Prognostic Benefits of Epithelial Mesenchymal Transition (EMT) markers; Ezrin&Twist-1 Expression in Squamous Cell Carcinoma (SCC) of the Cervix

Background The epithelial mesenchymal transition (EMT) process that has been incriminated in cancer metastases has been extensively studied in several cancers. EMT is controlled by several factors and signaling pathways. Studies about these factors are aiming to detect targeted therapy to several cancer types to improve patients' prognosis. Ezrin& Twist-1 were found to have many roles in EMT and cancer metastases in several cancer types but their role in Squamous Cell Carcinoma (SCC) of the cervix has not been clarified yet. Aim of this study is, to evaluate the prognostic roles of Ezrin& Twist-1 tissue protein expression in Squamous Cell Carcinoma (SCC) of the Cervix. Methods we have assessed theEzrin& Twist-1 expression using immunohistochemistry in section from 40 paraffin blocks of 40 patients of SCC of the cervix, we have followed the 40 patients for about 3 years aiming to detect the correlations between tissue protein expression of both markers, clincopathological features and patients prognosis. Results Ezrin expression was positively correlated with increased cancer size, presence of L. N metastases (p=0.003), higher cancer grade (p=0.006), presence of lymphovascular invasion (p=0.004), advanced FIGO stage (pless than0.001)and higher incidence of distant metastases (p=0.009). Twist-1 expression was positively correlated with increased cancer size, presence of L. N metastases (p=0.025), higher cancer grade (p=0.004), presence of lymphovascular invasion (p=0.002), advanced FIGO stage (pless than0.001)and higher incidence of distant metastases (p=0.006). Cases with increased expression of Ezrin and Twist-1 have higher rate of malignant progression, resistance to chemo-therapy, worse OS& DFS rates and recurrence of the disease after successful therapy (pless than0.001). We have found a highly significant correlation between both Ezrin& Twist-1expressions in SCC of the cervix (pless than0.001). Table 4, Fig 3. Conclusion, increased tissue protein expression of both Ezrin& Twist-1 is associated with poor clinicopathological and prognostic parameters of patients with SCC of the cervix.