Prediagnostic Plasma 25-Hydroxyvitamin D and Pancreatic Cancer Survival
Prediagnostic Plasma 25-Hydroxyvitamin D and Pancreatic Cancer Survival
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DOI：
10.1200/jco.2015.66.3005
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发表时间：
2016-08-20
影响因子：
45.3
通讯作者：
Wolpin, Brian M.
中科院分区：
文献类型：
--
作者：
Yuan, Chen;Qian, Zhi Rong;Wolpin, Brian M.
PurposeAlthough维生素D抑制胰腺癌增殖的实验室模型，血浆25-羟基维生素D [25（OH）D]与患者生存率的关联在很大程度上是unexplored.Patients和MethodsWe分析了493例患者的生存率从五个前瞻性美国队列谁被诊断为胰腺癌从1984年至2008年。我们使用考克斯比例风险回归模型，根据年龄、队列、人种和种族、吸烟、诊断年份、分期和采血月份调整后的血浆25（OH）D水平（不足，< 20 ng/mL;相对不足，20 - 30 ng/mL;足够>= 30 ng/mL）估计死亡的风险比（HR）。我们还评估了30个标签的单核苷酸多态性的维生素D受体基因，需要P <0.002（0.05除以30个基因型变异）的统计significance.ResultsMean诊断前血浆水平的25（OH）D为24.6 ng/mL，和165例（33%）维生素D不足。与血药浓度不足的患者相比，血药浓度相对不足的患者死亡的多变量校正HR为0. 79（95% CI，0. 48 - 1. 29），血药浓度充足的患者为0. 66（95% CI，0. 49 - 0. 90）（P趋势= 0. 01）。在进一步调整体重指数和糖尿病史后，这些结果没有变化（P趋势= 0.02）。在诊断后5年内采集血液的患者中，相关性最强，将25（OH）D水平充足的患者与25（OH）D水平不足的患者进行比较，HR为0.58（95% CI，0.35 - 0.98）。维生素D受体基因的单核苷酸多态性没有达到我们校正的显著性阈值P <0.002; rs7299460与生存率最密切相关（每个次要等位基因的HR，0.80; 95% CI，0.68至0.95;结论：我们观察到诊断前血浆25（OH）D水平足够高的胰腺癌患者总体生存期较长。(C)2016年美国临床肿瘤学会
PurposeAlthough vitamin D inhibits pancreatic cancer proliferation in laboratory models, the association of plasma 25-hydroxyvitamin D [25(OH) D] with patient survival is largely unexplored.Patients and MethodsWe analyzed survival among 493 patients from five prospective US cohorts who were diagnosed with pancreatic cancer from 1984 to 2008. We estimated hazard ratios (HRs) for death by plasma level of 25(OH) D (insufficient, < 20 ng/mL; relative insufficiency, 20 to, 30 ng/mL; sufficient >= 30 ng/mL) by using Cox proportional hazards regression models adjusted for age, cohort, race and ethnicity, smoking, diagnosis year, stage, and blood collection month. We also evaluated 30 tagging single-nucleotide polymorphisms in the vitamin D receptor gene, requiring P < .002 (0.05 divided by 30 genotyped variants) for statistical significance.ResultsMean prediagnostic plasma level of 25(OH) D was 24.6 ng/mL, and 165 patients (33%) were vitamin D insufficient. Compared with patients with insufficient levels, multivariable-adjusted HRs for death were 0.79 (95% CI, 0.48 to 1.29) for patients with relative insufficiency and 0.66 (95% CI, 0.49 to 0.90) for patients with sufficient levels (P trend = .01). These results were unchanged after further adjustment for body mass index and history of diabetes (P trend = .02). The association was strongest among patients with blood collected within 5 years of diagnosis, with an HR of 0.58 (95% CI, 0.35 to 0.98) comparing patients with sufficient to patients with insufficient 25(OH) D levels. No single-nucleotide polymorphism at the vitamin D receptor gene met our corrected significance threshold of P < .002; rs7299460 was most strongly associated with survival (HR per minor allele, 0.80; 95% CI, 0.68 to 0.95; P = .01).ConclusionWe observed longer overall survival in patients with pancreatic cancer who had sufficient prediagnostic plasma levels of 25(OH) D. (C) 2016 by American Society of Clinical Oncology