The diagnostic value of midkine as a novel serum biomarker in alpha-fetoprotein-negative hepatocellular carcinoma

ObjectiveThe objective of this study is to investigate the correlation between the expression levels of midkine (MDK) in the serum of patients with hepatocellular carcinoma (HCC) and various clinical features, and to evaluate the diagnostic efficacy of MDK in HCC cases that are negative for alpha-fetoprotein (AFP).MethodsSerum samples from 330 patients were collected from electronic cases and divided into three groups: HCC, benign liver disease, and healthy people. Serum MDK levels in all three groups were detected by ELISA. Correlation analysis was conducted to evaluate the relationship between serum MDK and liver function indexes and other traditional tumor markers in the HCC group. The receiver operating characteristic curve was used to analyze the diagnostic utility of MDK in HCC and AFP-negative HCC. In addition, univariate and multivariate analyses were performed to determine the correlation between MDK level and tumor metastasis, and clinicopathological features.ResultsMDK is significantly elevated in negative HCC (<i>P</i> = 0.001). The serum expression level of MDK in patients with HCC was found to be positively correlated with various indicators of liver injury (<i>P</i> < 0.05). Notably, elevated MDK expression was significantly associated with the China liver cancer staging system (CNLC) stage (<i>P</i> = 0.003) and complications (<i>P</i> = 0.000). Furthermore, the CNLC stage significantly impacted patient survival and metastasis (<i>P</i> = 0.016). Specifically, we propose that high levels of MDK expression are closely linked to poor tumor prognosis.ConclusionThe risk of tumor metastasis and the likelihood of poor prognosis in patients with HCC are significantly elevated in those exhibiting high levels of MDK. MDK could serve as a novel serum diagnostic marker for patients who are negative for AFP.