Evaluation of Serum Midkine as a Diagnostic Marker for Hepatocellular Carcinoma in Hepatitis C Virus Patients with Liver Cirrhosis

Background cancer in the world. Its incidence is increasing worldwide reaching half million cases each year. The primary marker for HCC is Alpha Feto Protein (AFP) which is not secreted in all cases of HCC and may be normal in as many as 40% of patients with early HCC. Midkine(MK) is a heparin-binding cytokine or growth factor, promoting survival, growth, migration, gene expression and other activities of target cells. MK is over expressed in hepatocellular carcinoma. The aim of the study is to evaluate the diagnostic value of MK as a tumor marker of HCC. This study was conducted on 85 patients who were classified into three groups: Group I (HCC) group included 45 patients with HCC. Group II (Liver cirrhosis) group included 30 patients without any evidence of hepatic focal lesions as excluded by ultrasonography and AFP estimation. Group III (control group) included 10 normal people. The level of AFP and MK were estimated for all cases together with full clinical assessment liver biochemical profile, viral markers, conventional US and triphasic abdominal CT for HCC cases. Serum AFP median level was significantly (P <0.05) elevated in the HCC group (116 ng/ml) when compared with both control (2.5 ng/ml) and liver cirrhosis (3.7 ng/ml) groups. Midkine median level was also significantly(P <0.05) elevated in the HCC group (538 ng/I) when compared with both the control (238 ng/I) and liver cirrhosis (292.5 ng/I) groups. There were no significant differences (P <0.05) were found in MK concentration between males and females in each studied group. Serum midkine level was significantly elevated (P <0.05) in HCC patients, so it can be used as a diagnostic marker for HCC.