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Comparative performance of the GAAD and ASAP scores in predicting early-stage hepatocellular carcinoma
Chongkonrat Maneenil1, Pimsiri Sripongpun1, Naichaya Chamroonkul1
1Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Background:
The gender, age, alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (GAAD) score is a recent predictive tool for hepatocellular carcinoma (HCC) but lacks comparison with the AFP, Sex, Age, and Protein induced by vitamin K absence-II (ASAP) score, which uses similar parameters with different assays and formulas. Our study aimed to evaluate the performance differences between these two scores.
Methods:
Blood samples from 622 patients with chronic liver diseases at Songklanagarind Hospital between 20 April 2023 and 31 December 2023 were analyzed. The cutoffs for the ASAP and GAAD scores were established as 0.526 and 2.570, respectively, and HCC diagnoses followed the European Association for the Study of the Liver (EASL) or the American Association for the Study of Liver Diseases (AASLD) guidelines.
Results:
HCC diagnoses were observed in 28.6% of patients, with 48.3% diagnosed with early-stage diseases (Barcelona Clinic Liver Cancer stage 0 = 23, A = 63). Hepatitis B virus infection (40.4%) and metabolic dysfunction-associated steatotic liver disease (21.3%) were predominant causes. The area under the receiver operating characteristic curve (AUROCs) of the ASAP and GAAD scores for predicting all-stage HCC were comparable (0.933 vs 0.937, P = 0.578). For early-stage HCC, AUROCs were 0.880 (ASAP) and 0.891 (GAAD) (P = 0.353). Sensitivity and specificity for predicting all-stage HCC were 83.15% and 91.44% (ASAP), and 82.58% and 89.64% (GAAD), respectively; these values for early-stage HCC were 66.28% and 91.44% (ASAP) and 67.44% and 89.64% (GAAD). Subgroup analyses by cirrhosis and etiology showed no significant differences. New cutoff values of -0.083 (ASAP) and 1.725 (GAAD) were identified for at least 80% sensitivity and specificity for predicting early-stage HCC.
Conclusion:
Both the GAAD and ASAP scores demonstrated excellent and comparable abilities in HCC detection across all stages, unaffected by cirrhosis or etiological differences.
