Comparison between models for detecting hepatocellular carcinoma in patients with chronic liver diseases of various etiologies: ASAP score versus GALAD score

Li-Yang Sun; Nan-Ya Wang; Yong-Kang Diao; Cun-Lin Yan; Zhu-Ping Fan; Lian-Hua Wei; Hui-Jun Li; Ming-Cheng Guan; Ming-Da Wang; Timothy M Pawlik; Wan Yee Lau; Feng Shen; Guo-Yue Lv; Tian Yang

doi:10.1016/j.hbpd.2023.12.004

Comparison between models for detecting hepatocellular carcinoma in patients with chronic liver diseases of various etiologies: ASAP score versus GALAD score

Hepatobiliary Pancreat Dis Int. 2023 Dec 30:S1499-3872(23)00242-4. doi: 10.1016/j.hbpd.2023.12.004. Online ahead of print.

Authors

Li-Yang Sun¹, Nan-Ya Wang², Yong-Kang Diao³, Cun-Lin Yan⁴, Zhu-Ping Fan⁵, Lian-Hua Wei⁶, Hui-Jun Li⁷, Ming-Cheng Guan⁸, Ming-Da Wang⁹, Timothy M Pawlik¹⁰, Wan Yee Lau¹¹, Feng Shen¹², Guo-Yue Lv¹³, Tian Yang¹⁴

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China; Department of Graduate, Bengbu Medical University, Bengbu 233000, China.
² Cancer Center, First Hospital of Jilin University, Changchun 130021, China.
³ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai 200438, China.
⁴ Department of Clinical Laboratory, Peking University First Hospital, Beijing 100034, China.
⁵ Department of Gastroenterology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China.
⁶ Department of Clinical Laboratory, Gansu Provincial Hospital, Lanzhou 730000, China.
⁷ Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
⁸ Department of Medical Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China.
⁹ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai 200438, China.
¹⁰ Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH 43215, USA.
¹¹ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai 200438, China; Faculty of Medicine, the Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China.
¹² Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai 200438, China; Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Navy Medical University, Shanghai 200438, China. Electronic address: fengshensmmu@gmail.com.
¹³ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China. Electronic address: lvgy@jlu.edu.cn.
¹⁴ Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun 130021, China; Department of Graduate, Bengbu Medical University, Bengbu 233000, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai 200438, China; Eastern Hepatobiliary Clinical Research Institute, Third Affiliated Hospital of Navy Medical University, Shanghai 200438, China. Electronic address: yangtiandfgd@hotmail.com.

PMID: 38199909
DOI: 10.1016/j.hbpd.2023.12.004

Abstract

Background: Diagnostic panels based on multiple biomarkers and clinical characteristics are considered more favorable than individual biomarker to diagnose hepatocellular carcinoma (HCC). Based on age, sex, alpha-fetoprotein (AFP), and protein induced by vitamin K absence II (PIVKA-II) with/without AFP-L3, ASAP and GALAD models are potential diagnostic panels. The diagnostic performances of these two panels were compared relative to HCC detection among patients with various etiologies of chronic liver diseases (CLDs).

Methods: A multicenter case-control study recruited CLDs patients with and without HCC from 14 Chinese hospitals. The etiologies of CLDs included hepatitis B virus (HBV), hepatitis C virus (HCV), alcoholic liver disease (ALD), and nonalcoholic fatty liver disease (NAFLD). Using area under the receiver operating characteristic curve (AUC) values, the diagnostic performances of ASAP and GALAD models were compared to detect HCC among patients with various etiologies of CLDs.

Results: Among 248 HCC patients and 722 CLD controls, the ASAP model demonstrated the highest AUC (0.886) to detect HCC at any stage, outperforming the GALAD model (0.853, P = 0.001), as well as any individual biomarker (0.687-0.799, all P < 0.001). In the subgroup analysis of various CLDs etiologies, the ASAP model outperformed the GALAD model to HCC independent of CLDs etiology. In addition, the ASAP model performed better in detecting early-stage (BCLC stage 0/A) HCC versus the GALAD model.

Conclusions: Despite using one less laboratory variable (AFP-L3), the ASAP model demonstrated better diagnostic performance than the GALAD model to detect all-stage HCC among patients with various etiologies of CLDs-related HCC.

Keywords: ASAP; Biomarker panel; Diagnosis; GALAD; Hepatocellular carcinoma.