Prognostic and diagnostic effects of high serum midkine on patients with hepatocellular carcinoma

Abstract

Background Midkine (MK) is a soluble cytokine, and its serum levels strongly correspond with protein expression levels in tumors. This study aimed to clarify the clinicopathological and prognostic significance of serum MK (s-MK) in patients with hepatocellular carcinoma (HCC).Methods Serum samples were obtained before surgery from 123 patients with HCC who underwent surgery between 2012 and 2020. Based on the receiver operating characteristics curve, the best cutoff value for s-MK in differentiating HCC from healthy cases was 426 pg/mL. Patients’ clinicopathological variables and overall survival were compared between the s-MK-positive group and the s-MK-negative group.Results The sensitivity, specificity, and accuracy of s-MK were 82.1%, 97.4%, and 88.0%, respectively. An s-MK-positive status was significantly associated with the number of tumors (≥ 2). The positivity rate of s-MK was significantly higher than that of α-fetoprotein and protein induced by vitamin K absence-II. In total, only 28% of the patients were positive for s-MK. The s-MK positive group showed significantly worse overall survival than the s-MK negative group. The multivariate analysis revealed that an s-MK-positive status was independently associated with poor prognosis.Conclusion s-MK was useful in detecting early HCC. A s-MK-positive status was associated with the number of tumors and was an independent prognostic risk factor.