Performance of GALAD, GAAD, and ASAP for Early HCC Detection in Chronic Liver Disease: A Systematic Review and Meta-Analysis.
Abstract
Multi-biomarker panels have shown promise to improve hepatocellular carcinoma (HCC) surveillance in patients with chronic liver disease; however, we lack comparative data on their relative performance for early-stage HCC detection.
We conducted a systematic review of PubMed, Ovid MEDLINE, and Embase databases from January 2010 to November 2024 to identify studies evaluating the performance of three commercially available blood-based biomarker panels (GALAD, GAAD, and ASAP) for HCC surveillance. Pooled estimates were calculated using the DerSimonian and Laird method for a random-effects model.
Of 44 eligible studies (<i>n</i> = 33,100 patients) examining HCC surveillance, 37 studies evaluated GALAD, 12 GAAD, and 11 ASAP. Pooled sensitivities of the biomarker panels for early-stage HCC ranged from 70.1% to 74.1%, with pooled specificities ranging from 83.3% to 87.2%. Among studies directly comparing biomarker panels, sensitivity for early-stage HCC did not significantly differ for GALAD versus GAAD (RR 0.96, 95% CI: 0.80-1.15) or GALAD versus ASAP (RR 1.12, 95% CI: 0.79-1.60). The pooled sensitivity of GALAD for early-stage HCC was higher than that of ultrasound among studies directly comparing the two (79.0% [95% CI: 62.2-89.6] versus 73.3% [95% CI: 45.4-90.1], respectively); however, this difference was not statistically significant (RR 1.09, 95% CI: 0.78-1.51). Studies were limited by inclusion of patients with non-cirrhotic liver disease, varying biomarker cutoffs across studies, and high statistical heterogeneity (<i>I</i> <sup>2</sup> >50%) for pooled estimates.
Multi-biomarker panels including GALAD, GAAD, and ASAP demonstrate promising performance for early-stage HCC detection, supporting their prospective validation for HCC surveillance.
EDRN PI Authors
- (None specified)
Medline Author List
- Arvind A
- Deodhar S
- Gopal P
- Jarrah M
- Parikh ND
- Singal AG
- Yang JD