Prognostic impact of immunohistochemical expression of ezrin in highly malignant soft tissue sarcomas.
OBJECTIVE
Ezrin is a cytoskeleton linker protein that is actively involved in regulating the growth and metastatic capacity of cancer cells. It has recently been reported to be involved in dissemination of pediatric soft tissue sarcoma (STS).


METHODS
To further evaluate the prognostic value of ezrin in STS progression, we screened 50 primary STSs of high malignancy grade using immunohistochemistry. At the initial surgery, all patients were without local or distant metastasis. The expression was then compared with the outcome during follow-up for at least 4 years or until the patients' death.


RESULTS
Twenty-five of the 50 STSs analyzed (50%) showed ezrin immunoreactivity in the membrane and cytoplasm of the tumor cells. A significant association was shown between positive expressions of ezrin and death in disease as well as overall survival (P = 0.014 and 0.007, respectively). Similarly, ezrin expression was significantly associated with development of distant metastasis during follow-up (P = 0.031), also excluding locally recurrent disease (P = 0.049). The relative abundance of metastasis in ezrin-positive cases was observed both over time and irrespective of time. In comparison with clinical, histopathologic, and genetic characteristics of the STSs, ezrin expression was found to correlate significantly with an infiltrative growth pattern outside the tumor capsule as well as with copy number gain of chromosomal region 9cen-q22.


CONCLUSIONS
Our findings suggest that ezrin immunoreactivity could be valuable as an additional prognostic marker in highly malignant STSs and support a causative role of ezrin in STS tumor dissemination.
Weng
Wen-Hui
WH
Department of Molecular Medicine, Karolinska University Hospital-Solna, Stockholm, Sweden. Wendy.Weng@cmm.ki.se
Ahlén
Jan
J
Aström
Kristina
K
Lui
Weng-Onn
WO
Larsson
Catharina
C
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D002462:Cell Membrane / Q000378:metabolism; D002899:Chromosomes, Human, Pair 9 / Q000235:genetics; D003593:Cytoplasm / Q000378:metabolism; D003598:Cytoskeletal Proteins; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D006801:Humans; D007124:Immunoenzyme Techniques; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009693:Nucleic Acid Hybridization; D010750:Phosphoproteins / Q000378:metabolism*; D011379:Prognosis; D012509:Sarcoma / Q000378:metabolism* / Q000473:pathology; D015996:Survival Rate; D000099149:Ezrin
D014408:Biomarkers, Tumor; D003598:Cytoskeletal Proteins; D019394:Ki-67 Antigen; D010750:Phosphoproteins; D000099149:Ezrin