Ahmed RAMADAN, Ashraf Omar ABDELAZIZ, Mohamed Mahmoud NABEEL, Mirna ATEF, Mai Hamed KAMEL, Tamer Mahmoud ELBAZ, Ammar HATEM, Eman MEDHAT, Ahmed Hosni ABDELMAKSOUD, Rania LITHY, Rabab MAHER, Sabrin AA MOHAMED, Amgad Hamed KAMEL, Hend Ibrahim SHOUSHA
Hepatology Forum - 2026;7(2):101-107
Background and Aim: The GALAD score (Gender, Age, AFP, AFP-L3, and Des-gamma-carboxy prothrombin) is a mathematical model that incorporates gender, age, alpha-fetoprotein (AFP), the lens culinaris agglutinin-reactive fraction of AFP (AFP-L3), and des-gamma-carboxy prothrombin (DCP). It has been developed to assess the presence of hepatocellular carcinoma (HCC) in patients with chronic liver disease. This study aimed to evaluate the efficacy of the GALAD score in predicting HCC and assessing its prognosis in patients with hepatitis C-related HCC who had received prior direct-acting antiviral (DAA) treatment. Materials and Methods: This case-control study included patients with hepatitis C virus (HCV)-related liver cirrhosis who had been treated with DAAs, with or without HCC, recruited from the HCC clinic at Kasr Al-Ainy Hospital, Cairo University. Patients were followed until death or the end of the study period. Collected data included clinical and laboratory parameters, levels of DCP, AFP, and AFP-L3, imaging findings, treatment response, and survival outcomes. Logistic regression analysis was used to identify independent predictors of HCC, mortality, and recurrence. Results: Eighty-eight patients with HCV-related HCC following DAA treatment and 88 patients without HCC were recruited, with no significant differences in gender or age between the two groups. Participants with HCC had a higher mean GALAD score than those without HCC (4.32+/-2.47 vs. 1.32+/-1.46, p<0.001). The area under the receiver operating characteristic (ROC) curve (AUC) for the GALAD score in diagnosing HCC at a cut-off value of 3.805 was 0.849 (95% confidence interval [CI]: 0.794-0.905, p<0.001), with a sensitivity of 59.3% and a specificity of 97.7%. Multivariate logistic regression identified liver stiffness (odds ratio [OR]=1.140, 95% CI: 1.007-1.291, p=0.038) and the GALAD score (OR=2.378, 95% CI: 1.171-4.831, p=0.017) as independent predictors of HCC. The GALAD score demonstrated low prognostic value for mortality, with an AUC of 0.564 (95% CI: 0.434-0.693). Patients with HCC recurrence had a slightly higher baseline GALAD score than those without recurrence (6.16 vs. 4.18, p=0.032). Conclusion: The GALAD score demonstrated adequate diagnostic performance for predicting HCC following DAA therapy but showed low prognostic value.
