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GALAD outperforms aMAP and ALBI for predicting HCC in patients with compensated advanced chronic liver disease: A
Erica Villa1, Rossella Donghia2, Valentina Baldaccini1
1Gastroenterology Unit, CHIMOMO Department, University of Modena & Reggio Emilia, Italy.
Insights
The GALAD score accurately predicts hepatocellular carcinoma (HCC) risk in liver cirrhosis patients. This study found GALAD superior to other scoring systems for early HCC detection, improving surveillance strategies.
Area of Science:
- Hepatology
- Oncology
- Biomarker Discovery
Background:
- Surveillance for hepatocellular carcinoma (HCC) is crucial in liver cirrhosis patients.
- Current methods like ultrasound and alpha-fetoprotein (AFP) have limitations in diagnostic accuracy.
- Novel scoring systems are needed to improve early HCC detection.
Purpose of the Study:
- To compare the predictive performance of the GALAD score against other established scoring systems for HCC onset.
- To evaluate the GALAD score's accuracy in a 12-year prospective study of patients with advanced chronic liver disease.
- To assess the utility of GALAD in diverse patient sub-cohorts, including viral hepatitis, NASH, and alcohol-related liver disease.
Main Methods:
- A prospective study followed 545 patients with compensated advanced chronic liver disease for 12 years, monitoring for HCC occurrence via regular imaging and AFP levels.
- Statistical analysis employed Harrell's C-index for censored data and Receiver Operating Characteristic (ROC) curve analysis to compare predictive performances.
- A HCC Risk model was developed using univariate and multivariate Cox proportional hazard regression.
Main Results:
- The GALAD score demonstrated superior accuracy in predicting HCC development compared to the albumin-bilirubin (ALBI) score and the age, gender, bilirubin, albumin, and platelets (APBG) score.
- Area Under the Curve (AUC) values for GALAD ranged from 0.7268 to 0.6851 at 5 and 10 years across the total cohort and sub-cohorts.
- GALAD showed a strong association with HCC risk (Hazard Ratio > 1, p < 0.05) and offered better risk prediction, particularly in the alcohol cohort.
Conclusions:
- The GALAD score is the most reliable and accurate system for detecting HCC risk in patients with compensated advanced chronic liver disease.
- This finding supports the integration of the GALAD score into routine surveillance protocols for liver cirrhosis.
- Enhanced HCC risk prediction can lead to more timely interventions and improved patient outcomes.
Background And Aims:
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.
Approach And Results:
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.
Conclusions:
GALAD is the most reliable and accurate score system to detect HCC risk of development in patients with compensated advanced chronic liver disease.
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