Tissue Biomarkers for Prognosis of Prostate Cancer: A Systematic Review and Meta-analysis

Background: Although numerous investigators have made efforts to assess prognostic biomarkers of prostate cancer, no biomarker has been recommended for clinical practice. Methods: According to REMARK (Reporting recommendations for tumor marker prognostic studies) and MISFISHIE (Minimum information specification for in situ hybridization and immunohistochemistry experiments) guidelines, the published articles of immunohistochemistry-based prognostic biomarkers on prostate cancer were extracted and pooled. Results: Ninety-three prognostic biomarkers from 92 high-quality cohort studies were included in this meta-analysis. Our analysis reveals some promising independent prognostic biomarkers, including Ki-67 [ all-cause mortality (ACM) HR, 1.85; 95% confidence interval (CI), 1.06-3.25; PSM HR, 1.82; 95% CI, 1.42-2.34; DFS HR, 1.51; 95% CI, 1.31-1.75]; Bcl-2 (ACM HR, 2.14; 95% CI, 1.27-3.58; PSM HR, 1.61; 95% CI, 1.01-2.57; DFS HR, 3.86; 95% CI, 2.14-6.96); CD147(ACM HR, 2.63; 95% CI, 1.19-5.81; DFS HR, 5.84; 95% CI, 3.41-9.99); COX-2 (PSM HR, 7.6; 95% CI, 0.7-80.1; DFS HR, 7.9; 95% CI, 2.62-23.83); ALDH1A1(ACM HR, 1.73; 95% CI, 1.163-2.527; PSM HR, 1.05; 95% CI, 1.028-1.107), and FVIII (ACM HR, 1.76; 95% CI, 1.19-2.60; PSM HR, 1.01; 95% CI, 1.01-1.02). Conclusions: Our analysis identified a subset of biomarkers (Ki-67, Bcl-2, CD147, COX-2, ALDH1A1, and FVIII) that may have prognostic value for predicting the outcome of patients with prostate cancer. Impact: These reliable prognostic biomarkers will improve the clinical management of patients with prostate cancer. (C) 2014 AACR.