Research Papers:

Midkine is a serum and urinary biomarker for the detection and prognosis of non-small cell lung cancer

Xin Xia _, Jian-Jun Lu, Shui-Shen Zhang, Chun-Hua Su and Hong-He Luo

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Oncotarget. 2016; 7:87462-87472. https://doi.org/10.18632/oncotarget.13865

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Xin Xia1,*, Jian-Jun Lu1,*, Shui-Shen Zhang1,*, Chun-Hua Su1,, Hong-He Luo1

1Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People’s Republic of China

*These authors contributed equally to this work and share first authorship

Correspondence to:

Jian-Jun Lu, email: [email protected]

Hong-He Luo, email: [email protected]

Keywords: midkine, non-small cell lung cancer (NSCLC), serum biomarker, urine biomarker, survival

Received: June 14, 2016     Accepted: October 19, 2016     Published: December 10, 2016


Midkine, a heparin-binding growth factor, has been identified as a promising cancer biomarker. In non-small cell lung cancer (NSCLC), the serum and urine midkine levels have not been intensively investigated. The aim of the present study was to investigate the diagnostic and prognostic potential of serum and urine midkine levels in patients with NSCLC. The serum midkine levels were measured in 153 patients with NSCLC, 23 patients with benign pulmonary disease and 95 healthy controls using ELISA. Urine midkine levels were examined in 20 controls and 45 patients with NSCLC. Midkine expression in tumor tissues from 72 patients with NSCLC who underwent definitive surgical resection without any pre-operative treatments was examined by immunohistochemistry. Serum levels were significantly higher in patients with NSCLC than in healthy controls (657.36±496.58 pg/ml vs. 194.49±122.57 pg/ml, P<0.001). As shown in the ROC curve analysis, the sensitivity and specificity of the cut-off serum midkine concentration of 400 pg/ml for predicting the presence of NSCLC were 71.2% and 88.1%, respectively. Positive correlations between the serum midkine levels and immunohistochemistry staining scores (r=0.315, P=0.007) and between the serum midkine levels and urine midkine levels (r=0.636, P<0.001) were observed using Spearman’s bivariate correlations. The serum midkine concentration was identified as an independent prognostic factor by multivariate analysis, and its overexpression yielded a relative risk of death of 2.072 (0.01<P<0.05, 95%CI: 1.104-3.890). Thus, the serum and urine midkine levels may be useful, minimally invasive biomarkers for detecting and predicting the prognosis of NSCLC.

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