循环25-羟维生素D水平可预测早期非小细胞肺癌患者的生存率。

Circulating 25-hydroxyvitamin D levels predict survival in early-stage non-small-cell lung cancer patients.

作者信息

Zhou Wei, Heist Rebecca S, Liu Geoffrey, Asomaning Kofi, Neuberg Donna S, Hollis Bruce W, Wain John C, Lynch Thomas J, Giovannucci Edward, Su Li, Christiani David C

机构信息

Departments of Environmental Health, Harvard School of Public Health, Boston, MA 02115, USA.

出版信息

J Clin Oncol. 2007 Feb 10;25(5):479-85. doi: 10.1200/JCO.2006.07.5358.

DOI:10.1200/JCO.2006.07.5358

PMID:17290055

Abstract

PURPOSE

Our previous analyses suggested that surgery in the summertime with higher vitamin D intake is associated with improved survival in patients with early-stage non-small-cell lung cancer (NSCLC). We further investigated the results of circulating 25-hydroxyvitamin D (25[OH]D) levels on overall survival (OS) and recurrence-free survival (RFS) in NSCLC patients.

PATIENTS AND METHODS

Among 447 patients with early-stage NSCLC, data were analyzed using Cox proportional hazards models, adjusting for age, sex, stage, smoking, and treatment.

RESULTS

The median follow-up time was 72 months (range, 0.2 to 141), with 161 recurrences and 234 deaths. For OS, the adjusted hazard ratio (AHR) was 0.74 (95% CI, 0.50 to 1.10; Ptrend = .07) for the highest versus lowest quartile of 25(OH)D levels. Stratified by stage, a strong association was observed among stage IB-IIB patients (AHR, 0.45; 95% CI, 0.24 to 0.82; Ptrend = .002), but not among stage IA patients (AHR, 1.10; 95% CI, 0.62 to 1.96; Ptrend = .53). Similar effects of 25(OH)D levels were observed among the 309 patients with dietary information (AHR, 0.74; 95% CI, 0.46 to 1.17; Ptrend = .19). For the joint effects of 25(OH)D level and vitamin D intake, the combined high 25(OH)D levels and high vitamin D intake (by median) were associated with better survival than the combined low 25(OH)D levels and low vitamin D intake (AHR, 0.64; 95% CI, 0.42 to 0.98; Ptrend = .06). Again, stronger associations were observed among stage IB-IIB than IA patients. Similar effects of 25(OH)D levels and vitamin D intake were observed for RFS.

CONCLUSION

Vitamin D may be associated with improved survival of patients with early-stage NSCLC, particularly among stage IB-IIB patients.

摘要

目的

我们之前的分析表明，夏季手术且维生素D摄入量较高与早期非小细胞肺癌（NSCLC）患者生存率提高相关。我们进一步研究了循环25-羟维生素D（25[OH]D）水平对NSCLC患者总生存期（OS）和无复发生存期（RFS）的影响。

患者与方法

在447例早期NSCLC患者中，采用Cox比例风险模型分析数据，并对年龄、性别、分期、吸烟和治疗情况进行校正。

结果

中位随访时间为72个月（范围0.2至141个月），有161例复发和234例死亡。对于OS，25(OH)D水平最高四分位数与最低四分位数相比，校正风险比（AHR）为0.74（95%CI，0.50至1.10；P趋势 = 0.07）。按分期分层，IB-IIB期患者中观察到强相关性（AHR，0.45；95%CI，0.24至0.82；P趋势 = 0.002），但IA期患者中未观察到（AHR，1.10；95%CI，0.62至1.96；P趋势 = 0.53）。在309例有饮食信息的患者中观察到25(OH)D水平有类似影响（AHR，0.74；95%CI，0.46至1.17；P趋势 = 0.19）。对于25(OH)D水平和维生素D摄入量的联合影响，25(OH)D水平高且维生素D摄入量高（按中位数）组合与25(OH)D水平低且维生素D摄入量低组合相比，生存期更好（AHR，0.64；95%CI，0.42至0.98；P趋势 = 0.06）。同样，IB-IIB期患者中的相关性比IA期患者更强。对于RFS，观察到25(OH)D水平和维生素D摄入量有类似影响。