The GALAD score was superior to individual serum markers in detecting hepatocellular carcinoma in patients with nonalcoholic steatohepatitis, according to a case-control study published in Clinical Gastroenterology and Hepatology.
“Surveillance of NASH patients for HCC is inadequate in particular as hepatocarcinogenesis may occur even in the absence of cirrhosis,” Jan Best, researcher at University Hospital Magdeburg, department of gastroenterology, hepatology and infectious disease in Magdeburg, Germany, and colleagues wrote. “In our international multicenter study, the GALAD score was successfully tested for detection of early and non-cirrhotic HCC to address current limitations in early HCC detection in NASH.”
The study comprised 357 patients with nonalcoholic steatohepatitis, 126 of whom also had HCC. Investigators compared the performance of serum levels of alpha-fetoprotein, AFP isoform L3 and des-gamma-carboxy prothrombin with the GALAD score to detect HCC in patients with NASH. They used receiver operating characteristic curves and corresponding area under the curves for the comparisons.
The GALAD score detected patients with any stage of HCC with an AUC of 0.96 vs. 0.88 for AFP (P = .0021), 0.86 for AFP-L3 (P < .0001) and 0.87 for DCP (P > .5). These data suggest GALAD can detect HCC independent of cirrhosis or stage of HCC.
Further, the overall diagnostic performance of GALAD was higher (P < .0005) than each biomarker and the GALAD score had a sensitivity of 84.8% and a specificity of 95.2%.
Best and colleagues also analyzed data from a Japanese prospective cohort study in which 392 patients with nonalcoholic fatty liver disease were under surveillance for HCC for a median of 167 months. Twenty-eight of these patients developed HCC after a median 10.3 years. The researchers observed the GALAD score was higher in patients developing HCC during surveillance, with a significant increase of the GALAD score a few months prior to HCC diagnosis.
“These findings suggest that GALAD should be investigated as a potential tool for screening of NASH individuals to detect HCC at a resectable stage,” the researchers wrote. – by Erin T. Welsh
Disclosure: Best reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.