 (95% CI, 0.85-0.91) in the EDRN cohort. The combination of GALAD and ultrasound (GALADUS score) further improved the performance of the GALAD score in the single-center cohort, achieving an AUC of 0.98 (95% CI, 0.96-0.99; cutoff -0.18, sensitivity 95%, specificity 91%).
CONCLUSIONS
The performance of the GALAD score was superior to ultrasound for HCC detection. The GALADUS score further enhanced the performance of the GALAD score.
IMPACT
The GALAD score was validated in the United States.
背景
GALAD 评分是一种基于血清生物标志物的模型，可预测患有慢性肝病的患者发生肝细胞癌（HCC）的概率。我们旨在评估 GALAD 评分与肝脏超声在 HCC 检测中的表现。
方法
对来自早期检测研究网络（EDRN）二期 HCC 研究的 111 名 HCC 患者和 180 名肝硬化或慢性乙型肝炎对照患者的单中心队列，以及来自 EDRN 的 233 名早期 HCC 和 412 名肝硬化患者的多中心队列进行了分析。
结果
GALAD 评分用于 HCC 检测的 ROC 曲线下面积（AUC）为 0.95 [95%置信区间（CI），0.93-97]，高于超声（0.82，<0.01）。当截断值为-0.76 时，GALAD 评分对 HCC 检测的灵敏度为 91%，特异性为 85%。GALAD 评分对早期 HCC 检测的 AUC 仍然很高，为 0.92（95%CI，0.88-0.96；截断值-1.18，灵敏度 92%，特异性 79%）。GALAD 评分在 EDRN 队列中用于 HCC 检测的 AUC 为 0.88（95%CI，0.85-0.91）。GALAD 和超声的联合（GALADUS 评分）进一步提高了单中心队列中 GALAD 评分的性能，AUC 达到 0.98（95%CI，0.96-0.99；截断值-0.18，灵敏度 95%，特异性 91%）。
结论
GALAD 评分在 HCC 检测中的表现优于超声。GALADUS 评分进一步提高了 GALAD 评分的性能。
影响
GALAD 评分在美国得到验证。
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