ASAP Score versus GALAD Score for detection of hepatitis C-related hepatocellular carcinoma: A multicenter case-control analysis

Si-Yu Liu; Chao Li; Li-Yang Sun; Ming-Cheng Guan; Li-Hui Gu; Dong-Xu Yin; Lan-Qing Yao; Lei Liang; Ming-Da Wang; Hao Xing; Hong Zhu; Timothy M Pawlik; Wan Yee Lau; Feng Shen; Xiang-Min Tong; Tian Yang

doi:10.3389/fonc.2022.1018396

ASAP Score versus GALAD Score for detection of hepatitis C-related hepatocellular carcinoma: A multicenter case-control analysis

Front Oncol. 2022 Sep 30:12:1018396. doi: 10.3389/fonc.2022.1018396. eCollection 2022.

Authors

Si-Yu Liu^{1

2}, Chao Li³, Li-Yang Sun⁴, Ming-Cheng Guan⁵, Li-Hui Gu³, Dong-Xu Yin⁶, Lan-Qing Yao³, Lei Liang⁴, Ming-Da Wang^{3

7}, Hao Xing³, Hong Zhu⁵, Timothy M Pawlik⁸, Wan Yee Lau^{3

9}, Feng Shen^{3

7}, Xiang-Min Tong^{1

2}, Tian Yang^{2

4

6

7}

Affiliations

¹ Department of Laboratory Medicine, Lishui Municipal Central Hospital, the Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, China.
² The Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China.
³ Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University (Navy Medical University), Shanghai, China.
⁴ Department of Hepatobiliary, Pancreatic and Minimal Invasive Surgery, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China.
⁵ Department of Medical Oncology, the First Affiliated Hospital of Soochow University, Suzhou, China.
⁶ School of Clinical Medicine, Hangzhou Medical College, Hangzhou, China.
⁷ Eastern Hepatobiliary Clinical Research Institute (EHCRI), Third Affiliated Hospital of Navy Medical University, Shanghai, China.
⁸ Department of Surgery, Ohio State University, Wexner Medical Center, Columbus, OH, United States.
⁹ Faculty of Medicine, the Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.

Abstract

Background: The GALAD and ASAP scores are two well-recognized algorithms to estimate the risk of hepatocellular carcinoma (HCC) based on gender, age, alpha-fetoprotein (AFP), protein induced by vitamin K absence or Antagonist-II (PIVKA-II) and AFP-L3 (included in the GALAD score but not in the ASAP score). The current study sought to compare the diagnostic performance of each score to detect HCC among patients infected with hepatitis C virus (HCV).

Methods: A multicenter case-control study was undertaken in which blood samples were collected from HCVinfected patients with and without HCC. Using the area under the receiver operating characteristic curve (AUROC), ASAP and GALAD scores were compared relative to diagnostic performance to detect any stage HCV-HCC and early-stage HCV-HCC.

Results: The analytic cohort included 168 HCV-HCC patients and a control group of 193 HCV-infected patients. The ASAP score had a higher AUROC to detect any stage HCV-HCC versus the GALAD score, both in the overall group (0.917 vs. 0.894, P=0.057) and in the cirrhosis subgroup (0.909 vs. 0.889, P=0.132). Similar results were noted relative to the detection of early-stage HCV-HCC, whether defined by BCLC staging (stage 0-A: 0.898 vs. 0.860, P=0.026) or 8^th TNM staging (stage I: 0.899 vs. 0.870, P=0.070). In subgroup analysis to detect AFP-negative HCV-HCC, the ASAP score also demonstrated a higher AUROC than the GALAD score to detect any stage HCV-HCC in the AFP-negative subgroup (0.815 vs. 0.764, P=0.063).

Conclusions: The ASAP score had better diagnostic performance for early detection of HCV-HCC compared with the GALAD score. The ASAP score may be preferrable to the GALAD score for HCC screening and surveillance among HCV-infected patients.

Keywords: alpha-fetoprotein; biomarker; diagnosis; hepatitis C virus; hepatocellular carcinoma; lens culinaris agglutinin-reactive fraction of alpha-fetoprotein; protein induced by vitamin K absence or antagonist-II.