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BMC Medical Genetics logoLink to BMC Medical Genetics
. 2019 Jan 21;20:22. doi: 10.1186/s12881-019-0750-x

Glutathione S-transferase pi 1 variant and squamous cell carcinoma susceptibility: a meta-analysis of 52 case-control studies

Shuang Wang 1, Jingqi Zhang 1, Fan Jun 1, Zhijie Bai 2,
PMCID: PMC6340173  PMID: 30665373

Abstract

Background

There are several meta-analyses on the genetic relationship between the rs1695 polymorphism within the GSTP1 (glutathione S-transferase pi 1) gene and the risk of different SCC (squamous cell carcinoma) diseases, such as ESCC (oesophageal SCC), HNSCC (head and neck SCC), LSCC (lung SCC), and SSCC (skin SCC). Nevertheless, no unified conclusions have been drawn.

Methods

Herein, an updated meta-analysis was performed to evaluate the probable impact of GSTP1 rs1695 on the susceptibility to different SCC diseases under six genetic models (allele, carrier, homozygote, heterozygote, dominant, and recessive). Three online databases, namely, PubMed, WOS (Web of Science), and Embase (Excerpta Medica Database), were searched.

Results

Initially, we obtained a total of 497 articles. Based on our selection criteria, we eventually included 52 case-control studies (9763 cases/15,028 controls) from 47 eligible articles. As shown in the pooling analysis, there was no difference in the risk of overall SCC disease between cases and controls [allele, Pa (P value of association test) = 0.601; carrier, Pa = 0.587; homozygote, Pa = 0.689; heterozygote, Pa = 0.167; dominant, Pa = 0.289; dominant, Pa = 0.548]. Similar results were obtained after stratification by race (Asian/Caucasian), genotyping, control source, and disease type (ESCC/HNSCC/LSCC/SSCC) (all Pa > 0.05).

Conclusion

The rs1695 polymorphism within the GSTP1 gene is not associated with the risk of overall SCC or a specific SCC type, including ESCC, HNSCC, LSCC, and SSCC.

Keywords: GSTP1, Polymorphism, Squamous cell carcinoma, Susceptibility

Background

SCC (squamous cell carcinoma), also termed “epidermal carcinoma,” is a malignant tumour that takes part in epidermis or adnexal cells and exhibits distinct degrees of keratosis [13]. SCC exists in the squamous epithelium of several places, e.g., skin, mouth, lung, lips, oesophagus, cervix, and vagina [46]. Based on GWAS (genome-wide association study) data, more and more reported genetic polymorphisms are believed to contribute to the aetiologies of different SCC types. For instance, a series of genes, including CADM1 (cell adhesion molecule 1), AHR (aryl hydrocarbon receptor), and SEC16A (SEC16 homolog A, endoplasmic reticulum export factor), may be related with the risk of SCC [7]. Two variants within the KLF5 (Kruppel-like factor 5) gene on chromosome 13q22.1, namely, rs1924966 and rs115797771, may be relevant to ESCC (oesophageal SCC) susceptibility [8]. Herein, we determined whether GSTP1 (glutathione S-transferase pi 1) gene polymorphism is associated with the susceptibility to different SCC patterns.

GSTP1, a member of the GST (glutathione S-transferase) family in humans, is associated with the biological detoxification or biotransformation process through catalysing the conjugation of many hydrophobic and electrophilic compounds with reduced glutathione [9, 10]. The GSTP1 gene, which is located on human chromosome 11q13, comprises seven exons and six introns [11]. Two common polymorphisms, namely, rs1695 A/G polymorphism in exon five (p.Ile105Val) and rs1138272 C/T polymorphism in exon six (p.Ala114Val), have been reported [12, 13].

Several SCC/GSTP1 rs1695-associated meta-analyses with conflicting conclusions have been reported. For instance, in 2009, Zendehdel et al. enrolled three case-control studies [1416], performed a meta-analysis to assess the association between GSTP1 rs1695 and ESCC risk in Caucasian populations, and found a borderline significant association [16]. In 2014, Song et al. enrolled 21 case-control studies to perform a meta-analysis concerning the role of the GSTP1 rs1695 polymorphism in the risk of oesophageal cancers, including EAC (oesophageal adenocarcinoma) and ESCC [17]. The subgroup meta-analysis of ESCC containing thirteen case-control studies showed a positive correlation, particularly in the Caucasian population [17]. However, in 2015, Tan et al. performed another meta-analysis with twenty case-control studies on overall oesophageal cancer and reported negative results in both ESCC and EAC subgroups [18]. Accordingly, we performed an updated meta-analysis with a relatively larger sample size to reevaluate the potential impact of the GSTP1 rs1695 A/G polymorphism on the susceptibility to SCC diseases, mainly including ESCC, SSCC, HNSCC (head and neck SCC), and LSCC (lung SCC).

Methods

Electronic database retrieval

We reviewed three on-line databases, including PubMed, WOS (Web of Science), and Embase (Excerpta Medica Database), through January 2018 using the following main search keywords: Carcinoma, Squamous Cell; Carcinomas, Squamous Cell; Squamous Cell Carcinomas; Squamous Cell Carcinoma; Carcinoma, Squamous; Carcinomas, Squamous; Squamous Carcinoma; Squamous Carcinomas; Carcinoma, Epidermoid; Carcinomas, Epidermoid; Epidermoid Carcinoma; Epidermoid Carcinomas; Carcinoma, Planocellular; Carcinomas, Planocellular; Planocellular Carcinoma; Planocellular Carcinomas; SCC; GSTP1; Glutathione S-Transferase pi; Glutathione S Transferase pi; GST Class-phi; Class-phi, GST; GST Class phi; Glutathione Transferase P1–1; Glutathione Transferase P1 1; Transferase P1–1, Glutathione; GSTP1 Glutathione D-Transferase; D-Transferase, GSTP1 Glutathione; GSTP1 Glutathione D Transferase; Glutathione D-Transferase, GSTP1; Polymorphism; Polymorphism, Genetic; Polymorphisms, Genetic; Genetic Polymorphisms; Genetic Polymorphism; Polymorphism (Genetics); Polymorphisms (Genetics); and Polymorphism; Polymorphisms.

Eligible article screening

We performed a literature search and screened the retrieved articles as per the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines [19]. Selection criteria included duplicated articles; data from animal or cell experiments; meeting abstract or meta-analysis; review, trials or case reports; data of GSTP1 expression; not SCC or GSTP1; lack confirmed histopathological data; combined GA + AA genotype frequency; without the control data; and P value of HWE (Hardy-Weinberg equilibrium) less than 0.05. Eligible case-control studies provided sufficient genotype frequency data of the GSTP1 gene rs1695 polymorphism in each case and control group.

Data extraction

Two investigators independently extracted the data and evaluated the methodological quality of each article by means of the NOS (Newcastle-Ottawa Scale) system. One table contains the following basic information: first author, publication year, region, race, genotyping assay, genotype frequency, disease type, control source, P values of HWE, study number, and sample size of the case/control.

Data synthesis

We utilized STATA software (StataCorp LP, College Station, TX, USA) for the following statistical analyses. The allele (allele G vs. A), carrier (carrier G vs. A), homozygote (GG vs. AA), heterozygote (AG vs. AA), dominant (AG + GG vs. AA), and recessive (GG vs. AA+AG) models were utilized to target the GSTP1 gene rs1695 G/A polymorphism. We calculated the OR (odds ratio), 95% CIs (confidence intervals) and Pa (P value of association test) values to estimate the association. When the Ph (P value of heterogeneity) was > 0.1 or I2 was < 50.0%, a fixed-effects model was adopted. Otherwise, a random-effects model was selected.

Considering the factors of race, genotyping assay, control source, and disease type, we performed the corresponding subgroup meta-analyses. We also carried out Egger’s/Begg’s tests to determine a potential publication bias. The presence of a publication bias was considered when PE (P value of Egger’s test) and PB (P value of Begg’s test) were below 0.05. Sensitivity analysis was applied to assess data stability and robustness.

Results

Article retrieval and screening

The article retrieval and selection processes during our meta-analysis were conducted as described in the flow chart shown in Fig. 1. After our literature search, a total of 497 articles were obtained. Then, 168 articles with duplicated data and 214 articles meeting the exclusion criteria were excluded. Next, we assessed the eligibility of the remaining 115 full-text articles. After the exclusion of 68 ineligible articles, a total of 47 articles containing 52 case-control studies [1416, 2063] were ultimately recruited for our meta-analysis. Table 1 summarizes the extracted basic information.

Fig. 1.

Fig. 1

Flow chart of eligible article selection

Table 1.

Basic information of the eligible articles in the meta-analysis

First author Year Region Race Assay Case Disease type Control Control source P HWE
AA AG GG AA AG GG
Abbas 2004 France Caucasian PCR-RFLP 21 21 3 ESCC 59 56 9 PB 0.38
Cabelguenne 2001 France Caucasian PCR-RFLP 89 57 16 HNSCC 146 139 25 HB 0.31
Cai 2006 China Asian PCR-RFLP 143 58 3 ESCC 265 116 12 PB 0.87
Cho 2006 Korea Asian Gene sequencing 201 85 7 HNSCC 211 112 10 HB 0.29
Dura 2013 Netherlands Caucasian PCR 48 42 15 ESCC 246 261 84 PB 0.27
Dzian 2012 Netherlands Caucasian PCR-RFLP 56 45 11 LSCC 153 115 22 PB/HB 0.95
Evans 2004 USA Caucasian PCR-RFLP 123 132 27 HNSCC 97 85 24 PB 0.42
Fryer 2005 Australia Caucasian PCR-RFLP 59 51 18 SSCC 95 90 25 HB 0.60
Harth 2008 Germany Caucasian PCR-melting-curve 145 122 45 HNSCC 130 138 32 HB 0.62
Jain 2006 India Asian PCR-RFLP 46 23 7 ESCC 72 56 9 HB 0.67
Jourenkova 1999a France Caucasian PCR-RFLP 49 53 15 HNSCC 86 64 22 HB 0.07
Jourenkova 1999b France Caucasian PCR-RFLP 62 52 15 HNSCC 86 64 22 HB 0.07
Jourenkova 1998 France Caucasian PCR-RFLP 46 41 11 LSCC 86 64 22 HB 0.07
Kelders 2002 Netherlands Caucasian PCR-RFLP 36 38 13 HNSCC 26 18 7 HB 0.20
Kihara 1999 Japan Asian PCR-RFLP 84 32 9 LSCC 184 65 8 HB 0.45
Larsen 2006 Australia Caucasian PCR-RFLP 230 213 51 LSCC 161 169 49a HB 0.66
Australia Caucasian PCR-RFLP 230 213 51 LSCC 112 100 35b PB 0.11
Leichsenring 2006 Brazil Mixed PCR-RFLP 30 34 8 HNSCC 30 25 5 PB 0.95
Leite 2007 Brazil Mixed PCR-RFLP 14 13 2 SSCC 60 46 18 PB 0.07
Lewis 2002 UK Caucasian PCR-RFLP 14 17 1 LSCC 64 74 13 HB 0.19
Li 2010 South African Black African PCR-RFLP 56 59 26 ESCC 76 83 27 PB 0.58
Mixed PCR-RFLP 34 52 11 ESCC 30 51 13 PB 0.24
Li 2007 USA Caucasian PCR-RFLP 336 356 111 HNSCC 333 385 121 PB 0.57
Liang 2005 China Asian diASA-AMP 58 32 4 LSCC 132 86 9 HB 0.27
Liu 2010 China Asian PCR-RFLP 66 29 0 ESCC 61 27 3 PB 1.00
Malik 2010 India Asian PCR-RFLP 53 36 14 ESCC 111 75 9 PB 0.41
Matejcic 2011 South African Black African TaqMan genotyping 79 155 91 ESCC 100 242 132 PB 0.57
South African Mixed TaqMan genotyping 69 112 48 ESCC 145 191 92 PB 0.05
McWilliams 2000 USA Mixed PCR-RFLP 60 73 13 HNSCC 58 51 15 HB 0.47
Miller 2006 USA Caucasian PCR-RFLP 190 173 49 LSCC 579 623 141 PB 0.16
Moaven 2010 Iran Asian PCR-RFLP 84 50 14 ESCC 74 54 8 PB 0.65
Nazar 2003 USA Mixed PCR-RFLP 35 29 9 LSCC 199 234 54 PB 0.23
Olshan 2000 USA Mixed PCR-RFLP 40 62 7 HNSCC 68 80 20 HBc 0.63
USA Mixed PCR-RFLP 18 38 7 HNSCC 7 13 5 HBd 0.82
Oude 2003 Netherlands Caucasian PCR-RFLP 116 90 29 HNSCC 125 121 39 PB 0.27
Peters 2006 USA Mixed PCR-RFLP 303 311 76 HNSCC 333 329 86 PB 0.73
Ramsay 2001 UK Caucasian SSCP 10 10 0 SSCC 53 71 17 HB 0.36
Risch 2001 Germany Caucasian PCR-RFLP 76 77 18 LSCC 167 151 35 HB 0.92
Rossini 2007 Brazil Mixed PCR-RFLP 42 65 18 ESCC 116 108 28 PB 0.71
Ruwali 2009 India Caucasian PCR-RFLP 224 112 14 HNSCC 199 138 13 PB 0.06
Ruwali 2011 India Caucasian PCR-RFLP 316 162 22 HNSCC 285 195 20 PB 0.06
Ryberg 1997 Norway Caucasian PCR-RFLP 20 34 13 LSCC 153 117 27 PB 0.50
Schneider 2004 Germany Caucasian PCR-melting-curve 81 75 27 LSCC 298 254 70 PB/HB 0.16
Soucek 2010 Czech/Polish Caucasian TaqMan drug metabolism genotyping 56 53 7 HNSCC 57 50 10 PB 0.52
Soya 2007 India Asian PCR-RFLP 219 162 27 UADTSCC 120 88 12 PB 0.42
Stücker 2002 France Caucasian PCR-RFLP 54 46 15 LSCC 124 120 20 HB 0.22
Tan 2000 China Asian PCR-RFLP 93 48 9 ESCC 91 53 6 PB 0.62
To 2002 Spain Caucasian PCR-RFLP 101 84 19 HNSCC 100 78 23 PB 0.20
To 1999 Spain Caucasian PCR-RFLP 29 20 3 LSCC 64 54 14 PBb 0.61
Spain Caucasian PCR-RFLP 29 20 3 LSCC 90 90 20 PBe 0.72
van 1999 Netherlands Caucasian PCR-RFLP 5 6 2 ESCC 146 89 12 PB 0.74
Zendehdel 2009 Sweden Caucasian Pyrosequencing 26 42 10 ESCC 208 207 38 PB 0.18

PCR polymerase chain reaction, PCR-RFLP polymerase chain reaction-restriction fragment length polymorphism, diASA-AMP di-allele-specific-amplification with artificially modified primers assay, SSCP Single-stranded conformational polymorphism, ESCC oesophageal squamous cell carcinoma, HNSCC head and neck squamous cell carcinoma, LSCC lung squamous cell carcinoma, SSCC skin squamous cell carcinoma, OSCC oral squamous cell carcinoma, UADTSCC upper aerodigestive tract squamous cell carcinoma, PB population-based, HB hospital-based, PHWE P value of hardy-weinberg equilibrium

aCOPD patients without LSCC, bhealthy smokers; ccontrol from Caucasian population; dcontrol from Black African population; econtrol from general population

Overall meta-analysis

First, we performed the overall meta-analysis, which included 52 case-control studies with 9763 cases and 15,028 controls (Table 2). The fixed-effects model was applied in all meta-analyses, because no substantial between-study heterogeneity was detected [Table 2, I2 value < 50.0%, Ph > 0.1]. As shown in Table 2, no altered susceptibility to SCC disease in cases was observed compared with controls [allele, Pa = 0.601; carrier, Pa = 0.587; homozygote, Pa = 0.689; heterozygote, Pa = 0.167; dominant, Pa = 0.289; dominant, Pa = 0.548]. These data suggest that the rs1695 polymorphism within the GSTP1 gene does not contribute to the risk of overall SCC.

Table 2.

Meta-analysis of the GSTP1 rs1695 A/G polymorphism

Statistical analysis Index Allele Carrier Homozygote Heterozygote Dominant Recessive
Association OR 0.99 0.99 1.02 0.96 0.97 1.03
95% CIs 0.95~1.03 0.94~1.03 0.93~1.12 0.91~1.02 0.92~1.03 0.94~1.12
P a 0.601 0.587 0.689 0.167 0.289 0.548
Sample size case 9763 9763 9763 9763 9763 9763
control 15,028 15,028 15,028 15,028 15,028 15,028
study 52 52 52 52 52 52
Heterogeneity I2 15.5% 0.0% 9.7% 7.7% 11.8% 1.2%
P h 0.174 0.999 0.278 0.318 0.239 0.450
Model Fixed Fixed Fixed Fixed Fixed Fixed
Egger’s test t 1.14 1.38 0.13 2.36 2.16 −0.31
P E 0.259 0.175 0.899 0.022 0.036 0.760
Begg’s test z 0.53 0.84 0.77 1.96 1.82 1.29
P B 0.597 0.398 0.444 0.049 0.068 0.198

OR odds ratio, CIs confidence intervals, Pa, P value of association test, Ph, P value of heterogeneity test, PE, P value of Egger’s test, PB, P value of Begg’s test

Subgroup analysis

Next, we performed additional subgroup meta-analyses according to the factors of race (Asian/Caucasian), genotyping assay (PCR-RFLP), control source (PB/HB), and disease type (ESCC/HNSCC/LSCC/SSCC). As shown in Tables 3 and 4, there were no significant associations in any subgroup analysis for all genetic models tested (all Pa > 0.05). The forest plot of the subgroup analysis by disease type under the allele model is shown in Fig. 2.

Table 3.

Subgroup analysis of the GSTP1 rs1695 A/G polymorphism by race, genotyping assay and control source

Factor Subgroup Index Allele Carrier Homozygote Heterozygote Dominant Recessive
Race Asian OR (95% CIs) 1.00 (0.89~1.12) 0.98 (0.86~1.11) 1.29 (0.94~1.76) 0.90 (0.78~1.04) 0.94 (0.82~1.08) 1.35 (0.99~1.83)
P a 0.948 0.716 0.114 0.139 0.361 0.058
Case/control 1696/2139 1696/2139 1696/2139 1696/2139 1696/2139 1696/2139
Study number 10 10 10 10 10 10
Race Caucasian OR (95% CIs) 0.98 (0.93~1.03) 0.98 (0.82~1.04) 1.00 (0.89~1.12) 0.94 (0.87~1.01) 0.95 (0.89~1.02) 1.02 (0.91~1.14)
P a 0.358 0.447 0.984 0.099 0.153 0.716
Case/control 5968/9719 5968/9719 5968/9719 5968/9719 5968/9719 5968/9719
Study number 30 30 30 30 30 30
genotyping assay PCR-RFLP OR (95% CIs) 0.99 (0.94~1.03) 0.99 (0.93~1.04) 1.01 (0.91~1.12) 0.96 (0.90~1.03) 0.97 (0.91~1.03) 1.01 (0.91~1.12)
P a 0.542 0.579 0.874 0.260 0.351 0.824
Case/control 8008/11,342 8008/11,342 8008/11,342 8008/11,342 8008/11,342 8008/11,342
Study number 42 42 42 42 42 42
control source PB OR (95% CIs) 0.98 (0.94~1.03) 0.98 (0.93~1.04) 1.00 (0.90~1.12) 0.96 (0.89~1.03) 0.96 (0.90~1.03) 1.02 (0.92~1.13)
P a 0.519 0.572 0.943 0.214 0.287 0.751
Case/control 6697/10,170 6697/10,170 6697/10,170 6697/10,170 6697/10,170 6697/10,170
Study number 31 31 31 31 31 31
control source HB OR (95% CIs) 0.98 (0.91~1.06) 0.98 (0.90~1.07) 1.00 (0.84~1.20) 0.95 (0.86~1.06) 0.96 (0.87~1.07) 1.01 (0.85~1.19)
P a 0.586 0.638 0.977 0.377 0.461 0.944
Case/control 2771/3946 2771/3946 2771/3946 2771/3946 2771/3946 2771/3946
Study number 19 19 19 19 19 19

Pa, P value of association test

PCR-RFLP polymerase chain reaction-restriction fragment length polymorphism, PB population-based, HB hospital-based, OR odds ratio, CIs confidence intervals

Table 4.

Subgroup analysis of the GSTP1 rs1695 A/G polymorphism by SCC type

Subgroup Index Allele Carrier Homozygote Heterozygote Dominant Recessive
ESCC OR (95% CIs) 1.05 (0.96~1.15) 1.03 (0.93~1.14) 1.15 (0.95~1.39) 1.00 (0.88~1.14) 1.03 (0.92~1.17) 1.13 (0.95~1.34)
P a 0.263 0.568 0.155 0.970 0.575 0.160
Case/control 1934/3951 1934/3951 1934/3951 1934/3951 1934/3951 1934/3951
Study number 15 15 15 15 15 15
HNSCC OR (95% CIs) 0.95 (0.89~1.01) 0.96 (0.89~1.03) 0.94 (0.82~1.09) 0.94 (0.87~1.02) 0.93 (0.86~1.01) 0.95 (0.83~1.09)
P a 0.112 0.247 0.408 0.131 0.102 0.459
Case/control 4671/4961 4671/4961 4671/4961 4671/4961 4671/4961 4671/4961
Study number 18 18 18 18 18 18
LSCC OR (95% CIs) 1.00 (0.93~1.08) 1.00 (0.92~1.09) 1.04 (0.88~1.24) 0.97 (0.87~1.07) 0.98 (0.89~1.09) 1.06 (0.90~1.25)
P a 0.940 0.973 0.616 0.526 0.741 0.485
Case/control 2574/5421 2574/5421 2574/5421 2574/5421 2574/5421 2574/5421
Study number 15 15 15 15 15 15
SSCC OR (95% CIs) 0.91 (0.70~1.19) 0.94 (0.69~1.28) 0.83 (0.46~1.49) 0.94 (0.64~1.36) 0.91 (0.64~1.30) 0.86 (0.49~1.51)
P a 0.493 0.688 0.532 0.728 0.605 0.597
Case/control 177/475 177/475 177/475 177/475 177/475 177/475
Study number 3 3 3 3 3 3

ESCC oesophageal squamous cell carcinoma, HNSCC head and neck squamous cell carcinoma, LSCC lung squamous cell carcinoma, SSCC skin squamous cell carcinoma, OR odds ratio, CIs confidence intervals, Pa, P value of association test

Fig. 2.

Fig. 2

Data of subgroup analysis by SCC type (allele model)

Furthermore, we included all case-controls studies regarding the specific SCC type and conducted a series of subgroup analyses by race and control source. However, similar results were obtained (data not shown). As a result, the GSTP1 gene rs1695 polymorphism is not likely related to the genetic susceptibility of a specific SCC type, including ESCC, HNSCC, LSCC, and SSCC.

Publication bias and sensitivity analysis

The publication bias analysis data obtained from Egger’s and Begg’s tests are shown in Table 2. There was no remarkable publication bias in most genetic models (PE > 0.05, PB > 0.05), except for the heterozygote (PE = 0.022, PB = 0.049) and dominant (PE = 0.036) models. The funnel plot (allele model) is displayed in Fig. 3a-b. Moreover, our sensitivity analysis led us to consider the stability of the data. Figure 4 shows a representative example of the sensitivity analysis (allele model).

Fig. 3.

Fig. 3

Funnel plot of publication bias analysis. a Egger’s test; b Begg’s test

Fig. 4.

Fig. 4

Sensitivity analysis data (allele model)

Discussion

In the current meta-analysis, we first focused on the genetic relationship between the GSTP1 rs1695 A/G polymorphism and the risk of overall SCC and then conducted subgroup analyses by the specific histological status. After rigorous screening, four main types of SCC, namely, ESCC, HNSCC, ESCC, and SSCC, were targeted.

ESCC, a type of squamous epithelium differentiation of a malignant tumour within the oesophagus, accounts for the vast majority of oesophageal cancers [64, 65]. ESCC often presents in physiological or pathological stenosis of the oesophagus, and genetic factors, carcinogens, and/or chronic irritants may contribute to the pathogenesis of ESCC [64, 65]. The GSTP1 rs1695 A/G polymorphism is significantly related to the risk of ESCC in the Kashmiri population [42]. Similarly, GSTP1 rs1695 may be an independent risk factor for ESCC in Western populations [53]. Nevertheless, different associations were detected in other reports. For instance, no difference between unrelated controls and ESCC cases was observed in a French population [14] or a Chinese population [61]. Therefore, a meta-analysis was required to comprehensively evaluate the role of the GSTP1 rs1695 A/G polymorphism in ESCC risk. Herein, we recruited 15 case-control studies involving 1934 cases and 3951 controls and performed a new meta-analysis to examine the association between the GSTP1 rs1695 A/G polymorphism and ESCC susceptibility. The carrier (carrier G vs. A) model, as well as the allele, homozygote, heterozygote, dominant and recessive genetic models, was used. Our results in the stratified analysis of specific ESCCs are consistent with the data of Tan et al. [18].

Similarly, inconsistent results regarding an association between the GSTP1 rs1695 A/G polymorphism and LSCC risk have been reported in different races and geographical locations [24, 31, 33, 34, 37, 40, 45, 47, 52, 56, 57, 60, 63]. Here, we failed to detect a positive correlation between GSTP1 rs1695 and LSCC susceptibility, consistent with the prior meta-analysis of Feng in 2013 [66] and Xu in 2014 [67].

Head and neck cancer comprises cancers of the mouth, nose, sinuses, salivary glands, throat, and lymph nodes in the neck, and HNSCC is the major pathologic type [68]. In 2012, Lang et al. enrolled 28 case-control studies to perform a meta-analysis regarding the genetic effect of the GSTP1 rs1695 A/G polymorphism on overall head and neck cancer [69]. The authors were unable to identify a positive association between the GSTP1 rs1695 A/G polymorphism and the risk of overall head and neck cancer. Nevertheless, the potential role of GSTP1 rs1695 in the susceptibility to HNSCC was not assessed. Therefore, we performed a subgroup meta-analysis of HNSCC involving 18 case-control studies, but did not identify an association between GSTP1 rs1695 and HNSCC risk.

SSCC, SBCC (skin basal cell carcinoma) and (MM malignant melanoma) are the three main types of cutaneous cancer [4]. Herein, we did not identify an association between the GSTP1 rs1695 A/G polymorphism and SSCC risk, consistent with the prior meta-analyses regarding the correlation between GSTP1 rs1695 and the susceptibility to cutaneous cancer in 2015 [70, 71].

Human GST family genes, mainly including GSTA (glutathione S-transferase alpha), GSTM1 (glutathione S-transferase mu 1), GSTT1 (glutathione S-transferase theta 1) and GSTP1, encode phase II enzymes and are thus important for the body defence, metabolic detoxification of mutagens or chemical drugs, or cellular elimination of carcinogens [9, 10]. The rs1695 A/G polymorphism within the GSTP1 gene can result in the substitution of Ile (isoleucine) for Val (valine) at amino acid position 105, which may lower the cytosolic enzyme activity of GSTP1 protein [72, 73]. Although significant associations were not obtained in our overall meta-analysis or subgroup analyses by pathological type, we cannot rule out the potential genetic effect of the GSTP1 rs1695 A/G polymorphism.

There are still some limitations to our meta-analysis that should be clarified. Even though our findings were considered reliable by our sensitivity analysis and publication bias assessment, more eligible investigations are still warranted to further enhance the statistical power. We note that population-based controls were not utilized in each case-control study. The currently available data of genotypic and allelic frequency from the on-line databases led us to only target the rs1695 polymorphism of the GSTP1 gene. Other possible functional polymorphisms of the GSTP1 gene, such as rs1138272, or relative haplotypes will be important to examine in the future. We should also pay attention to the genetic relationship between GSTP1/GSTM1/GSTT1 polymorphisms and the risk of SCC.

Conclusion

In general, based on the currently published data, the GSTP1 gene rs1695 polymorphism is not associated with the susceptibility to overall SCC diseases, including ESCC, HNSCC, LSCC, and skin SCC. The confirmation or refutation of this conclusion merits further evidence.

Acknowledgements

Not applicable.

Funding

This study was supported in part by a grant of Science Foundation from Tianjin Municipal Commission of Health and Family Planning (2015KY11).

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

AHR

Aryl hydrocarbon receptor

CADM1

Cell adhesion molecule 1

diASA-AMP

Di-allele-specific- amplification with artificially modified primers assay

Embase

Excerpta Medica Database

ESCC

Oesophageal squamous cell carcinoma

GST

Glutathione S-transferase

GSTA

Glutathione S-transferase alpha

GSTM1

Glutathione S-transferase mu 1

GSTP1

Glutathione S-transferase pi 1

GSTT1

Glutathione S-transferase theta 1

GWAS

Genome-wide association study

HB

Hospital-based

HNSCC

Head and neck squamous cell carcinoma

HWE

Hardy-Weinberg equilibrium

KLF5

Kruppel like factor 5

LSCC

Lung squamous cell carcinoma

MM

Malignant melanoma

OSCC

Oral squamous cell carcinoma

PB

Population-based

PCR

Polymerase chain reaction

PCR-RFLP

Polymerase chain reaction-restriction fragment length polymorphism

SBCC

Skin basal cell carcinoma

SCC

Squamous cell carcinoma

SEC16A

SEC16 homolog A, endoplasmic reticulum export factor

SSCC

Skin squamous cell carcinoma

SSCP

Single-stranded conformational polymorphism

UADTSCC

Upper aerodigestive tract squamous cell carcinoma

WOS

Web of Science

Authors’ contributions

SW and ZB designed the study. SW, JZ and FJ extracted, analyzed, and interpreted the data. SW and ZB drafted the manuscript. All authors read and approved the final version of the manuscript.

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Shuang Wang, Email: willa770612@163.com.

Jingqi Zhang, Email: zjq20071029@163.com.

Fan Jun, Email: feixueyizu1981@163.com.

Zhijie Bai, Email: bzjky1127@126.com.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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