Serum 25-Hydroxyvitamin D3 Levels Are Associated With Breslow Thickness at Presentation and Survival From Melanoma
Serum 25-Hydroxyvitamin D3 Levels Are Associated With Breslow Thickness at Presentation and Survival From Melanoma
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DOI：
10.1200/jco.2009.22.1135
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发表时间：
2009-11-10
影响因子：
45.3
通讯作者：
Bishop, D. Timothy
中科院分区：
文献类型：
--
作者：
Newton-Bishop, Julia A.;Beswick, Samantha;Bishop, D. Timothy
目的进行队列研究来检验较高维生素 D 水平可降低黑色素瘤复发风险的假设。方法对 271 名黑色素瘤患者进行的初步回顾性研究表明，维生素 D 可以预防黑色素瘤复发。我们在利兹黑色素瘤队列中招募的 872 名患者的生存分析中测试了这些发现（中位随访时间为 4.7 年）。结果在回顾性研究中，服用维生素 D 补充剂的自我报告与黑色素瘤复发风险降低无显着相关性（比值比 = 0.6；95% CI，0.4 至 1.1；P = 0.09）。非复发者的平均 25-羟基维生素 D(3) 水平高于复发者（49 vs 46 nmol/L；P = .3；无统计学意义）。在队列（前瞻性）研究中，较高的 25-羟基维生素 D3 水平与诊断时较低的 Breslow 厚度相关（P = .002），并且独立保护复发和死亡：血清水平增加 20 nmol/L 时，无复发生存 (RFS) 的风险比为 0.79（95% CI，0.64 至 0.96；P = .01）。有证据表明维生素 D 受体 (VDR) BsmI 基因型与 RFS 的血清 25-羟基维生素 D3 水平之间存在相互作用。结论回顾性研究的结果与维生素 D 在黑色素瘤结局中的作用一致。该队列研究检验了这一假设，提供的证据表明，诊断时较高的 25-羟基维生素 D3 水平与肿瘤变薄和黑色素瘤生存率提高相关，且与 Breslow 厚度无关。黑色素瘤患者和黑色素瘤高危人群应确保维生素 D 充足。需要进行更多研究来确定黑色素瘤患者的最佳血清水平。
PurposeA cohort study was carried out to test the hypothesis that higher vitamin D levels reduce the risk of relapse from melanoma.MethodsA pilot retrospective study of 271 patients with melanoma suggested that vitamin D may protect against recurrence of melanoma. We tested these findings in a survival analysis in a cohort of 872 patients recruited to the Leeds Melanoma Cohort (median follow-up, 4.7 years).ResultsIn the retrospective study, self-reports of taking vitamin D supplements were nonsignificantly correlated with a reduced risk of melanoma relapse (odds ratio = 0.6; 95% CI, 0.4 to 1.1; P = .09). Nonrelapsers had higher mean 25-hydroxyvitamin D(3) levels than relapsers ( 49 v 46 nmol/L; P = .3; not statistically significant). In the cohort ( prospective) study, higher 25-hydroxyvitamin D3 levels were associated with lower Breslow thickness at diagnosis ( P = .002) and were independently protective of relapse and death: the hazard ratio for relapse-free survival (RFS) was 0.79 ( 95% CI, 0.64 to 0.96; P = .01) for a 20 nmol/L increase in serum level. There was evidence of interaction between the vitamin D receptor (VDR) BsmI genotype and serum 25-hydroxyvitamin D3 levels on RFS.ConclusionResults from the retrospective study were consistent with a role for vitamin D in melanoma outcome. The cohort study tests this hypothesis, providing evidence that higher 25-hydroxyvitamin D3 levels, at diagnosis, are associated with both thinner tumors and better survival from melanoma, independent of Breslow thickness. Patients with melanoma, and those at high risk of melanoma, should seek to ensure vitamin D sufficiency. Additional studies are needed to establish optimal serum levels for patients with melanoma.