Tumor Biology

, Volume 36, Issue 11, pp 8471–8478 | Cite as

The impact of immunohistochemical staining with ezrin-carbonic anhydrase IX and neuropilin-2 on prognosis in patients with metastatic renal cell cancer receiving tyrosine kinase inhibitors

  • Bulent Cetin
  • Ipek Isık Gonul
  • Suleyman Buyukberber
  • Barıs Afsar
  • Ozge Gumusay
  • Efnan Algın
  • Nedim Turan
  • Ahmet Ozet
  • Mustafa Benekli
  • Ugur Coskun
Research Article


The identification of prognostic factors in patients with renal cell carcinoma (RCC) represents an area of increasing interest. In this retrospective study, we evaluated the prognostic role of carbonic anhydrase-IX, ezrin, and neuropilin in metastatic RCC patients. The expression of several biomarkers were measured by immunohistochemistry (IHC) in 45 patients with advanced stage RCC treated with second-line tyrosine kinase inhibitors (TKIs) targeting vascular endothelial growth factor (VEGF) after failure of interferon-alpha between January 2007 and June 2012. Kaplan-Meier curves and log-rank tests were used for analysis of progression-free survival (PFS) and overall survival (OS), and a multivariate Cox proportional hazard model was employed to identify factors with an independent effect on the survival. Age, ezrin and neuropilin-2 overexpression were found to be statistically significant factors (P < 0.05) for PFS in the univariate analysis. Ezrin and neuropilin-2 overexpression, hemoglobin and albumin level were statistically significant factors (P < 0.05) for OS in the univariate analysis. Multivariate analysis revealed that low expression of ezrin and neuropilin-2 was an independent prognostic factor for PFS and OS. The median PFS was 4 months for patients overexpressing neuropilin-2 versus 11 months for those with lower expression of neuropilin-2 (p = 0.033). The median OS was longer in patients with low levels of neuropilin-2 expression (26 months) compared to patients overexpressing neuropilin-2 (13 months) (p = 0.023). Increased expression of ezrin was associated with poor prognosis in patients treated with TKIs targeting VEGF (PFS, 3 vs 7 months; p = 0.012). High ezrin expression was associated with shorter OS (p = 0.009). This is the first study in the literature showing that neuropilin-2 and ezrin are related with prognosis in patients with advanced RCC.


Advanced renal cell carcinoma Molecular markers Targeted drugs Prognostic factors 


Conflicts of interest



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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2015

Authors and Affiliations

  • Bulent Cetin
    • 1
  • Ipek Isık Gonul
    • 2
  • Suleyman Buyukberber
    • 3
  • Barıs Afsar
    • 4
  • Ozge Gumusay
    • 3
  • Efnan Algın
    • 5
  • Nedim Turan
    • 6
  • Ahmet Ozet
    • 3
  • Mustafa Benekli
    • 3
  • Ugur Coskun
    • 3
  1. 1.Department of Internal Medicine, Division of Medical OncologyVan Education and Research HospitalEdremitTurkey
  2. 2.Department of PathologyGazi University Faculty of MedicineAnkaraTurkey
  3. 3.Department of Internal Medicine, Division of Medical OncologyGazi University Faculty of MedicineAnkaraTurkey
  4. 4.Department of Internal Medicine, Division of NephrologyKonya Numune State HospitalKonyaTurkey
  5. 5.Department of Internal Medicine, Division of Medical OncologyAnkara Numune Education and Research HospitalAnkaraTurkey
  6. 6.Department of Internal Medicine, Division of Medical OncologyCumhuriyet University Faculty of MedicineSivasTurkey

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