一项关于血浆25-羟基维生素D浓度与结直肠癌风险的巢式病例对照研究。
A nested case control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer.
作者信息
Wu Kana, Feskanich Diane, Fuchs Charles S, Willett Walter C, Hollis Bruce W, Giovannucci Edward L
机构信息
Department of Nutrition, Harvard School of Public Health, 665 Huntington Ave, Bldg 2, Boston, MA 02115, USA.
出版信息
J Natl Cancer Inst. 2007 Jul 18;99(14):1120-9. doi: 10.1093/jnci/djm038. Epub 2007 Jul 10.
BACKGROUND
Low vitamin D status has long been implicated in colorectal carcinogenesis. We investigated this relationship in a nested case-control study within the Health Professionals Follow-up Study (HPFS), a large ongoing study of male health professionals living in the United States.
METHODS
Between 1993 and 2002, 179 colorectal cancer patients were diagnosed and matched to 356 control subjects by age and by month and year of blood collection. Results were also pooled with previously published results from the Nurses' Health Study (NHS) cohort, a large female cohort. Conditional logistic regression was used to analyze the association between plasma 25-hydroxyvitamin D [25(OH)D] and colorectal cancer, and pooled estimates were calculated using the method of DerSimonian and Laird. All statistical tests were two-sided.
RESULTS
In the HPFS, we observed a non-statistically significant inverse association between higher plasma 25(OH)D concentration and risk of colorectal cancer and a statistically significant inverse association for colon cancer (highest versus lowest quintile: odds ratio [OR] = 0.46, 95% confidence interval [CI] = 0.24 to 0.89; P(trend) = .005). After pooling the results from the HPFS and NHS, higher plasma 25(OH)D concentrations were statistically significantly associated with decreased risks of both colorectal cancer (highest versus lowest quintile, OR = 0.66, 95% CI = 0.42 to 1.05; P(trend) = .01) and colon cancer (highest versus lowest quintile, OR = 0.54, 95% CI = 0.34 to 0.86; P(trend) = .002). Inverse associations with plasma 25(OH)D concentration did not differ by location of colon cancer (proximal versus distal), but the number of patients was small and none of the associations was statistically significant. Opposite relationships between plasma 25(OH)D levels and risk of rectal cancers were found among men (positive) and women (inverse).
CONCLUSION
Our data provide additional support for the inverse association between vitamin D and colorectal and, in particular, colon cancer risk.
背景
长期以来，低维生素D状态一直被认为与结直肠癌的发生有关。我们在健康专业人员随访研究（HPFS）中的一项巢式病例对照研究中调查了这种关系，HPFS是一项针对居住在美国的男性健康专业人员正在进行的大型研究。
方法
在1993年至2002年期间，179例结直肠癌患者被诊断出来，并根据年龄以及采血的月份和年份与356名对照者进行匹配。结果还与护士健康研究（NHS）队列（一个大型女性队列）先前发表的结果进行了汇总。使用条件逻辑回归分析血浆25-羟基维生素D [25(OH)D]与结直肠癌之间的关联，并使用DerSimonian和Laird方法计算汇总估计值。所有统计检验均为双侧检验。
结果
在HPFS中，我们观察到较高的血浆25(OH)D浓度与结直肠癌风险之间存在非统计学显著的负相关，而与结肠癌存在统计学显著的负相关（最高五分位数与最低五分位数相比：比值比[OR]=0.46，95%置信区间[CI]=0.24至0.89；P(趋势)=.005）。在汇总HPFS和NHS的结果后，较高的血浆25(OH)D浓度与结直肠癌风险降低（最高五分位数与最低五分位数相比，OR = 0.66，95% CI = 0.42至1.05；P(趋势)=.01）和结肠癌风险降低（最高五分位数与最低五分位数相比，OR = 0.54，95% CI = 0.34至0.86；P(趋势)=.002）均存在统计学显著关联。血浆25(OH)D浓度与结肠癌风险的负相关在结肠癌的位置（近端与远端）方面没有差异，但患者数量较少，且没有一种关联具有统计学显著性。在男性（正相关）和女性（负相关）中发现血浆25(OH)D水平与直肠癌风险之间存在相反的关系。
结论
我们的数据为维生素D与结直肠癌，特别是结肠癌风险之间的负相关提供了额外的支持。
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