{
  "abstract": "Hepatocellular carcinoma (HCC) remains a major clinical and health-system burden in East and South-East Asia, and early-detection pathways remain vulnerable when alpha-fetoprotein (AFP) is low or non-informative. We developed and externally validated Extended-7 as a routine laboratory-based triage aid to prioritize diagnostic attention within hospital HCC early-detection and referral pathways. This two-center retrospective study evaluated a hospital-based laboratory triage model in a Ningbo development cohort (n=523; 267 HCC and 256 controls) and an independent Lihuili external-validation cohort (n=269; 150 HCC and 119 controls). Using these data, we developed and validated an HCC risk-stratification model intended to support prioritization for further diagnostic evaluation, not stand-alone diagnosis or replacement of imaging/pathology. Discrimination, calibration, decision-curve profiles, cohort-specific Youden operating characteristics, and exploratory AFP-low subgroups were evaluated against AFP, AFP-L3, PIVKA-II, a three-marker model, GALAD, and ASAP. Extended-7 combined ln(AFP+1), AFP-L3, ln(PIVKA-II+1), age, sex, platelet count, and albumin. Extended-7 achieved a 5-fold cross-validated AUC of 0.900 (95% CI, 0.871-0.924) in the development cohort and an external AUC of 0.738 (95% CI, 0.681-0.793). In external validation, discrimination was higher than GALAD (AUC 0.694; DeLong p=0.006), ASAP (AUC 0.643; p<0.001), and the three-marker model (AUC 0.602; p<0.001). At the external Youden cutoff, Extended-7 identified 119 of 150 HCC cases while classifying 47 of 119 non-HCC controls as false-positive triage referrals. In the external AFP-low subgroup, Extended-7 achieved an AUC of 0.808; the paired bootstrap comparison vs GALAD did not reach conventional statistical significance. External calibration was weak (Brier score 0.224; calibration slope 0.262). Extended-7 showed moderate external discrimination and may support laboratory-based prioritization in hospital HCC early-detection pathways, including patients with low AFP, while subgroup findings remain exploratory. However, transported probabilities require local recalibration, and prospective multicenter evaluation of referral thresholds, decision impact, and cost-effectiveness is needed before clinical implementation.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Clinical Laboratory, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, 315040, People's Republic of China.",
    "Department of Liver Disease, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, Zhejiang, 315010, People's Republic of China.",
    "Department of Clinical Laboratory, Ningbo No.2 Hospital, Wenzhou Medical University, Ningbo, Zhejiang, 315010, People's Republic of China."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Liqiao Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Xiaozhen Xu"
    },
    {
      "affs": [
        1
      ],
      "name": "Xingfen Zhang"
    },
    {
      "affs": [
        2
      ],
      "name": "Miao Cheng"
    },
    {
      "affs": [
        2
      ],
      "name": "Guosheng Gao"
    },
    {
      "affs": [
        1
      ],
      "name": "Xijie Lai"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/b90p6nkqnd9y1.bib",
  "cited_by": 0,
  "doi": "10.2147/jhc.s645422",
  "fulltext_url": "https://europepmc.org/articles/PMC13744181",
  "id": "b90p6nkqnd9y1",
  "issns": [
    "2253-5969"
  ],
  "landing_url": "https://europepmc.org/article/MED/42999838",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2721|Hepatocellular Carcinoma Treatment and Prognosis"
    ]
  ],
  "openalex": "W7225154602",
  "pdf_url": "https://europepmc.org/articles/PMC13744181?pdf=render",
  "pmcid": "PMC13744181",
  "pmid": "42999838",
  "published": "2026-11-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/b90p6nkqnd9y1.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T15:20:34Z",
      "native_id": "MED:42999838",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42999838"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis",
      "subfield": "general"
    }
  ],
  "title": "A Laboratory-Based Triage Model for Hepatocellular Carcinoma Early-Detection Pathways in Hospital-Evaluated Populations: Development and External Validation.",
  "title_text": "A Laboratory-Based Triage Model for Hepatocellular Carcinoma Early-Detection Pathways in Hospital-Evaluated Populations: Development and External Validation.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T15:20:34Z",
  "url": "https://research.draconitic.com/paper/b90p6nkqnd9y1",
  "venue": "Journal of hepatocellular carcinoma",
  "versions": []
}