血清 25-羟维生素 D 与大型巢式病例对照研究中的前列腺癌风险。
Serum 25-hydroxy vitamin D and prostate cancer risk in a large nested case-control study.
机构信息
Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 6120 Executive Blvd., Suite 320, Bethesda, MD 20982, USA.
出版信息
Cancer Epidemiol Biomarkers Prev. 2011 Sep;20(9):1850-60. doi: 10.1158/1055-9965.EPI-11-0403. Epub 2011 Jul 22.
BACKGROUND
Vitamin D compounds inhibit prostate tumorigenesis experimentally, but epidemiologic data are inconsistent with respect to prostate cancer risk, with some studies suggesting nonsignificant positive associations.
METHODS
The 25-hydroxy vitamin D [25(OH)D]-prostate cancer relation was examined in a nested case-control study within the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study of 50- to 69-year-old Finnish men. We matched 1,000 controls to 1,000 cases diagnosed during up to 20 years of follow-up on the basis of age (±1 year) and fasting blood collection date (±30 days). Conditional multivariate logistic regression models estimated ORs and 95% CIs. All statistical significance testing was 2-sided.
RESULTS
Cases had nonsignificantly 3% higher serum 25(OH)D levels (P = 0.19). ORs (95% CIs) for increasing season-specific quintiles of 25(OH)D concentrations were 1.00 (reference), 1.29 (0.95-1.74), 1.34 (1.00-1.80), 1.26 (0.93-1.72), and 1.56 (1.15-2.12), with P(trend) = 0.01. Analyses based on prespecified clinical categories and season-adjusted values yielded similar results. These findings seemed stronger for aggressive disease [OR (95% CI) for fifth quintile of serum 25(OH)D [1.70 (1.05-2.76), P(trend) = 0.02], among men with greater physical activity [1.85 (1.26-2.72), P(trend) = 0.002], higher concentrations of serum total cholesterol [2.09 (1.36-3.21), P(trend) = 0.003] or α-tocopherol [2.00 (1.30-3.07), P(trend) = 0.01] and higher intakes of total calcium [1.82 (1.20-2.76), P(trend) = 0.01] or vitamin D [1.69 (1.04-2.75), P(trend) = 0.08], or among those who had received the trial α-tocopherol supplements [1.74 (1.15-2.64), P(trend) = 0.006].
CONCLUSION
Our findings indicate that men with higher vitamin D blood levels are at increased risk of developing prostate cancer.
IMPACT
Greater caution is warranted with respect to recommendations for high-dose vitamin D supplementation and higher population target blood levels.
背景
维生素 D 化合物在实验中抑制前列腺肿瘤的发生，但关于前列腺癌风险的流行病学数据并不一致，一些研究表明存在无显著性的正相关关系。
方法
在一项针对 50 至 69 岁芬兰男性的 α-生育酚、β-胡萝卜素癌症预防研究中，我们在嵌套病例对照研究中检查了 25-羟维生素 D [25(OH)D]-前列腺癌的关系。我们根据年龄（±1 岁）和空腹采血日期（±30 天），将 1000 名病例与 1000 名匹配的对照相匹配。条件多变量逻辑回归模型估计了 ORs 和 95%置信区间。所有的统计显著性检验均为双侧。
结果
病例的血清 25(OH)D 水平平均高出 3%（P = 0.19）。按季节特异性 25(OH)D 浓度五分位数递增的 OR（95%CI）分别为 1.00（参考）、1.29（0.95-1.74）、1.34（1.00-1.80）、1.26（0.93-1.72）和 1.56（1.15-2.12），P（趋势）= 0.01。基于预定义的临床类别和季节调整值的分析得出了类似的结果。这些发现对于侵袭性疾病似乎更强[血清 25(OH)D 第 5 个五分位数的 OR（95%CI）为 1.70（1.05-2.76），P（趋势）= 0.02]，对于体力活动较多的男性[1.85（1.26-2.72），P（趋势）= 0.002]，血清总胆固醇[2.09（1.36-3.21），P（趋势）= 0.003]或α-生育酚[2.00（1.30-3.07），P（趋势）= 0.01]浓度较高，总钙[1.82（1.20-2.76），P（趋势）= 0.01]或维生素 D [1.69（1.04-2.75），P（趋势）= 0.08]摄入量较高，或接受试验α-生育酚补充剂的男性[1.74（1.15-2.64），P（趋势）= 0.006]。
结论
我们的研究结果表明，血清维生素 D 水平较高的男性患前列腺癌的风险增加。
影响
对于高剂量维生素 D 补充和更高的人群目标血液水平的建议，需要更加谨慎。
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