Midkine and Head and Neck Cancer

Another very good paper by Taku Yamashita¹   et. al. titled Serum midkine as a biomarker for malignancy, prognosis, and chemosensitivity in head and neck squamous cell carcinoman ( on the research side)  concludes:

" Several studies have shown that serum or plasma MK concentration is a prognostic marker in various cancer types, including esophageal cancer, oral cancer, neuroblastoma, and hepatocellular carcinoma [18, 27, 32, 46]. In this study, we showed that serum MK level was an independent factor associated with survival in patients with HNSCC. Because MK has been reported to be involved in various cancer-related functions [22-24, 37, 47, 48], it is easy to understand how MK overexpression may enhance the degree of malignancy and how MK expression could be associated with poor prognosis. Moreover, these findings suggest that MK may be both a biomarker and therapeutic molecular target for malignant neoplasms.

In conclusion, serum MK levels in patients with HNSCC were associated with malignancy and chemosensitivity to ICT and were an independent prognostic factor. Because MK is a secreted soluble protein, it is detectable in peripheral blood examinations. Therefore, serum MK may be a useful, minimally invasive biomarker for detecting malignancy early, selecting appropriate patients for ICT, and predicting prognosis in HNSCC.
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Acknowledgments
This work was partially supported by a grant for the Development of Advanced Medicine from the Ministry of Defense of Japan, Grant-in-Aid for Scientific Research(C) (JSPS KAKENHI Nos. 26462626, 26462627, 25462699) and Grant-in-Aid for Challenging Exploratory Research (JSPS KAKENHI No. 25670723) from the Ministry of Education, Culture, Sports, Science and Technology of Japan. Hideaki Shimada received research funding by CELLMID Ltd.
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Conflict of Interest
None declared. "




My take on it.

On the development sider this is yet another application for the latex bead assay being developed by Fujukura.  There because along with the Japanese Government, Cellmid paid for some of this research.

Why is the Japanese Government so interested in this?  One of the caused of squamous cell head and neck cancers is radiation.

http://www.cancer.gov/types/head-and-neck/head-neck-fact-sheet

Statistics

"One hundred and three patients newly diagnosed with HNSCC between February 2012 and August 2014 at the Department of Otolaryngology-Head and Neck Surgery, National Defense Medical College of Japan were enrolled in this study.  " " One hundred and sixteen individuals who were healthy volunteers or visited our clinic with benign otolaryngological disease were also included in this study as controls. "

In my humble yet aggressive  (lets finally get things rolling) view, the statistical results of this study are more than sufficient to justify a much larger trial, perhaps using the latex bead assay when it becomes available .  There are some  provisos though (there always are) ....... to get the a reasonable  statistical confidence from any midkine only assay  ..... we need to stratify the patients a little bit more...... and in my opinion .... investigate each patient a little bit more ro flag other illnesses that may result in higher than average serum midkine levels.

It's a bit of a no-brainer that older people have a range of conditions (arthritis, kidney disease and various (sometimes dormant) cancers) that  that increase midkine levels.  The bottom line is that if midkine (as a sole marker) has a better prediive value for younger patients LETS SET UP SEPARATE STATISTICAL CONFIDENCE TABLES FOR THE FOLLOWING AGE RANGES  .... say under 45, 45-55, 55-65 and over 65.

For the higher age ranges a simple look at the test result isn't enough.  Also test the patients kidneys, review their arthritis status and look for other cancers.  You don't require a medical degree or a higher maths degree to know that once these possiblities are excluded the midkine status of a 70 year old patient is likely to be as predictive as those of say a 45 year old patient.  If a cost effective midkine assay becomes available  linear (annual) shifts in a patient's midkine status can also be reviewed in reference to that patient's  broader medical status.

In a nutshell ...... the questions (calibrations) that need to be resolved though a larger study are clear.  The next step should be to get the Japanese Government on-side to fund the study.

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