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From the Journals

GALAD Score Enhances HCC Surveillance Accuracy

GALAD score improves hepatocellular carcinoma detection within 12 months of diagnosis, outperforming AFP in sensitivity and specificity, study shows.

Conexiant

A phase III biomarker validation study has found that the GALAD score could outperform alpha-fetoprotein in detecting hepatocellular carcinoma in patients with cirrhosis.

In a prospective, multicenter study, published in Gastroenterology, researchers followed 1,558 patients with cirrhosis across seven U.S. medical centers for a median of 2.2 years. Surveillance was conducted every 6 months per American Association for the Study of Liver Diseases guidelines. Blood samples were analyzed for AFP, AFP-L3, and des-gamma carboxyprothrombin (DCP) to calculate the GALAD score, which was then compared with AFP for prediagnosis detection.

Among the participants, 109 patients developed hepatocellular carcinoma (HCC), with 76 cases classified as very early or early-stage. The researchers demonstrated that GALAD offered superior sensitivity and specificity for HCC detection within 12 months of clinical diagnosis. GALAD demonstrated a significantly higher area under the curve (AUC) than AFP (0.78 vs 0.66, P < .001). At an 82% specificity cutoff (GALAD ≥ –1.36), GALAD’s sensitivity reached 62%, compared with AFP’s 41% sensitivity (P = .001).

"GALAD score, compared to AFP, improves the detection of HCC within 12 months before the actual diagnosis," said lead study author Tracey L. Marsh, of the Biostatistics Program in the Division of Public Health Sciences at Fred Hutch Cancer Center, and colleagues.

Further analysis showed that GALAD maintained consistent performance across viral and nonviral liver disease etiologies. The study also highlighted that each additional component of GALAD—AFP, AFP-L3, and DCP—contributed to improved diagnostic accuracy.

Given the limitations of current surveillance methods, incorporating GALAD could improve early detection in patients with cirrhosis. However, the study did not compare GALAD to ultrasound plus AFP for HCC detection, and further research is needed to optimize its cutoff values for different patient populations. The findings set the stage for a phase IV clinical utility study evaluating GALAD’s role in routine HCC surveillance.

No conflicts of interest were reported in the study.