Cancer Res Treat.  2009 Sep;41(3):138-144.

Clinical Value of Ezrin Expression in Primary Osteosarcoma

• Kim C
• Shin E
• Hong S
• Chon HJ
• Kim HR
• Ahn JR
• Hong MH
• Yang WI
• Roh JK
• Rha SY

Abstract

PURPOSE
Ezrin is a membrane cytoskeletal linker protein and it is known to be associated with metastasis of primary osteosarcoma. The aim of this study is to determine the relationship between an ezrin expression and several key clinical parameters and to elucidate its potential prognostic value for patients with osteosarcoma. MATERIALS AND METHODS: Seventy patients with histologically confirmed osteosarcoma and who had no distant metastasis were enrolled between 1995 and 2005 at Yonsei Cancer Center, Severance Hospital, Korea. The clinical parameters were retrospectively reviewed and immunohistochemical staining (IHC) for ezrin was performed using the surgically resected specimens. RESULTS: Of the 70 tumor specimens, 39 (55.7%) revealed an ezrin expression. More of an osteoblastic histology and an elevated initial ALP level were observed in the ezrin positive patients than in the ezrin negative patients (p=0.008 and 0.001, respectively). The proportion of patients who favorably responded to neoadjuvant chemotherapy (> or =90% necrosis) was significantly higher in the group of ezrin positive patients than that in the group of ezrin negative patient (72.2% vs 45.2%, respectively, p=0.024). The ezrin positive patients showed more frequent recurrence than did the ezrin negative patients (64.1% vs 35.5%, respectively, p=0.017). The patients with an ezrin expression also demonstrated poorer survival than did those patients without ezrin expression (5-year EFS: 31.7% vs 61.3%, respectively, p=0.023, 5-year OS: 53.4% vs 71.0%, respectively, p=0.022). When comparing EFS according to both an ezrin expression and chemoresponsiveness, there were trends that the ezrin negative/chemoresponsive group showed the best 5-year EFS (71.4%), followed by the ezrin negative/chemoresistant group (52.9%), the ezrin positive/chemoresponsive group (38.1%) and the ezrin positive/chemoresistant group (13.6%). These trends were statistically significant (p=0.036). CONCLUSION: The expression of ezrin by IHC staining was found in 55.7% of the patients with metastasis-free osteosarcoma. Immunoreactivity to ezrin is a negative prognostic factor for survival for the patients suffering with osteosarcoma. Identifying an ezrin expression might offer a valuable piece of information when treating patients with primary osteosarcoma.

Keyword

Osteosarcoma; Ezrin; Chemotherapy; Survival

MeSH Terms

Cytoskeletal Proteins
Humans
Korea
Membranes
Neoplasm Metastasis
Osteoblasts
Osteosarcoma
Recurrence
Retrospective Studies
Stress, Psychological
Cytoskeletal Proteins

Figure

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  Fig. 1 Examples of ezrin immunoreactivity in osteosarcoma. Original magnification×200.

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  Fig. 2 Kaplan-Meier estimates of EFS and OS.

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  Fig. 3 EFS and OS according to ezrin expression and chemoresponsiveness.

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