Comparison of diagnostic performance of GAAD, GALAD, and ASAP scores for detecting hepatocellular carcinoma in advanced liver fibrosis patients

Objectives: Alpha-fetoprotein L3 (AFP-L3 %) and protein induced by vitamin K absence-II (PIVKA-II) are used in diagnostic scores such as GAAD, GALAD, and ASAP for hepatocellular carcinoma (HCC) detection. Advanced liver fibrosis (ALF) is diagnosable by the liver fibrosis index and could be combined with these blood biomarkers for better HCC detection. Methods: This study developed an analytical framework to address the role of GAAD, GALAD, and ASAP in ALF patients as a risk score to predict HCC. By analyzing data from 21 HCC and 30 ALF patients, this analysis assessed the diagnostic accuracy of individual biomarkers, ASAP, GAAD, and GALAD. Results: GAAD slightly outperformed AFP (sensitivity: 76.2 %, specificity: 88.5 %). The combination of AFP and PIVKA-II also surpassed AFP alone. PIVKA-II and AFP-L3 showed the worst performance for identifying HCC. Conclusions: GAAD and ASAP showed comparable or slightly superior performance to AFP, suggesting potential for screening strategies that should be confirmed in larger studies.