肿瘤组织miR-23a联合MELK检测在骨肉瘤病情及预后评估中的临床价值  

Clinical value of miR-23a combined with MELK detection in the evaluation of osteosarcoma disease and prognosis

作　　者：杨琼 李健伟[2] 曾寒 欧阳柳 郑冲 Yang Qiong;Li Jianwei;Zeng Han;Ouyang Liu;Zheng Chong(Department of Orthopedics,Puren Hospital Affiliated to Wuhan University of Science and Technology,Hubei Province,Wuhan 430081,China;不详)

机构地区：[1]武汉科技大学附属普仁医院骨科,430081 [2]武汉科技大学附属普仁医院手足显微外科,430081 [3]华中科技大学同济医学院附属协和医院,武汉430022 [4]湖北文理学院附属襄阳市中心医院,襄阳441000

出　　处：《疑难病杂志》2024年第10期1182-1186,1192,共6页Chinese Journal of Difficult and Complicated Cases

基　　金：湖北省自然科学基金(WJ2019A167)。

摘　　要：目的分析肿瘤组织微小核糖核酸-23a(miR-23a)联合母体胚胎亮氨酸拉链激酶(MELK)水平对骨肉瘤病情及预后评估的临床价值。方法选择2019年1月—2022年1月武汉科技大学附属普仁医院骨科诊治的骨肉瘤患者93例为研究组,骨良性疾病患者53例为对照组。采用实时荧光定量PCR法检测组织miR-23a、MELK表达水平;采用受试者工作特征(ROC)曲线分析肿瘤组织miR-23a、MELK水平预测骨肉瘤患者预后不良的价值;多因素Cox回归分析骨肉瘤患者预后不良的危险因素;Kaplan-Meier模型分析miR-23a、MELK表达对骨肉瘤患者生存期的影响。结果研究组肿瘤组织miR-23a、MELK表达水平显著高于对照组(t/P=12.127/<0.001、11.291/<0.001);肿瘤最大径≥5 cm、有远处转移、Enneking分期Ⅲ期的骨肉瘤患者miR-23a、MELK表达高于肿瘤最大径<5 cm、无远处转移、Enneking分期Ⅰ~Ⅱ期患者(miR-23a:t/P=8.357/<0.001、9.112/<0.001、6.531/<0.001;MELK:t/P=11.265/<0.001、9.787/<0.001、10.462/<0.001);miR-23a、MELK水平及二者联合预测骨肉瘤患者预后不良的AUC分别为0.781、0.773、0.901,二者联合的AUC大于单独预测的AUC(Z/P=6.431/<0.001、0.705/<0.001);Cox回归分析显示,miR-23a高表达、MELK高表达、肿瘤最大径≥5 cm、有远处转移、Enneking分期Ⅲ期为骨肉瘤患者预后不良的独立危险因素[OR(95%CI)=4.100(1.426~6.774)、4.023(1.279~6.767)、2.250(1.041~3.459)、2.396(1.117~3.675)、2.489(1.028~3.951)];miR-23a≥1.14且MELK≥0.73的骨肉瘤患者中位生存期显著低于miR-23a<1.14或MELK<0.73的患者(中位生存期24.38月±4.52月vs.32.74月±5.16月,Log Rankχ^(2)=9.821,P<0.001)。结论骨肉瘤患者miR-23a和MELK表达与临床病理特征密切相关,可为骨肉瘤病情及预后评估提供基因水平的客观证据,二者联合检测可提高预测骨肉瘤预后不良的敏感度及特异度。Objective To analyze the clinical value of microribonucleic acid 23a(miR-23a)combined with maternal embryonic leucine zipper kinase(MELK)levels in assessing the condition and prognosis of osteosarcoma.Methods Ninety-three patients with osteosarcoma(study group)and 53 patients with benign bone diseases(control group)from Puren Hospital Affiliated to Wuhan University of Science and Technology between January 2019 and January 2022 were selected as study.The real time fluorescence quantitative PCR method was used to detect the expression levels of tissue miR-23a and MELK;the receiver operating characteristic(ROC)curve was used to analyze the value of tumor tissue miR-23a and MELK levels in predicting the poor prognosis of patients with osteosarcoma;Multivariate Cox regression analysis of risk factors for poor prognosis in patients with osteosarcoma;Kaplan-Meier model analyzed the impact of miR-23a and MELK expression on the survival of patients with osteosarcoma.Results The expression levels of miR-23a and MELK in tumor tissues of the study group were significantly higher than those of the control group(t/P=12.127/<0.001,11.291/<0.001);tumors with maximum diameter≥5cm,distant metastasis,and Enneking stageⅢThe expression of miR-23a and MELK in patients with osteosarcoma were higher than that in patients with tumors with a maximum diameter<5cm,no distant metastasis,and Enneking stage Ⅰ to Ⅱ(t/P=8.357/<0.001,11.265/<0.001,9.112/<0.001,9.787/<0.001,6.531/<0.001,10.462/<0.001);the AUCs of miR-23a,MELK levels and their combination in predicting poor prognosis in patients with osteosarcoma are 0.781,0.773,and 0.901 respectively,and the AUC of their combination was greater than that of miR-23a,MELK level alone(Z/P=6.431/<0.001,0.705/<0.001);Cox regression analysis showed that high expression of miR-23a,high expression of MELK,maximum tumor diameter≥5cm,distant metastasis,Enneking stageⅢwere independent risk factors for poor prognosis of osteosarcoma[OR(95%CI)=4.100(1.426-6.774),4.023(1.279-6.767),2.250(1.041-3.45

关 键 词：骨肉瘤 微小核糖核酸-23a 母体胚胎亮氨酸拉链激酶 临床病理特征 预后评估 

分 类 号：R738.1[医药卫生—肿瘤]