原文忠实转述了文献的内容，因此翻译应准确、简明，保持学术论文的语言风格和原句结构。以下是翻译的结果： 肝细胞癌（HCC）是全球癌症死亡的主要原因。血清生物标志物，如甲胎蛋白（AFP）、维生素K缺乏诱导蛋白-II、性别（Gender）、年龄、AFP-L3、AFP、Des-γ-羧基凝及原蛋白（GALAD）评分已被推荐用于HCC监测。然而，国际指南中不一致的建议限制了它们的临床应用价值。本多中心研究在6个拉丁美洲国家和2个欧洲国家收集了2000多名患者样本。该研究验证了GALAD评分在肝硬化病例中的表现，并在早期HCC和预诊断HCC检测中测试了优化版本。GALAD评分在拉丁美洲患者中可以在常规截断值-0.63的情况下，以AUC值为0.76，敏感性为70%，特异性为83%来区分HCC和肝硬化。在欧洲队列中，GALAD的AUC值为0.69，敏感性为66%，特异性为72%。在这2个大型多中心队列中优化评分后，AFP-L3对早期HCC检测的贡献很小。因此，我们开发了一种不包含AFP-L3的改进GALAD评分，即ASAP（年龄、性别、AFP和维生素K缺乏诱导蛋白-II），这在早期HCC检测中显示了希望，并得到了验证。ASAP评分还可以在诊断之前15个月识别高危肝硬化患者的晚期HCC（P < 0.0001），并以71%的敏感性在100%的特异性下区分HCC和血管瘤。我们在大样本队列的综合分析证实了GALAD评分对拉丁美洲、西班牙和荷兰患者在早期HCC检测中的实用性。优化后不包含AFP-L3的GALAD评分，即ASAP评分是一种良好的替代方法，并显示了更好的HCC预测能力。 版权所有©2023 The Author(s)。由Wolters Kluwer Health, Inc.代表美国肝病研究协会出版。

HCC is a major cause of cancer death worldwide. Serum biomarkers such as alpha-fetoprotein (AFP), protein induced by vitamin K absence-II, and the Gender, Age, AFP-L3, AFP, Des-gamma-carboxy prothrombin (GALAD) score have been recommended for HCC surveillance. However, inconsistent recommendations in international guidelines limit their clinical utility.In this multicenter study, over 2000 patient samples were collected in 6 Latin American and 2 European countries. The performance of the GALAD score was validated in cirrhotic cases, and optimized versions were tested for early-stage HCC and prediagnostic HCC detection.The GALAD score could distinguish between HCC and cirrhosis in Latin American patients with an AUC of 0.76, sensitivity of 70%, and specificity of 83% at the conventional cutoff value of -0.63. In a European cohort, GALAD had an AUC of 0.69, sensitivity of 66%, and specificity of 72%. Optimizing the score in the 2 large multicenter cohorts revealed that AFP-L3 contributed minimally to early-stage HCC detection. Thus, we developed a modified GALAD score without AFP-L3, the ASAP (age, sex, AFP, and protein induced by vitamin K absence-II), which showed promise for early-stage HCC detection upon validation. The ASAP score also identified patients with cirrhosis at high risk for advanced-stage HCC up to 15 months before diagnosis (p < 0.0001) and differentiated HCC from hemangiomas, with a specificity of 100% at 71% sensitivity.Our comprehensive analysis of large sample cohorts validates the GALAD score's utility in Latin American, Spanish, and Dutch patients for early-stage HCC detection. The optimized GALAD without AFP-L3, the ASAP score, is a good alternative and shows greater promise for HCC prediction.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.