What does this research mean for the field?

The ASAP score modestly outperforms AFP and PIVKA-II for diagnosing hepatocellular carcinoma in an Indian cohort, though its suboptimal performance in very-early-stage disease limits its utility to a complementary risk stratification tool rather than a standalone screening test. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare the diagnostic performance of alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), and the combined ASAP score for detecting hepatocellular carcinoma in an Indian tertiary care cohort.

September 10, 2026LiversOpen Access

Comparative Diagnostic Performance of AFP, PIVKA-II, and the ASAP Score for Hepatocellular Carcinoma: A Large Tertiary Care Referral Center Study from India

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Authors

SCSowjanya Chamarthi PSPasham Sathwika SSSai V. Sarada

Discussion

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Overview

Cross-sectional study demonstrates superior diagnostic performance of the ASAP score in chronic liver disease, highlighting its utility as a complementary tool rather than standalone screening.

Key Points

To compare the diagnostic performance of alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), and the combined ASAP score for detecting hepatocellular carcinoma in an Indian tertiary care cohort.
Conducted a single-center cross-sectional study of consecutive adults with chronic liver disease and healthy controls evaluated at AIG Hospitals, Hyderabad, India between January and December 2025 (N=1,305).
Measured serum AFP and PIVKA-II using chemiluminescent microparticle immunoassays, calculated ASAP scores (incorporating age, sex, AFP, and PIVKA-II), and established hepatocellular carcinoma diagnosis via standard imaging criteria.
Evaluated diagnostic performance via receiver operating characteristic (ROC) and precision-recall analyses using standard and optimized cut-offs derived from the Youden index and F1-score.
At standard cut-offs, AFP (20 ng/mL) demonstrated 93.3% specificity but only 29.6% sensitivity for early-stage hepatocellular carcinoma, whereas PIVKA-II (40 mAU/mL) yielded 82.7% sensitivity and 26.4% specificity.
The ASAP score (0.526 cut-off) delivered the best overall balance, with 69.4% sensitivity and 52.2% specificity in early-stage disease, 82.0% sensitivity and 52.2% specificity in cirrhotic cancer, and 81.9% sensitivity and 55.5% specificity overall.
Optimizing cut-offs to higher population-specific thresholds for PIVKA-II (71.3–98.1 mAU/mL) and ASAP (0.6–0.9) improved diagnostic trade-offs across all etiologies, including metabolic-dysfunction-associated steatotic liver disease.

Cite This Study

Chamarthi et al. (2026) studied this question.

synapsesocial.com/papers/6aa27be758559d80afc756c1 https://doi.org/10.3390/livers6050094

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September 10, 2026LiversOpen Access

Comparative Diagnostic Performance of AFP, PIVKA-II, and the ASAP Score for Hepatocellular Carcinoma: A Large Tertiary Care Referral Center Study from India

View Full Paper

Ask AI

Bookmark

Authors

SCSowjanya Chamarthi PSPasham Sathwika SSSai V. Sarada

Discussion

Member takes

Overview

Cross-sectional study demonstrates superior diagnostic performance of the ASAP score in chronic liver disease, highlighting its utility as a complementary tool rather than standalone screening.

Key Points

To compare the diagnostic performance of alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), and the combined ASAP score for detecting hepatocellular carcinoma in an Indian tertiary care cohort.
Conducted a single-center cross-sectional study of consecutive adults with chronic liver disease and healthy controls evaluated at AIG Hospitals, Hyderabad, India between January and December 2025 (N=1,305).
Measured serum AFP and PIVKA-II using chemiluminescent microparticle immunoassays, calculated ASAP scores (incorporating age, sex, AFP, and PIVKA-II), and established hepatocellular carcinoma diagnosis via standard imaging criteria.
Evaluated diagnostic performance via receiver operating characteristic (ROC) and precision-recall analyses using standard and optimized cut-offs derived from the Youden index and F1-score.
At standard cut-offs, AFP (20 ng/mL) demonstrated 93.3% specificity but only 29.6% sensitivity for early-stage hepatocellular carcinoma, whereas PIVKA-II (40 mAU/mL) yielded 82.7% sensitivity and 26.4% specificity.
The ASAP score (0.526 cut-off) delivered the best overall balance, with 69.4% sensitivity and 52.2% specificity in early-stage disease, 82.0% sensitivity and 52.2% specificity in cirrhotic cancer, and 81.9% sensitivity and 55.5% specificity overall.
Optimizing cut-offs to higher population-specific thresholds for PIVKA-II (71.3–98.1 mAU/mL) and ASAP (0.6–0.9) improved diagnostic trade-offs across all etiologies, including metabolic-dysfunction-associated steatotic liver disease.

Cite This Study

Chamarthi et al. (2026) studied this question.

synapsesocial.com/papers/6aa27be758559d80afc756c1 https://doi.org/10.3390/livers6050094

View Full Paper

Ask AI

Bookmark