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.