Meta-analysis of Associations of the Ezrin Gene with Human Osteosarcoma Response to Chemotherapy and Prognosis

Various studies examining the relationship between Ezrin overexpression and response to chemotherapy andclinical outcome in patients with osteosarcoma have yielded inconclusive results. We accordingly conducted ameta-analysis of 7 studies (n = 318 patients) that evaluated the correlation between Ezrin and histologic responseto chemotherapy and clinical prognosis (death). Data were synthesized in receiver operating characteristic curvesand with fixed-effects and random-effects likelihood ratios and risk ratios. Quantitative synthesis showed thatEzrin is not a prognostic factor for the response to chemotherapy. The positive likelihood ratio was 0.538 (95%confidence interval [95% CI], 0.296- 0.979; random-effects calculation), and the negative likelihood ratio was2.151 (95% CI, 0.905- 5.114; random-effects calculations). There was some between-study heterogeneity, butno study showed strong discriminating ability. Conversely, Ezrin positive status tended to be associated with alower 2-year survival (risk ratio, 2.45; 95% CI, 1.26-4.76; random-effects calculation) with some between-studyheterogeneity that disappeared when only studies that employed immunohistochemistry were considered (riskratio, 2.97; 95% CI, 2.01- 4.40; fixed-effects calculation). To conclude, Ezrin is not associated with the histologicresponse to chemotherapy in patients with osteosarcoma, whereas Ezrin positivity was associated with a lower2-year survival rate regarding risk of death at 2 years. Expression change of Ezrin is an independent prognosticfactor in patients with osteosarcoma.