Diagnostic performance comparisons of two commonly used multi-biomarker-based scores for detection of hepatocellular carcinoma in non-alcoholic fatty liver disease

Background and aims:The ASAP and GALAD scores are widely used diagnostic models for detecting hepatocellular carcinoma(HCC),incorporating factors such as sex,age,alpha-fetoprotein(AFP),protein induced by vitamin K absence or antagonist-Ⅱ(PIVKA-Ⅱ),and lens culinaris agglutinin-reactive fraction of AFP(AFP-L3%).This study compares the diagnostic efficacy of the ASAP and GALAD scores in the early detection of HCC in patients with non-alcoholic fatty liver disease(NAFLD).Methods:NAFLD patients with and without HCC were recruited from 12 Chinese tertiary hospitals.Serum levels of AFP,PIVKA-II,and AFP-L3%were measured.The diagnostic accuracy of individual biomarkers,the ASAP score,and the GALAD score in detecting NAFLD-HCC at various stages was evaluated using receiver operating characteristic(ROC)curves and area under the curve(AUC)values.Results:In a cohort of 147 NAFLD-HCC cases and 460 NAFLD controls,both the ASAP and GALAD scores outperformed individual biomarkers in detecting NAFLD-HCC.The ASAP score demonstrated a high AUC of 0.910(sensitivity:80.3%,specificity:92.8%)for identifying NAFLD-HCC at all stages,surpassing AFP(AUC:0.716,P<0.001),PIVKA-II(AUC:0.849,P<0.001),AFP-L3%(AUC:0.663,P<0.001),and the GALAD score(AUC:0.882,P?0.014).Comparable results were observed for early-stage NAFLD-HCC and for detecting HCC in NAFLD patients with or without cirrhosis.Conclusion:The ASAP score,which excludes the AFP-L3%indicator,demonstrated superior performance in differentiating NAFLD-HCC compared to the GALAD score,suggesting its potential for early screening of HCC in NAFLD patients.