Churilla Thomas M, Lesko Samuel L, Brereton Harmar D, Klem Mary, Donnelly Patrick E, Peters Christopher A
The Commonwealth Medical College, Scranton, Pennsylvania, USA.
BMJ Open. 2011 Dec 19;1(2):e000397. doi: 10.1136/bmjopen-2011-000397. Print 2011.
Objectives Low serum vitamin D levels have been associated with risk for certain malignancies, but studies have not directly analysed levels between community oncology and primary care practices. The purpose of this study was to compare serum vitamin D levels in patients at a community oncology practice with non-cancer patients at a primary care practice. Design Retrospective case-control study. 25-Hydroxyvitamin D levels were ordered for screening in both cancer and non-cancer patients. Levels were compared in univariate and multivariate analyses adjusted for age, body mass index and season of blood draw. Setting A community-based radiation oncology centre and a community-based primary care practice: both located in Northeastern Pennsylvania, USA. Participants 170 newly diagnosed cancer patients referred for initial consultation at the community oncology centre from 21 November 2008 to 18 May 2010, and 170 non-cancer patients of the primary care practice who underwent screening for hypovitaminosis D for the first time from 1 January 2009 to 31 December 2009. Primary and secondary outcome measures The primary outcome measure was mean serum vitamin D level, and the secondary outcome measures were frequencies of patients with vitamin D levels <20 ng/ml and levels <30 ng/ml. Results The oncology patients had a significantly lower mean serum vitamin D level (24.9 ng/ml) relative to a cohort of non-cancer primary care patients (30.6 ng/ml, p<0.001) from the same geographical region. The relationship retained significance after adjustment for age, body mass index and season of blood draw in multivariate analysis (p=0.001). Levels <20 and <30 ng/ml were more frequent in the oncology patients (OR (95% CI)=2.59 (1.44 to 4.67) and 2.04 (1.20 to 3.46), respectively) in multivariate analysis. Conclusions Cancer patients were found to have low vitamin D levels relative to a similar cohort of non-cancer primary care patients from the same geographical region.
目的 血清维生素D水平低与某些恶性肿瘤风险相关，但研究尚未直接分析社区肿瘤学与初级保健机构之间的水平差异。本研究的目的是比较社区肿瘤学实践中患者与初级保健机构中非癌症患者的血清维生素D水平。设计 回顾性病例对照研究。对癌症患者和非癌症患者均进行25-羟维生素D水平检测以进行筛查。在对年龄、体重指数和采血季节进行调整的单因素和多因素分析中比较水平。地点 一个基于社区的放射肿瘤中心和一个基于社区的初级保健机构：均位于美国宾夕法尼亚州东北部。参与者 2008年11月21日至2010年5月18日在社区肿瘤中心转诊进行初次咨询的170例新诊断癌症患者，以及2009年1月1日至2009年12月31日首次接受维生素D缺乏筛查的初级保健机构的170例非癌症患者。主要和次要结局指标 主要结局指标是血清维生素D平均水平，次要结局指标是维生素D水平<20 ng/ml和<30 ng/ml患者的频率。结果 与来自同一地理区域的非癌症初级保健患者队列（30.6 ng/ml，p<0.001）相比，肿瘤患者的血清维生素D平均水平显著更低（24.9 ng/ml）。在多因素分析中对年龄、体重指数和采血季节进行调整后，这种关系仍具有显著性（p=0.001）。在多因素分析中，肿瘤患者中维生素D水平<20 ng/ml和<30 ng/ml的情况更常见（OR（95%CI）分别为2.59（1.44至4.67）和2.04（1.20至3.46））。结论 相对于来自同一地理区域的类似非癌症初级保健患者队列，发现癌症患者的维生素D水平较低。
