Evaluation of serum Midkine as a novel biomarker for the diagnosis of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is the most common type of primary liver malignancy, accounting for about 90% of all primary hepatic malignancy. Most of them occur due to chronic liver disease, usually due to hepatitis B virus or hepatitis C virus. Aim The aim of the study was to assess the validity of serum midkine as a noninvasive diagnostic marker for HCC especially early stage of cirrhosis and compare the diagnostic performance of serum midkine, α‑fetoprotein, and their combination in HCC. Patients and methods This study was conducted on 40 HCC patients, 24 liver cirrhosis patients and 16 age‑matched and sex‑matched healthy controls. Serum Midkine level was measured by the ELISA technique using Human Midkine ELISA Kit, catalog no: E‑EL‑H2297 96T, purchased from Elabscience (China). Results Midkine level was significantly higher in newly diagnosed HCC patients than in the nonmalignant control group (liver cirrhosis and healthy controls). Diagnostic performance of serum Midkine showed the best specificity (93.75%) in diagnosing HCC among healthy controls and the combination of Midkine and α‑fetoprotein improved the diagnostic accuracy (92.86%) and enhanced the sensitivity (95.0%). Conclusion In conclusion, this study has shown that serum Midkine level in HCC patients is a good marker for the detection of HCC and in distinguishing HCC from cirrhotic patients. We also found that there was positive association between the level of Midkine and the advancement of the HCC, so this marker can be used as a prognostic marker in patients with HCC.