Ouyang Wei, Wang Ming-Da, Guan Ming-Cheng, Diao Yong-Kang, Sun Li-Yang, Wang Nan-Ya, Shen Feng, Zhu Hong, Yang Tian
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.
ILIVER. 2024 May 21;3(2):100098. doi: 10.1016/j.iliver.2024.100098. eCollection 2024 Jun.
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).
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.
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, < 0.001), PIVKA-II (AUC: 0.849, < 0.001), AFP-L3% (AUC: 0.663, < 0.001), and the GALAD score (AUC: 0.882, = 0.014). Comparable results were observed for early-stage NAFLD-HCC and for detecting HCC in NAFLD patients with or without cirrhosis.
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.
ASAP和GALAD评分是广泛用于检测肝细胞癌（HCC）的诊断模型，纳入了性别、年龄、甲胎蛋白（AFP）、维生素K缺乏或拮抗剂-II诱导蛋白（PIVKA-II）以及AFP的刀豆球蛋白A反应分数（AFP-L3%）等因素。本研究比较了ASAP和GALAD评分在非酒精性脂肪性肝病（NAFLD）患者早期检测HCC中的诊断效能。
从12家中国三级医院招募了患有和未患有HCC的NAFLD患者。检测血清AFP、PIVKA-II和AFP-L3%水平。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）值评估个体生物标志物、ASAP评分和GALAD评分在检测不同阶段NAFLD-HCC中的诊断准确性。
在147例NAFLD-HCC病例和460例NAFLD对照的队列中，ASAP和GALAD评分在检测NAFLD-HCC方面均优于个体生物标志物。ASAP评分在识别所有阶段的NAFLD-HCC时显示出较高的AUC，为0.910（敏感性：80.3%，特异性：92.8%），超过了AFP（AUC：0.716，<0.001）、PIVKA-II（AUC：0.849，<0.001）、AFP-L3%（AUC：0.663，<0.001）以及GALAD评分（AUC：0.882，=0.014）。在早期NAFLD-HCC以及检测有或无肝硬化的NAFLD患者中的HCC时观察到了类似的结果。
排除AFP-L3%指标的ASAP评分在区分NAFLD-HCC方面表现优于GALAD评分，表明其在NAFLD患者HCC早期筛查中的潜力。
