Vitamin D Insufficiency and Prognosis in Non-Hodgkin's Lymphoma
Vitamin D Insufficiency and Prognosis in Non-Hodgkin's Lymphoma
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DOI：
10.1200/jco.2010.28.6674
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发表时间：
2010-09-20
影响因子：
45.3
通讯作者：
Cerhan, James R.
中科院分区：
文献类型：
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作者：
Drake, Matthew T.;Maurer, Matthew J.;Cerhan, James R.
目的维生素D缺乏在美国很常见，在一些研究中，低水平与较高的癌症发病率有关，包括非霍奇金淋巴瘤(NHL)。最近的数据还表明，维生素D缺乏与某些癌症的预后不良有关，尽管没有关于NHL的数据。患者和方法我们在983名新诊断的NHL患者的前瞻性队列中检验了循环中25-羟基维生素D[25(OH)D]水平可以预测无事件生存(EFS)和总生存(OS)的假设。结果确诊时平均年龄62岁(19~94岁)，其中44%的患者在确诊后120天内25(OH)D水平不足(25 ng/mL)。中位随访期为34.8个月，共发生404例事件和193例死亡(168例死于淋巴瘤)。在调整已知的预后因素和治疗后，25(OH)D缺乏的弥漫性大B细胞淋巴瘤(DLBCL)患者有较低的EFS(危险比，1.41；95%CI，0.98~2.04)和OS(HR，1.99；95%CI，1.27~3.13)；25(OH)D缺乏的T细胞淋巴瘤患者也有较差的EFS(HR，1.94；95%CI，1.04~3.61)和OS(HR，2.38；95%CI，1.04~5.41)。其他非霍奇金淋巴瘤亚型与EFS无关。在DLBCL和T细胞淋巴瘤患者中，较高的1，25(OH)(2)D水平与较好的EFS和OS相关，提示任何可能的肿瘤1-α-羟基酶活性不能解释25(OH)D的相关性。结论25(OH)D缺乏与DLBCL和T细胞淋巴瘤的下EFS和OS有关。这些患者的维生素D水平正常化是否会改善结果，还需要在未来的试验中进行测试。
Purpose Vitamin D insufficiency is common in the United States, with low levels linked in some studies to higher cancer incidence, including non-Hodgkin's lymphoma (NHL). Recent data also suggest that vitamin D insufficiency is related to inferior prognosis in some cancers, although there are no data for NHL.Patients and Methods We tested the hypothesis that circulating 25-hydroxyvitamin D [25(OH)D] levels are predictive of event-free survival (EFS) and overall survival (OS) in a prospective cohort of 983 newly diagnosed patients with NHL. 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were measured by liquid chromatography-tandem mass spectrometry.Results Mean age at diagnosis was 62 years (range, 19 to 94 years); 44% of patients had insufficient 25(OH)D levels (< 25 ng/mL) within 120 days of diagnosis. Median follow-up was 34.8 months; 404 events and 193 deaths (168 from lymphoma) occurred. After adjusting for known prognostic factors and treatment, 25(OH)D insufficient patients with diffuse large B-cell lymphoma (DLBCL) had inferior EFS (hazard ratio [HR], 1.41; 95% CI, 0.98 to 2.04) and OS (HR, 1.99; 95% CI, 1.27 to 3.13); 25(OH) D insufficient patients with T-cell lymphoma also had inferior EFS (HR, 1.94; 95% CI, 1.04 to 3.61) and OS (HR, 2.38; 95% CI, 1.04 to 5.41). There were no associations with EFS for the other NHL subtypes. Among patients with DLBCL and T-cell lymphoma, higher 1,25(OH)(2)D levels were associated with better EFS and OS, suggesting that any putative tumor 1-alpha-hydroxylase activity did not explain the 25(OH)D associations.Conclusion 25(OH)D insufficiency was associated with inferior EFS and OS in DLBCL and T-cell lymphoma. Whether normalizing vitamin D levels in these patients improves outcomes will require testing in future trials.