Serum midkine level as a diagnostic biomarker of hepatocellular carcinoma in Egyptian patients with chronic hepatitis C

Background
Early diagnosis and treatment are the keys for effective treatment of patients with hepatocellular carcinoma (HCC). The use of serological markers in patients at the highest risk of developing HCC may thus decrease HCC mortality and reduce medical costs. Midkine (MK) has an essential role in activities related to carcinogenesis such as proliferation, anti-apoptosis, transformation, migration, and angiogenesis, in many types of tumors, including HCC.


Aim
To evaluate serum levels of MK as a diagnostic biomarker for early detection of HCC in relation to conventional markers, such as alpha-fetoprotein (AFP).


Patients and methods
This study was conducted on 90 individuals who attended the Hepatogastroenterology and Infectious Diseases Department, Al-Zahraa University Hospital, Al Azhar University. The patients were divided into three groups: group I comprised 30 patients with HCC on top of hepatitis C virus and group II comprised 30 patients with cirrhotic liver post-hepatitis C virus.


Control group
The control group comprised 30 healthy adult participants.


Results
Highly statistically significant increase in serum MK in groups I and II in comparison to the control group and statistically significant increase in group I in comparison to group II. Serum MK can be used to discriminate between groups I and II at a cutoff level of more than 97.7,with 80% sensitivity, 90% specificity, 88.9% positive predictive value and 81.8% negative predictive value and area under curve=0.94. Also, it used to discriminate between groups I and III at a cutoff level of more than 76.5, with 100% sensitivity, specificity, positive predictive value, and negative predictive value with area under the curve=1.0.


Conclusion
MK is more accurate than AFP in diagnosing HCC, especially in detecting early stage HCC and AFP-negative HCC.