血清维生素D浓度与前列腺癌风险：一项巢式病例对照研究。
Serum vitamin D concentration and prostate cancer risk: a nested case-control study.
作者信息
Ahn Jiyoung, Peters Ulrike, Albanes Demetrius, Purdue Mark P, Abnet Christian C, Chatterjee Nilanjan, Horst Ronald L, Hollis Bruce W, Huang Wen-Yi, Shikany James M, Hayes Richard B
机构信息
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Blvd, Bethesda, MD 20892, USA.
出版信息
J Natl Cancer Inst. 2008 Jun 4;100(11):796-804. doi: 10.1093/jnci/djn152. Epub 2008 May 27.
BACKGROUND
Epidemiological studies have yielded inconsistent associations between vitamin D status and prostate cancer risk, and few studies have evaluated whether the associations vary by disease aggressiveness. We investigated the association between vitamin D status, as determined by serum 25-hydroxyvitamin D [25(OH)D] level, and risk of prostate cancer in a case-control study nested within the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.
METHODS
The study included 749 case patients with incident prostate cancer who were diagnosed 1-8 years after blood draw and 781 control subjects who were frequency matched by age at cohort entry, time since initial screening, and calendar year of cohort entry. All study participants were selected from the trial screening arm (which includes annual standardized prostate cancer screening). Conditional logistic regression was used to estimate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) by quintile of season-standardized serum 25(OH)D concentration. Statistical tests were two-sided.
RESULTS
No statistically significant trend in overall prostate cancer risk was observed with increasing season-standardized serum 25(OH)D level. However, serum 25(OH)D concentrations greater than the lowest quintile (Q1) were associated with increased risk of aggressive (Gleason sum > or = 7 or clinical stage III or IV) disease (in a model adjusting for matching factors, study center, and history of diabetes, ORs for Q2 vs Q1 = 1.20, 95% CI = 0.80 to 1.81, for Q3 vs Q1 =1.96, 95% CI = 1.34 to 2.87, for Q4 vs Q1 = 1.61, 95% CI = 1.09 to 2.38, and for Q5 vs Q1 = 1.37, 95% CI = 0.92 to 2.05; P(trend) = .05). The rates of aggressive prostate cancer for increasing quintiles of serum 25(OH)D were 406, 479, 780, 633, and 544 per 100 000 person-years. In exploratory analyses, these associations with aggressive disease were consistent across subgroups defined by age, family history of prostate cancer, diabetes, body mass index, vigorous physical activity, calcium intake, study center, season of blood collection, and assay batch.
CONCLUSION
The findings of this large prospective study do not support the hypothesis that vitamin D is associated with decreased risk of prostate cancer; indeed, higher circulating 25(OH)D concentrations may be associated with increased risk of aggressive disease.
背景
流行病学研究显示维生素D水平与前列腺癌风险之间的关联并不一致，而且很少有研究评估这种关联是否因疾病侵袭性而异。在前列腺、肺、结肠和卵巢（PLCO）癌筛查试验中的一项病例对照研究中，我们调查了由血清25-羟基维生素D[25(OH)D]水平所确定的维生素D状态与前列腺癌风险之间的关联。
方法
该研究纳入了749例前列腺癌新发病例患者，这些患者在采血后1至8年被诊断出患有前列腺癌，以及781例对照受试者，这些对照受试者在队列入组时的年龄、首次筛查后的时间以及队列入组的日历年份上进行了频率匹配。所有研究参与者均选自试验筛查组（其中包括年度标准化前列腺癌筛查）。采用条件逻辑回归，根据季节标准化血清25(OH)D浓度的五分位数估计调整后的比值比（OR）及95%置信区间（CI）。统计检验为双侧检验。
结果
随着季节标准化血清25(OH)D水平升高，未观察到总体前列腺癌风险有统计学显著趋势。然而，血清25(OH)D浓度高于最低五分位数（Q1）与侵袭性疾病（Gleason评分总和≥7或临床分期为III或IV期）风险增加相关（在调整匹配因素、研究中心和糖尿病史的模型中，Q2与Q1相比的OR = 1.20，95%CI = 0.80至1.81；Q3与Q1相比的OR = 1.96，95%CI = 1.34至2.87；Q4与Q1相比的OR = 1.61，95%CI = 1.09至2.38；Q5与Q1相比的OR = 1.37，95%CI = 0.92至2.05；P趋势 = 0.05）。血清25(OH)D五分位数升高时侵袭性前列腺癌的发病率分别为每10万人年406、479、780、633和544例。在探索性分析中，这些与侵袭性疾病的关联在按年龄、前列腺癌家族史、糖尿病、体重指数、剧烈体力活动、钙摄入量、研究中心、采血季节和检测批次定义的亚组中是一致的。
结论
这项大型前瞻性研究的结果不支持维生素D与降低前列腺癌风险相关的假设；事实上，循环中较高的25(OH)D浓度可能与侵袭性疾病风险增加相关。
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