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Performance of GALAD, GAAD, and ASAP for Early HCC Detection in Chronic Liver Disease: A Systematic Review and
Mohammad Jarrah1, Ashwini Arvind1, Purva Gopal2
1Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Insights
Multi-biomarker panels like GALAD, GAAD, and ASAP show promise for early hepatocellular carcinoma (HCC) detection. These blood tests offer comparable sensitivity and specificity for surveillance in patients with chronic liver disease.
Area of Science:
- Hepatology
- Oncology
- Biomarker Discovery
Background:
- Hepatocellular carcinoma (HCC) surveillance in chronic liver disease patients can be improved with multi-biomarker panels.
- Comparative data on the performance of commercially available panels for early-stage HCC detection is limited.
Purpose of the Study:
- To systematically review and compare the performance of three blood-based biomarker panels (GALAD, GAAD, ASAP) for early-stage HCC detection.
- To evaluate the pooled sensitivity and specificity of these panels in HCC surveillance.
Main Methods:
- Systematic review of PubMed, Ovid MEDLINE, and Embase databases (Jan 2010 - Nov 2024).
- Inclusion of 44 studies (33,100 patients) evaluating GALAD, GAAD, and ASAP panels.
- Calculation of pooled estimates using a random-effects model (DerSimonian and Laird method).
Main Results:
- Pooled sensitivities for early-stage HCC ranged from 70.1% to 74.1%; specificities ranged from 83.3% to 87.2%.
- No significant difference in sensitivity was found between GALAD vs. GAAD or GALAD vs. ASAP.
- GALAD showed numerically higher sensitivity than ultrasound for early HCC, but the difference was not statistically significant.
Conclusions:
- Multi-biomarker panels (GALAD, GAAD, ASAP) demonstrate promising performance for early-stage HCC detection.
- These findings support the prospective validation of these panels for HCC surveillance in at-risk populations.
Background:
Multi-biomarker panels have shown promise to improve hepatocellular carcinoma (HCC) surveillance in patients with chronic liver disease; however, we lack comparative data on their relative performance for early-stage HCC detection.
Methods:
We conducted a systematic review of PubMed, Ovid MEDLINE, and Embase databases from January 2010 to November 2024 to identify studies evaluating the performance of three commercially available blood-based biomarker panels (GALAD, GAAD, and ASAP) for HCC surveillance. Pooled estimates were calculated using the DerSimonian and Laird method for a random-effects model.
Results:
Of 44 eligible studies (n = 33,100 patients) examining HCC surveillance, 37 studies evaluated GALAD, 12 GAAD, and 11 ASAP. Pooled sensitivities of the biomarker panels for early-stage HCC ranged from 70.1% to 74.1%, with pooled specificities ranging from 83.3% to 87.2%. Among studies directly comparing biomarker panels, sensitivity for early-stage HCC did not significantly differ for GALAD versus GAAD (RR 0.96, 95% CI: 0.80-1.15) or GALAD versus ASAP (RR 1.12, 95% CI: 0.79-1.60). The pooled sensitivity of GALAD for early-stage HCC was higher than that of ultrasound among studies directly comparing the two (79.0% [95% CI: 62.2-89.6] versus 73.3% [95% CI: 45.4-90.1], respectively); however, this difference was not statistically significant (RR 1.09, 95% CI: 0.78-1.51). Studies were limited by inclusion of patients with non-cirrhotic liver disease, varying biomarker cutoffs across studies, and high statistical heterogeneity (I 2 >50%) for pooled estimates.
Conclusion:
Multi-biomarker panels including GALAD, GAAD, and ASAP demonstrate promising performance for early-stage HCC detection, supporting their prospective validation for HCC surveillance.
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