Background: Hepatocellular carcinoma (HCC) is a frequent and major cause of cancer mortality in the Philippines, mostly due to its late diagnosis. For better survival, early detection is essential. This study compared the performance of three surveillance strategies in the detection of HCC: a Modified GALAD score (a serum biomarker-based model), ASAPUSTE score (blood plus ultrasound and transient elastography), and the standard surveillance strategy, serum AFP plus ultrasound.

Methodology: This is a single-center case-control study of 26 HCC cases and 92 controls with cirrhosis or patients at-risk for HCC were analyzed.

Results: The Modified GALAD score demonstrated the highest sensitivity (96.2%) with an AUC of 0.775 compared with standard surveillance (76.9%) and ASAPUSTE (65.4%). The addition of transient elastography (ASAPUSTE) did not improve sensitivity (65%), but enhanced specificity (37%) in this study cohort.

Conclusion: A blood-based surveillance strategy (Modified GALAD) using serum biomarkers combined with demographic information offers an accurate approach to detect HCC without the use of imaging.

Keywords: Hepatocellular carcinoma, AFP, PIVKA, Transient elastography

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