High ezrin immunoreactivity is an indicator of poor survival in squamous cell carcinoma of uterine cervix

Context: Ezrin, the membrane-linking protein, is highly expressed in several types of human cancers, and correlations between its immunoreactivity and histopathological data as well as patient outcome have previously been shown. Aims: The aim of our study was to investigate the expression of ezrin in cases of cervical squamous cell carcinoma, then correlate the data with survival and other clinicopathological variables. Materials and Methods: We carried out immunohistochemical analysis of ezrin in 64 cases of cervical cancer and correlated it to clinicopathologic variables and disease outcome. Results: Ezrin was identified in 50 (78.1%) of 64 studied cervical cancer cases, which was classified as weak, moderate and marked in 16%, 28% and 56%, respectively. In contrast to the predominantly membranous immunoreactivity in normal cervical epithelium, it was cytoplasmic in cancer cells. Ezrin expression significantly correlated with lymph node metastasis and development of distant metastasis (P<0.001 and 0.0006, respectively), as well as with tumor grade and stage (P=0.02 and 0.05, respectively), but not with other variables such as age, tumor size, and histological type. Regarding outcome, high ezrin expression was associated with short disease-specific survival (DSS) and disease-free survival (DFS) and poor metastasis survival (MS); (P<0.001). Ezrin expression significantly predicted both the 5-year MS, DSS, and DFS, recording P value<0.001 in each. Conclusions: Our results suggested that ezrin expression may represent an effective prognostic marker and a potential target for treatment of invasion and metastasis in cervical cancer.