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 Nine-ty-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 ≥ 5 cm,distant metastasis,and Enneking stage Ⅲ The 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 metas-tasis,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 stage Ⅲ were independent risk factors for poor prognosis of osteosarcoma[OR(95％CI)=4.100(1.426-6.774),4.023(1279-6.767),2250(1.041-3.459),2.396(1.117-3.675),2.489(1.028-3.951)];the median survival time of osteosarcoma patients with miR-23a≥ 1.14 and MELK ≥0.73 was signifi-cantly lower than that of patients with miR-23a＜1.14 or MELK＜0.73(median survival time 2438±452 months vs.32.74±5.16 months,Log Rank x2=9.821,P＜0.001).Conclusion The expression of miR-23a and MELK in patients with osteosar-coma is closely related to the clinicopathological characteristics,which can provide objective evidence at the gene level for the assessment of osteosarcoma disease and prognosis.The combined detection of the two can improve the sensitivity and specificity in predicting poor prognosis of osteosarcoma.
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