Diagnostic and prognostic performances of GALAD score in staging and 1-year mortality of hepatocellular carcinoma: A prospective study

Table 2 Diagnostic performances of GALAD score and other biomarkers on Barcelona Clinic Liver Cancer staging, aggressive features, and prognostic performances for 1-year mortality of hepatocellular carcinoma

Scores	Barcelona Clinic Liver Cancer staging		Aggressive featuresa,2	1-year mortality3
	0 vs A2	0/A vs B/C/D2
GALAD
AUC (95%CI)	0.6097 (0.40–0.82)	0.8677 (0.80–0.93)	0.8385 (0.75–0.92)	0.7108 (0.60–0.82)
Cutoff values	≥ -1.95	≥ 2.65	≥ 7.22	≥ 6.83
Sensitivity/Specificity (%)	81.48/53.85	74.67/85.00	75.00/85.54	60.00/72.63
PPV/NPV (%)	78.57/58.33	90.32/64.15	66.67/89.87	31.58/89.61
Positive/Negative LR	1.77/0.34	4.98/0.30	5.19/0.29	2.19/0.55
Correctly classified (%)	72.50	78.26	82.61	70.43
PIVKA-II
AUC (95%CI)	0.7236 (0.54–0.91)	0.8970 (0.84–0.95)	0.7718 (0.68–0.86)	0.7395 (0.63–0.85)
Cutoff values	≥ 37	≥ 354	≥ 581	≥ 2959
Sensitivity/Specificity (%)	77.78/76.92	81.33/92.50	93.75/63.86	75.00/68.42
PPV/NPV (%)	87.50/62.50	95.31/72.55	50.00/96.36	33.33/92.86
Positive/Negative LR	3.37/0.29	10.84/0.20	2.59/0.10	2.38/0.37
Correctly classified (%)	77.50	85.22	72.17	69.57
AFP
AUC (95%CI)	0.5655 (0.36–0.77)	0.7525 (0.67–0.84)	0.7613 (0.65–0.87)	0.5405 (0.39–0.69)
Cutoff values	≥ 4.4	≥ 16	≥ 79	≥ 79
Sensitivity/Specificity (%)	74.07/53.85	74.67/60.00	75.00/71.08	50.00/60.00
PPV/NPV (%)	76.92/50.00	77.78/55.81	50.00/88.06	20.83/85.07
Positive/Negative LR	1.60/0.48	1.87/0.42	2.59/0.35	1.25/0.83
Correctly classified (%)	67.50	69.57	72.17	58.26
AFP-L3
AUC (95%CI)	0.5128 (0.32–0.70)	0.7058 (0.61–0.80)	0.6969 (0.58–0.82)	0.7361 (0.61–0.86)
Cutoff values	≥ 4.83	≥ 7.4	≥ 12.3	≥ 14.5
Sensitivity/Specificity (%)	51.85/53.85	64.00/77.50	65.63/71.08	65.00/72.63
PPV/NPV (%)	70.00/35.00	84.21/53.45	46.67/84.29	33.33/90.79
Positive/Negative LR	1.12/0.89	2.84/0.46	2.27/0.48	2.38/0.48
Correctly classified (%)	52.50	68.70	69.57	71.30
Comparison of AUC
GALAD and PIVKA-II	P = 0.1798	P = 0.2353	P = 0.0683	P = 0.5349
GALAD and AFP	P = 0.3721	P < 0.001a	P = 0.0136a	P < 0.001a
GALAD and AFP-L3	P = 0.2992	P < 0.001a	P = 0.0152a	P = 0.6656
PIVKA-II and AFP	P = 0.1100	P < 0.001a	P = 0.8476	P = 0.0086a
PIVKA-II and AFP-L3	P = 0.0409a	P < 0.001a	P = 0.2801	P = 0.9610

^aP value < 0.05 is statistically significant.

¹Macrovascular invasion or portal vein thrombosis or extrahepatic metastasis.

²Optimal cutoff points were determined to the point closest-to- (0,1) corner in the receiver operating characteristic plane (Euclidean distance).

³Cutoff values were adapted based on the Euclidean distance criteria to maximize specificity for predicting the 1-year mortality with acceptable sensitivity.

AFP: Alpha-fetoprotein; AFP-L3: Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein; AUC: Area under the curve; LR: The likelihood ratio; NPV: Negative predictive value; PIVKA-II: Protein induced by vitamin K absence- II; PPV: Positive predictive value; ROC: Receiver operating characteristic.