Gastroenterology Unit, CHIMOMO Department, University of Modena & Reggio Emilia, Italy.
National Institute of Gastroenterology, IRCCS "Saverio de Bellis", Castellana Grotte, Italy.
Hepatol Commun. 2023 Sep 15;7(10). doi: 10.1097/HC9.0000000000000262. eCollection 2023 Oct 1.
Surveillance programs are strongly recommended in patients with liver cirrhosis for early detection of HCC development. Six-monthly ultrasound sonography is the most reliable and commonly used technique, especially when associated with serum determination of α-fetoprotein, but different score systems have been proposed to overcome the unsatisfactory diagnostic accuracy of α-fetoprotein. The aim of this 12-year prospective study is to compare the gender, age, AFP-L3, AFP, des-gamma-carboxy prothrombin (GALAD) versus age, gender, bilirubin, albumin, and platelets and albumin-bilirubin scores in predicting HCC onset.
A cohort of 545 consecutive patients with compensated advanced chronic liver disease without suspected focal lesions was followed up every 6 months by liver imaging and α-fetoprotein to detect HCC occurrence. Harrell's C-index for censored data was employed to evaluate the performance of any parameters or scores helping to predict HCC development. ROC curve analysis showed that the GALAD score was more accurate in evaluating HCC development than albumin-bilirubin and age, gender, bilirubin, albumin, and platelets. The AUC ranged from 0.7268 to 0.6851 at 5 and 10 years, both in the total cohort and in the sub-cohorts (viral hepatitis, NASH, and alcohol). The HCC Risk model was constructed using univariate and multivariate Cox proportional hazard regression analysis, showing a strong association of GALAD with HR > 1, p < 0.05, in the total and sub-cohorts, and a better risk prediction in the alcohol cohort, both alone and standardized with other blood parameters.
GALAD is the most reliable and accurate score system to detect HCC risk of development in patients with compensated advanced chronic liver disease.
强烈建议对肝硬化患者进行监测计划，以早期发现 HCC 的发生。每 6 个月进行一次超声检查是最可靠和常用的技术，尤其是当与血清甲胎蛋白（α-fetoprotein，AFP）测定结合使用时，但不同的评分系统已被提出以克服 AFP 诊断准确性不理想的问题。本 12 年前瞻性研究的目的是比较性别、年龄、AFP-L3、AFP、脱γ-羧基凝血酶原（des-gamma-carboxy prothrombin，GALAD）与年龄、性别、胆红素、白蛋白和血小板以及白蛋白-胆红素评分在预测 HCC 发病中的作用。
本研究纳入了一组 545 例代偿性晚期慢性肝病且无可疑局灶性病变的连续患者，每 6 个月通过肝脏影像学和 AFP 随访以检测 HCC 的发生。采用删失数据的 Harrell's C 指数评估有助于预测 HCC 发生的任何参数或评分的性能。ROC 曲线分析显示，与白蛋白-胆红素和年龄、性别、胆红素、白蛋白和血小板相比，GALAD 评分在评估 HCC 发生方面更为准确。AUC 范围在 5 年和 10 年时分别为 0.7268 至 0.6851，在总队列和亚队列（病毒性肝炎、非酒精性脂肪性肝炎和酒精性肝病）中均如此。使用单因素和多因素 Cox 比例风险回归分析构建 HCC 风险模型，显示 GALAD 与 HR > 1 具有强烈相关性（p < 0.05），在总队列和亚队列中均如此，并且在酒精性肝病亚队列中，无论是单独使用还是与其他血液参数标准化使用，GALAD 都具有更好的风险预测能力。
GALAD 是检测代偿性晚期慢性肝病患者 HCC 发生风险最可靠和准确的评分系统。
