Digestive Diseases

April 01, 2025

The global burden of hepatocellular carcinoma (HCC) is growing, especially in Africa where patients often present with this disease at a young age and when the cancer has already progressed to an advanced stage. HCC is the second most common cancer in African men and the sixth most common cancer in African women.

In sub-Saharan African countries, where imaging and therapeutic resources are limited, the median survival for people diagnosed with HCC is 2.5 months. Studies to identify and validate predictive models for early detection are therefore necessary to inform policy and practice in Africa and globally.

A multianalyte model known as the GALAD score was developed to estimate the likelihood of HCC and improve early detection rates. This algorithm incorporates gender, age and the levels of three serological biomarkers for HCC: Lens culinaris agglutinin-reactive fraction of alpha fetoprotein (AFP-L3%), total AFP and des-gamma-carboxy-prothrombin (DCP).

Although the GALAD score has high accuracy in diagnosing HCC in Asia, Europe and North America, this model has not been validated in people living in Africa. Because the GALAD score performance has been found to vary by etiology, race and stage of HCC, Mayo Clinic researchers recently conducted a validation study to assess the accuracy of the GALAD serological model in the diagnosis of HCC in a cohort of individuals from Ghana. The results of that study were published in Cancer Research Communications in 2024.

Methods

The researchers abstracted and analyzed clinical data and serum samples from 78 people diagnosed with HCC and 93 patients diagnosed with cirrhosis (control group) at outpatient hepatology clinics at three teaching hospitals in Ghana. They constructed a logistic regression model predicting HCC status based on the GALAD score to obtain the receiver operating characteristic (ROC) curve for GALAD, and they calculated the area under the receiver operating characteristic (AUROC) curve with a 95% confidence interval (CI).

Results

Overall, the research data suggests that the GALAD score has a high accuracy for HCC detection in individuals from sub-Saharan Africa.

• The median GALAD score was higher among patients with HCC (8.0) compared with the control group (-4.1).
• The area under the curve (AUC) of the GALAD score for HCC detection was 0.86 (95% CI, range 0.79 to 0.92).
• At a cutoff value of -0.37, the GALAD score had a sensitivity of 0.81 and a specificity of 0.86.
• The AUC (95% CI) was 0.87 (range 0.80 to 0.95) and 0.81 (range 0.67 to 0.94) in patients testing positive for the hepatitis B virus and patients testing negative for hepatitis B virus, respectively.

"These findings demonstrate that the GALAD score, previously validated in the U.S., Europe and Asia, also performs well in an African setting, where the primary cause of HCC and age of onset differ from other populations," explains Lewis R. Roberts, M.B., Ch.B., Ph.D. Dr. Roberts is a gastroenterologist and liver cancer researcher at Mayo Clinic in Rochester, Minnesota, who served as the corresponding author on the study publication. "As African guidelines for HCC management are developed, this and similar evidence can be used to inform guidelines for clinical practice."

Although this study demonstrates that the GALAD score has a high accuracy rate in the diagnosis of HCC in an African cohort, Dr. Roberts notes that additional research is needed to better understand HCC risk in Africans. "Collaborative multicenter studies, including genome-wide association studies across Africa to help identify those persons who are at highest risk for HCC, are needed to advance the field, to help in prevention, and to improve diagnosis of HCC and survival rates."

For more information

Nartey YA, et al. GALAD score for the diagnosis of hepatocellular carcinoma in sub-Saharan Africa: A validation study in Ghanaian patients. Cancer Research Communications. 2024;4:2653.

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