GALAD score accuracy in detection of hepatocellular carcinoma in cirrhotic patients: a single-center study

Abstracts Background and aim As a major complication of cirrhosis, hepatocellular carcinoma necessitates early diagnosis for better clinical outcomes. The GALAD score, which integrates serum biomarkers such as alpha-fetoprotein, AFP-L3, and des-gamma carboxy prothrombin, has shown promising results for hepatocellular carcinoma detection. This study aims to evaluate the diagnostic performance of the GALAD score in cirrhotic patients for the detection of hepatocellular carcinoma. Methods A cross-sectional study was conducted on two hundred cirrhotic patients, who were divided into two groups: HCC group consisting of 100 cirrhotic patients with hepatocellular carcinoma and non-HCC group consisting of 100 cirrhotic patients without hepatocellular carcinoma (as evident by contrast-enhanced imaging). They were admitted to the Tropical Medicine and Gastroenterology Department at Aswan University Hospital during the period from February 2023 to February 2024. All participants underwent clinical evaluation, laboratory tests, abdominal ultrasonography, and contrast-enhanced triphasic multi-slice CT scans of the abdomen and pelvis. The diagnostic accuracy of the GALAD score was compared with other clinical, radiological, and serological markers. Results HCC Group exhibited higher median GALAD scores compared to the non-HCC group (− 3.16 vs. 2.72, respectively) ( p value < 0.001). The GALAD score demonstrated high diagnostic accuracy at a cutoff value of − 0.47. The GALAD score achieved a sensitivity of 91% and a specificity of 85%, with a positive predictive value (PPV) of 86.0% and a negative predictive value (NPV) of 90.4%, resulting in an overall accuracy of 88.0%, with an area under the curve (AUC) of 0.95 (95% CI: 0.92–0.98) ( p < 0.001). Individual biomarkers such as AFP, AFP-L3, and DCP also showed significant differences between the two groups, but the GALAD score outperformed them in terms of sensitivity and specificity. Conclusion The GALAD score is a highly accurate diagnostic tool for distinguishing HCC from non-HCC cirrhotic patients, with superior performance compared to individual biomarkers. It provides a reliable non-invasive method for early detection of HCC, with strong potential for clinical application in cirrhotic populations.