Association between ezrin protein expression and the prognosis of colorectal adenocarcinoma

Abstract

Ezrin is involved in maintaining cell structure and cell motility. Expression levels of the ezrin gene correlate with numerous human malignancies. The aim of this study was to explore the role of ezrin in tumor progression and the prognostic evaluation of colorectal adenocarcinoma (CRA). The levels of ezrin protein in 186 CRA samples were evaluated using immunohistochemistry. Furthermore, the correlation between the expression of ezrin and the clinicopathological features of CRA was evaluated with the χ2 and Fisher's exact tests, survival rates were calculated using the Kaplan-Meier method, and the correlation between prognostic factors and patient survival was calculated by Cox analysis. Ezrin protein expression demonstrated an immunohistochemical cytoplasmic staining pattern in CRA. The difference between the positive rate of ezrin expression in CRA (38.7%, 72/186) and the adjacent normal mucosal tissues was deemed to be statistically significant (91.9%, 171/186; P=0.000). The positive rate of ezrin expression in cases with a large tumor, serosal invasion, lymph node (LN) metastasis, high LN ratio (LNR) and at a late tumor stage was significantly lower than in cases without these factors (P=0.044, P=0.032, P=0.002, P=0.011 and P=0.000, respectively). The 5-year survival rate of CRA without ezrin expression was lower than CRA with expression (P=0.000). Furthermore, analysis by Kaplan-Meier demonstrated that CRA cases with poor differentiation, serosal invasion and at a late tumor stage combined with no ezrin expression had a lower survival rate than cases that had these factors plus ezrin expression (P=0.000, respectively). Additionally, the non-expression of ezrin emerged as a significant independent prognostic factor in CRA prognosis (HR, 0.562; 95% CI, 0.404-0.783; P=0.001), in addition to the LNR (HR, 0.589; 95% CI, 0.369-0.939; P=0.026) and tumor stage (HR, 0.655; 95% CI, 0.487-0.880; P=0.005). This study demonstrated that ezrin may be useful to identify at-risk patients who may benefit from a more aggressive adjuvant therapy following tumor resection. Ezrin may serve as a useful therapeutic biomarker.

Immunohistochemical Study of Ezrin Expression in Colorectal Carcinoma: A Comparative Study between Objective Method and Digital Quantitative Assessment

“…Similar result was obtained by Wang et al, (2009) and Patara et al, (2011). Against this finding, Lin and Chen, (2013) and Fathi et al, (2017) reported that no significant relationship was found between ezrin expression and degree of differentiation of colorectal carcinoma in their studied cases. This may be attributed to different sample size.…”

“…The overall score was expressed as the sum of the intensity and the percentage scores with the product ranging from 0-7. On the bases of the final score, expression was categorized as negative (0-1), weakly positive (2-4) and strongly positive (5-7) (Lin and Chen, 2013).…”

Prognostic significance of CD133 and ezrin expression in colorectal carcinoma

“…The sum of staining intensity and the staining extent scores was used as final staining score. The specimens were divided into three groups according to their scores: 0–1, negative (−); 2–4, weakly positive (+); and 5–7, strongly positive (++) .…”

Loss of ezrin in human intrahepatic cholangiocarcinoma is associated with ectopic expression of E‐cadherin

“…Non-expression of ezrin has been more commonly observed in colorectal adenocarcinoma with poor prognostic factors, leading to late-stage tumours and short survival times. 25 Negative or weak ezrin expression in serous ovarian and urothelial bladder has also been reported, and correlated with poor patient outcome. 14,17,18 Similarly, we have shown that, in CCAs, non-expression or low expression of ezrin is more frequently observed in peripheral CCA than in perihilar CCA.…”

“…In contrast, decreased or no expression of ezrin has been reported in several tumours. Non‐expression of ezrin has been more commonly observed in colorectal adenocarcinoma with poor prognostic factors, leading to late‐stage tumours and short survival times . Negative or weak ezrin expression in serous ovarian and urothelial bladder has also been reported, and correlated with poor patient outcome .…”