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The association between SPINK1 and clinical outcomes in patients with prostate cancer: a systematic review and meta-analysis

Authors Zhang X, Yin X, Shen P, Sun G, Yang Y, Liu J, Chen N, Zeng H

Received 10 November 2016

Accepted for publication 28 February 2017

Published 22 June 2017 Volume 2017:10 Pages 3123—3130


Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Ingrid Espinoza

Xingming Zhang,1,* Xiaoxue Yin,2,* Pengfei Shen,1,* Guangxi Sun,1 Yaojing Yang,1 Jiandong Liu,1 Ni Chen,2 Hao Zeng1

1Department of Urology, Institute of Urology, 2Department of Pathology, West China Hospital, Sichuan University, Chengdu, People’s Republic of China

*These authors contributed equally to this work

Abstract: Evidence of the prognostic role of serine peptidase inhibitor Kazal type 1 (SPINK1) in prostate cancer (PCa) is controversial. The aim of this study was, therefore, to evaluate the association between SPINK1 and clinical outcomes in PCa. Searches were made of PubMed, Medline, Embase, and the China Biology Medicine disc (CBMdisc) up to January 2017. The Newcastle–Ottawa Scale was used to assess the risk of bias of included studies. RevMan software was used to perform meta-analysis, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method was employed for assessing the quality of the evidence. Ten studies with 17,161 patients were included in the analysis. Random-effect models were adopted for all outcomes with significant heterogeneities. In patients treated with radical prostatectomy, SPINK1 was associated with biochemical recurrence (BCR) (hazard ratio [HR] =1.41, 95% confidence interval [CI]: 1.01–1.97; P=0.04), but not PCa-specific mortality (HR =0.93, 95% CI: 0.33–2.57; P=0.88), and overall survival (OS) (HR =0.89, 95% CI: 0.58–1.35; P=0.57). In metastatic PCa, SPINK1 was significantly associated with castration-resistant PCa-free survival (HR =3.87, 95% CI: 1.87–8.00; P=0.0003) and OS (HR =2.59, 95% CI: 1.16–5.78; P=0.02). However, the quality of the evidence was very low for all study outcome measures. In conclusion, although SPINK1 was not a predictor of PCa mortality or OS among patients who underwent radical prostatectomy, it may have prognostic value in metastatic PCa.

Keywords: SPINK1, clinical outcomes, prostate cancer, meta-analysis, systematic review

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