Prakash HS, Sehrawat A, Swamy AM, Sundriyal D. Refining early detection of hepatocellular carcinoma: The promise of the GALAD score. World J Gastroenterol 2026; 32(7): 115044 [DOI: 10.3748/wjg.v32.i7.115044]
Corresponding Author of This Article
Amit Sehrawat, Associate Professor, Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh 249203, Uttarakhand, India. dramitsehrawat@gmail.com
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Oncology
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 21, 2026 (publication date) through Feb 6, 2026
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World Journal of Gastroenterology
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1007-9327
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Prakash HS, Sehrawat A, Swamy AM, Sundriyal D. Refining early detection of hepatocellular carcinoma: The promise of the GALAD score. World J Gastroenterol 2026; 32(7): 115044 [DOI: 10.3748/wjg.v32.i7.115044]
World J Gastroenterol. Feb 21, 2026; 32(7): 115044 Published online Feb 21, 2026. doi: 10.3748/wjg.v32.i7.115044
Refining early detection of hepatocellular carcinoma: The promise of the GALAD score
Harsha S Prakash, Amit Sehrawat, Anusha Mruthyunjaya Swamy, Deepak Sundriyal
Harsha S Prakash, Amit Sehrawat, Anusha Mruthyunjaya Swamy, Deepak Sundriyal, Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh 249203, Uttarakhand, India
Author contributions: Prakash HS and Sehrawat A contributed to the conceptualization of the editorial; Prakash HS, Sehrawat A, Swamy AM, and Sundriyal D contributed to the writing and preparation of the manuscript; all authors critically reviewed and approved the final version of the editorial.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amit Sehrawat, Associate Professor, Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Virbhadra Road, Rishikesh 249203, Uttarakhand, India. dramitsehrawat@gmail.com
Received: October 20, 2025 Revised: November 28, 2025 Accepted: December 19, 2025 Published online: February 21, 2026 Processing time: 110 Days and 13 Hours
Abstract
This letter discusses the original article by Villa et al, published in the World Journal of Gastroenterology. Our primary focus is on the GALAD score, its components, standardization, and population-specific variations. We also attempted to discuss the current applications of GALAD score and how combining it with imaging modalities like ultrasound could improve it. Hepatocellular carcinoma (HCC) is still one of the leading causes of cancer death, and early detection is crucial to its prognosis. Current surveillance methods, like alpha-fetoprotein (AFP) and ultrasound, are not very specific, especially when it comes to metabolic-associated steatotic liver disease. Gender, age, AFP, AFP-L3, and des-gamma-carboxy prothrombin are all included in the operator-independent, non-invasive GALAD score, which has become a promising biomarker-based diagnostic tool for HCC. Population-specific cut-points with high sensitivity and specificity have been proposed by multicenter studies like Villa et al, particularly for differentiating between HCC and cirrhosis and healthy controls. However, there is no universal threshold due to variation across etiology, population, and assay technology. GALAD must be a context-sensitive auxiliary in the clinical setting, guiding surveillance intervals and imaging choices while improving predictive performance through serial measurement. Early detection is further improved by integration with imaging modalities, such as the GALADUS score. Standardized biomarker techniques and prospective, multi-ethnic validation are required for broad clinical use and optimal HCC surveillance.
Core Tip: Compared to alpha-fetoprotein (AFP) and ultrasonography alone, the GALAD score, which takes into account age, sex, AFP, AFP-L3, and des-gamma-carboxy prothrombin, shows superior diagnostic effectiveness for hepatocellular carcinoma. However, different groups have different best cut-offs, which supports the idea that a global criterion is inappropriate. Future multi-ethnic prospective studies and integration with imaging (e.g., GALADUS) are necessary for the standardized, cost-effective detection of early hepatocellular carcinoma.
