Correlation of ezrin expression level and clinical significance for patients with bone and soft tissue sarcomas: a meta-analysis

Osteosarcoma, Ewing sarcoma, and chondrosarcoma are the most common malignancies of bone in the first 3 decades, which originates from primitive bone-forming mesenchymal cells. However, the prognostic value of Ezrin expression in osteosarcoma patients' survival or the clinical features remains controversial. In this regard, we conducted a meta-analysis to evaluate the correlation of Ezrin expression level and clinical significance for patients with bone and soft tissue sarcomas. Literature searches in PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBMdisc), WanFang Database were conducted from inception to January 2017 with no restriction to language. Methodological quality of the included studies was also assessed. Studies were pooled and summary hazard ratios (HRs) with corresponding confidence intervals (CIs) were calculated by using the STATA 12.0 software. A total of 19 clinical cohort studies with 1498 bone and soft tissue sarcomas patients were included for meta-analysis. The results of meta-analysis showed that high level of Ezrin expression was associated with poorer OS (HR=1.91, 95% CI: 1.72 similar to 2.12, P=0.001) and MFS (HR=1.63, 95% CI: 1.10 similar to 2.40, P=0.014). Subgroup analysis indicated that pooled HR estimate for overall survival was 1.75 (95% CI: 1.48-2.07, P=0.001) for patients with osteosarcoma, 1.92 (95% CI: 1.58-2.35, P=0.001) for patients with chondrosarcoma, 2.01 (95% CI: 1.64-2.45, P=0.001) for patients with synovial sarcoma, 2.21 (95% CI: 1.52-3.21, P=0.001) for patients with Ewing sarcoma, and 7.98 (95% CI: 1.79-35.39, P=0.006) for patients with malignant fibrous histiocytoma. However, there is no significant difference in EFS (HR=1.55, 95% CI: 0.59 similar to 4.07, P=0.374). Ezrin may be a novel biomarker in promoting tumor cell invasion and metastasis and with a great prognostic value for patients with bone and soft tissue sarcomas.