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Ezrin expression predicts local recurrence and development of metastases in soft tissue sarcomas
  1. Ana Carneiro1,
  2. Pär-Ola Bendahl1,
  3. Måns Åkerman2,
  4. Henryk A Domanski2,
  5. Anders Rydholm3,
  6. Jacob Engellau1,
  7. Mef Nilbert1,4
  1. 1Department of Oncology, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
  2. 2Department of Pathology, Institute of Laboratory Sciences, Skane University Hospital, Lund University, Lund, Sweden
  3. 3Department of Orthopaedics, Institute of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
  4. 4Clinical Research Centre, Hvidovre University Hospital, Copenhagen University, Hvidovre, Denmark
  1. Correspondence to Ana Carneiro, Department of Oncology, Skane University Hospital, Barngatan 2, SE-221 85 Lund, Sweden; ana.carneiro{at}


Background Ezrin is a cytoskeletal protein involved in tumour growth and invasion. Ezrin expression has been suggested to play a role in metastasis in paediatricosteosarcoma and rhabdomyosarcoma.

Aim To evaluate the prognostic role of ezrin in a large series of soft tissue sarcoma of the extremities and trunk wall.

Methods Ezrin expression was evaluated by immunohistochemistry on tissue microarrays from a mixed series of 256 soft tissue sarcomas. The expression patterns were correlated to local recurrence and metastasis as well as to established prognostic factors in soft tissue sarcoma.

Results Increased ezrin expression predicted development of metastasis (HR=1.8, 95% CI 1.1 to 2.8; p=0.007) and local recurrence, also after adjustment for surgical margin (HR=2.4, 95% CI 1.4 to 4.3; p=0.02). Correlations to established prognostic factors showed strong associations between ezrin and necrosis (OR=3.9, p<0.0001) and ezrin and growth pattern (OR=3.1, p=0.03).

Conclusions Ezrin independently predicts development of local recurrences and metastases in soft tissue sarcomas. The possibility of preoperative evaluation makes ezrin a potential marker for identification of high-risk sarcoma patients who would benefit from neoadjuvant therapy.

  • Prognosis
  • preoperative
  • neoadjuvant
  • biopsy
  • growth pattern
  • immunocytochemistry
  • metastasis
  • soft tissue tumours

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  • Funding The study was supported by the Swedish Cancer Fund, the Swedish Research Council, the Nilsson Cancer Foundation, the Kamprad Cancer Foundation, and the Region Skåne/ALF Funds. AC has received a fellowship from the Portuguese Foundation for Science and Technology (SFRH/BD/27561/2006).

  • Competing interests None.

  • Ethics approval The Lund University research ethics committee granted ethical permission for the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.