HCC Blood Test Score Tracks Tumor Size, Not Liver Disease Severity

The continuous composite score from a multi-target hepatocellular carcinoma (HCC) blood test (mt-HBT) correlated strongly with tumor size and was largely unaffected by the cause or severity of underlying liver disease, according to ALTUS study data presented by Binu John, MD, MPH, at The Liver Meeting 2026 in Denver, Colorado.

“It was very reassuring to see that there was no correlation of the [mt-HBT] level with the stage of their liver disease, and it really correlated only with the size of the tumor,” John, associate professor of medicine at the University of Miami, told HCPLive.

What Does the Composite Score Reveal?

The mt-HBT (Oncoguard Liver) combines methylated DNA markers, alpha-fetoprotein, and sex into a score from 0 to 1, with results above 0.2255 considered positive.¹ In the prospective ALTUS study of 2463 adults undergoing HCC surveillance, the score correlated with tumor size (ρ = 0.63) but not tumor number, and was significantly higher for HCCs outside vs within Milan criteria (P = .003).¹ Scores rose stepwise across LI-RADS categories, with indeterminate LR-3 and LR-4 observations falling between non-HCC findings and definite HCC.¹ Liver disease severity showed only a weak correlation with score.¹

The analysis builds on primary ALTUS results showing the test detected early-stage HCC with greater sensitivity than ultrasound (66.7% vs 22.2%), though with lower specificity (81.8% vs 98.6%).²

Where Could Blood-Based Surveillance Fit?

John notes that only 25% to 50% of eligible patients receive consistent surveillance, in part because ultrasound requires a separate visit. A blood test could be drawn during routine clinic visits. Still, he says longitudinal data on repeated testing every 6 months are needed before wider adoption.

Watch the full interview to hear John discuss how the score might help clinicians interpret indeterminate imaging findings and track changes after treatment, and what ongoing 18-month follow-up may reveal.

References

1. John B, Camardo M, Singal A, et al. Composite score from a multi-target HCC blood test reflects tumor size and stage in the ALTUS study. Presented at: The Liver Meeting 2026; November 5-9, 2026; Denver, CO.
2. John BV, Camardo M, Singal AG, et al. Multi-target blood test for hepatocellular carcinoma early detection: a cross-sectional analysis of the prospective ALTUS study. J Hepatol. Published online 2026. PMID: 42800682
3. John BV, Camardo M, Porter K, et al. Performance of the multi-target hepatocellular carcinoma blood test: design and rationale of the ALTUS study. Hepatol Commun. 2025;9(11):e0800. doi:10.1097/HC9.0000000000000800