College of Medicine, Mayo Clinic, Rochester, MN 55905, USA.
J Clin Oncol. 2010 Sep 20;28(27):4191-8. doi: 10.1200/JCO.2010.28.6674. Epub 2010 Aug 16.
Vitamin D insufficiency is common in the United States, with low levels linked in some studies to higher cancer incidence, including non-Hodgkin's lymphoma (NHL). Recent data also suggest that vitamin D insufficiency is related to inferior prognosis in some cancers, although there are no data for NHL.
We tested the hypothesis that circulating 25-hydroxyvitamin D [25(OH)D] levels are predictive of event-free survival (EFS) and overall survival (OS) in a prospective cohort of 983 newly diagnosed patients with NHL. 25(OH)D and 1,25-dihydroxyvitamin D [1,25(OH)(2)D] levels were measured by liquid chromatography-tandem mass spectrometry.
Mean age at diagnosis was 62 years (range, 19 to 94 years); 44% of patients had insufficient 25(OH)D levels (< 25 ng/mL) within 120 days of diagnosis. Median follow-up was 34.8 months; 404 events and 193 deaths (168 from lymphoma) occurred. After adjusting for known prognostic factors and treatment, 25(OH)D insufficient patients with diffuse large B-cell lymphoma (DLBCL) had inferior EFS (hazard ratio [HR], 1.41; 95% CI, 0.98 to 2.04) and OS (HR, 1.99; 95% CI, 1.27 to 3.13); 25(OH)D insufficient patients with T-cell lymphoma also had inferior EFS (HR, 1.94; 95% CI, 1.04 to 3.61) and OS (HR, 2.38; 95% CI, 1.04 to 5.41). There were no associations with EFS for the other NHL subtypes. Among patients with DLBCL and T-cell lymphoma, higher 1,25(OH)(2)D levels were associated with better EFS and OS, suggesting that any putative tumor 1-α-hydroxylase activity did not explain the 25(OH)D associations.
25(OH)D insufficiency was associated with inferior EFS and OS in DLBCL and T-cell lymphoma. Whether normalizing vitamin D levels in these patients improves outcomes will require testing in future trials.
维生素 D 不足在美国很常见，一些研究表明低水平的维生素 D 与癌症发病率升高有关，包括非霍奇金淋巴瘤（NHL）。最近的数据还表明，维生素 D 不足与某些癌症的预后不良有关，尽管 NHL 没有相关数据。
我们通过液体色谱-串联质谱法检测了 983 名新诊断为 NHL 的患者中循环 25-羟维生素 D [25(OH)D]水平是否与无事件生存（EFS）和总生存（OS）相关。25(OH)D 和 1,25-二羟维生素 D [1,25(OH)(2)D]水平。
诊断时的平均年龄为 62 岁（范围，19 至 94 岁）；44%的患者在诊断后 120 天内存在 25(OH)D 水平不足（<25ng/ml）。中位随访时间为 34.8 个月；404 例事件和 193 例死亡（168 例死于淋巴瘤）。在调整已知的预后因素和治疗因素后，弥漫性大 B 细胞淋巴瘤（DLBCL）患者 25(OH)D 不足者的 EFS 较差（风险比 [HR]，1.41；95%CI，0.98 至 2.04）和 OS（HR，1.99；95%CI，1.27 至 3.13）；T 细胞淋巴瘤患者 25(OH)D 不足者 EFS 也较差（HR，1.94；95%CI，1.04 至 3.61）和 OS（HR，2.38；95%CI，1.04 至 5.41）。其他 NHL 亚型与 EFS 无关联。在 DLBCL 和 T 细胞淋巴瘤患者中，较高的 1,25(OH)(2)D 水平与更好的 EFS 和 OS 相关，表明任何假定的肿瘤 1-α-羟化酶活性都不能解释 25(OH)D 的相关性。
25(OH)D 不足与 DLBCL 和 T 细胞淋巴瘤患者的 EFS 和 OS 较差有关。在这些患者中，使维生素 D 水平正常化是否能改善结局，需要在未来的试验中进行检验。
