Association of Ezrin expression with the progression and prognosis of gastrointestinal cancer: a meta-analysis

BACKGROUND: Ezrin, a cytoskeletal protein, is involved in cell adhesion. Several studies have been performed to explore the association between Ezrin and gastrointestinal cancers, but the results are inconclusive. This meta-analysis aims to assess the prognostic value of Ezrin. MATERIALS AND METHODS/FINDINGS: PubMed and EMBASE were searched. Pooled hazard ratio (HR), odds ratio (OR) and 95% confidence intervals (CI) were utilized to evaluate the association between Ezrin expression and various clinical parameters. 2701 patients from 19 studies were included in the meta-analysis. For gastric cancer, Ezrin expression was associated with tumor grade (OR 2.32, 95% CI 1.53–3.52), TNM stage (OR 4.69, 95% CI 1.38–15.89), lymph node involvement (OR 3.96, 95% CI 1.47–10.70) and overall survival (HR 1.88, 95% CI 1.33–2.66). In colorectal cancer, Ezrin expression was associated with tumor grade (OR 3.94, 95% CI 2.10–3.78), TNM stage (OR 5.66, 95% CI 1.41–22.67), lymph node metastasis (OR 9.52, 95% CI 3.93–23.02), distant metastasis (OR 3.06, 95% CI 1.77–5.31), disease free survival (HR 2.48, 95% CI 1.44–4.28). For esophageal cancer, Ezrin expression was associated with lymph node metastasis (OR 2.07, 95% CI 1.00–4.28) and overall survival (HR 1.49, 95% CI 1.17–1.89). CONCLUSIONS: Ezrin expression is significantly associated with tumor grade, TNM stage, and lymph node metastasis in gastric and colorectal cancers. For gastric cancers, Ezrin is useful in predicting distant metastasis. Survival data showed that high Ezrin expression is associated with poor prognosis in gastric, colorectal and esophageal cancers. Our findings suggest that Ezrin might be a potential biomarker in several gastrointestinal cancers.