Prospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 7, 2024; 30(17): 2343-2353
Published online May 7, 2024. doi: 10.3748/wjg.v30.i17.2343
Diagnostic and prognostic performances of GALAD score in staging and 1-year mortality of hepatocellular carcinoma: A prospective study
Oraphan Jitpraphawan, Witchakorn Ruamtawee, Mala Treewatchareekorn, Supatsri Sethasine
Oraphan Jitpraphawan, Supatsri Sethasine, Division of Gastroenterology and Hepatology, Department of Medicine, Navamindradhiraj University, Dusit 10300, Bangkok, Thailand
Witchakorn Ruamtawee, Clinical Research Center, Research Facilitation Division, Navamindradhiraj University, Dusit 10300, Bangkok, Thailand
Mala Treewatchareekorn, Division of Clinical Chemistry and Immunology, Navamindradhiraj University, Dusit 10300, Bangkok, Thailand
Author contributions: Jitpraphawan O, Sethasine S, and Ruamtawee W contributed to the conception and design of the study, data collection, statistical analysis and data interpretation; Treewatchareekorn M conducted the sample analysis; Sethasine S and Ruamtawee W contributed to the drafting of the article and critical revision of the manuscript.
Supported by The Navamindradhiraj University Research Fund and the Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, No. 005/2565.
Institutional review board statement: The study was approved by the Institutional Review Board of the Faculty of Medicine Vajira Hospital (No. COA 165/2564).
Clinical trial registration statement: This study is registered at https://www.thaiclinicaltrials.org. The registration identification number is TCTR20230312003.
Informed consent statement: All participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data used in the current study are available from the corresponding author upon reasonable request at supatsri@nmu.ac.th.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: Https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Supatsri Sethasine, MD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Medicine, Navamindradhiraj University, Samsen Road, Dusit 10300, Bangkok, Thailand. supatsri@nmu.ac.th
Received: February 9, 2024
Revised: March 9, 2024
Accepted: April 11, 2024
Published online: May 7, 2024
Processing time: 86 Days and 4.5 Hours
Abstract
BACKGROUND

The GALAD score has improved early hepatocellular carcinoma (HCC) detection rate. The role of the GALAD score in staging and predicting tumor characteristics or clinical outcome of HCC remains of particular interest.

AIM

To determine the diagnostic/prognostic performances of the GALAD score at various phases of initial diagnosis, tumor features, and 1-year mortality of HCC and compare the performance of the GALAD score with those of other serum biomarkers.

METHODS

This prospective, diagnostic/prognostic study was conducted among patients with newly diagnosed HCC at the liver center of Vajira Hospital. Eligible patients had HCC staging allocation using the Barcelona Clinic Liver Cancer (BCLC) categorization. Demographics, HCC etiology, and HCC features were recorded. Biomarkers and the GALAD score were obtained at baseline. The performance of the GALAD score and biomarkers were prospectively assessed.

RESULTS

Exactly 115 individuals were diagnosed with HCC. The GALAD score increased with disease severity. Between BCLC-0/A and BCLC-B/C/D, the GALAD score predicted HCC staging with an area under the curve (AUC) of 0.868 (95%CI: 0.80–0.93). For identifying the curative HCC, the AUC of GALAD score was significantly higher than that of Alpha-fetoprotein (AFP) (0.753) and Lens culinaris agglutinin-reactive fraction of AFP-L3 (0.706), and as good as that of Protein induced by vitamin K absence-II (PIVKA-II) (0.897). For detecting aggressive features, the GALAD score gave an AUC of 0.839 (95%CI: 0.75–0.92) and significantly outperformed compared to that of AFP (0.761) and AFP-L3 (0.697), with a trend of superiority to that of PIVKA-II (0.772). The performance to predict 1-year mortality of GALAD score (AUC: 0.711, 95%CI: 0.60–0.82) was better than that of AFP (0.541) and as good as that of PIVKA-II (0.736). The optimal cutoff value of GALAD score was ≥ 6.83, with a specificity of 72.63% for exhibiting substantial reduction in the 1-year mortality.

CONCLUSION

The GALAD model can diagnose HCC at the curative stage, including the characteristic of advanced disease, more than that by AFP and AFP-L3, but not PIVKA-II. The GALAD score can be used to predict the 1-year mortality of HCC.

Keywords: Alpha-fetoprotein; Barcelona clinic liver cancer; GALAD score; Hepatocellular carcinoma; Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein; Protein induced by vitamin K absence-II

Core Tip: The GALAD score performance showed a benefit not only in the accuracy of curative hepatocellular carcinoma (HCC) staging but also in the characteristic of advanced disease. Incorporating the GALAD model may increase the opportunity for prognosis prioritization for patients with HCC to predict the 1-year mortality.