Wongjarupong N, Negron-Ocasio GM, Mara KC, et al. - Given that the BALAD score and BALAD-2 class derived from bilirubin, albumin, AFP, AFP-L3, and des-gamma-carboxyprothrombin (DCP) have shown effectiveness in predicting death in hepatocellular carcinoma (HCC), researchers performed this study to validate these in North America. They analyzed 148 HCC patients who had undergone testing for all five biomarkers at diagnosis. For BALAD scores 1, 2, 3, and 4 vs BALAD 0, the estimated hazard ratios (HR) for mortality were 1.24, 1.79, 2.83, and 7.19, respectively. For BALAD-2 classes 2, 3, and 4 vs BALAD-2 class 1, the HR for death were estimated to be 1.25, 1.75, and 6.20. Based on the findings, it was concluded that survival of HCC patients in North America can be predicted using BALAD models at diagnosis. Not only tumor progression and metastasis of HCC was reflected by AFP, AFP-L3, and DCP but also these enabled differentiation of the BALAD model from other predictive models.