Kristal Alan R, Till Cathee, Song Xiaoling, Tangen Catherine M, Goodman Phyllis J, Neuhauser Marian L, Schenk Jeannette M, Thompson Ian M, Meyskens Frank L, Goodman Gary E, Minasian Lori M, Parnes Howard L, Klein Eric A
Cancer Prevention Program; Departments of Epidemiology and
SWOG Statistical Center, Fred Hutchinson Cancer Research Center;
Cancer Epidemiol Biomarkers Prev. 2014 Aug;23(8):1494-504. doi: 10.1158/1055-9965.EPI-14-0115. Epub 2014 Apr 14.
In vitro, animal, and ecological studies suggest that inadequate vitamin D intake could increase prostate cancer risk, but results of biomarker-based longitudinal studies are inconsistent.
Data for this case (n = 1,731) and cohort (n = 3,203) analysis are from the Selenium and Vitamin E Cancer Prevention Trial. Cox proportional hazard models were used to test whether baseline plasma vitamin D (25-hydroxy) concentration, adjusted for season of blood collection, was associated with the risk of total and Gleason score 2-6, 7-10, and 8-10 prostate cancer.
There were U-shaped associations of vitamin D with total cancer risk: compared with the first quintile, HRs were 0.83 [95% confidence interval (CI), 0.66-1.03; P = 0.092], 0.74 (95% CI, 0.59-0.92; P = 0.008), 0.86 (95% CI, 0.69-1.07; P = 0.181), and 0.98 (95% CI, 0.78-1.21; P = 0.823), for the second through fifth quintiles, respectively. For Gleason 7-10 cancer, corresponding HRs were 0.63 (95% CI, 0.45-0.90; P = 0.010), 0.66 (95% CI, 0.47-0.92; P = 0.016), 0.79 (95% CI, 0.56-1.10; P = 0.165), and 0.88 (95% CI, 0.63-1.22; P = 0.436). Among African American men (n = 250 cases), higher vitamin D was associated with reduced risk of Gleason 7-10 cancer only: in the a posteriori contrast of quintiles 1-2 versus 3-5, the HR was 0.55 (95% CI, 0.31-0.97; P = 0.037), with no evidence of dose-response or a U-shaped association.
Both low and high vitamin D concentrations were associated with increased risk of prostate cancer, and more strongly for high-grade disease.
The optimal range of circulating vitamin D for prostate cancer prevention may be narrow. Supplementation of men with adequate levels may be harmful. Cancer Epidemiol Biomarkers Prev; 23(8); 1494-504. ©2014 AACR.
体外、动物及生态学研究表明，维生素D摄入不足可能会增加前列腺癌风险，但基于生物标志物的纵向研究结果并不一致。
本病例（n = 1731）和队列（n = 3203）分析的数据来自硒和维生素E癌症预防试验。采用Cox比例风险模型，检验经采血季节校正后的基线血浆维生素D（25-羟基）浓度与总前列腺癌以及Gleason评分2-6、7-10和8-10前列腺癌风险之间的关联。
维生素D与总癌症风险呈U型关联：与第一五分位数相比，第二至第五五分位数的风险比（HR）分别为0.83[95%置信区间（CI），0.66 - 1.03；P = 0.092]、0.74（95%CI，0.59 - 0.92；P = 0.008）、0.86（95%CI，0.69 - 1.07；P = 0.181）和0.98（95%CI，0.78 - 1.21；P = 0.823）。对于Gleason 7-10级癌症，相应的HR分别为0.63（95%CI，0.45 - 0.90；P = 0.010）、0.66（95%CI，0.47 - 0.92；P = 0.016）、0.79（95%CI，0.56 - 1.10；P = 0.165）和0.88（95%CI，0.63 - 1.22；P = 0.436）。在非裔美国男性（n = 250例）中，较高的维生素D水平仅与Gleason 7-10级癌症风险降低相关：在五分位数1-2与3-5的事后对比中，HR为0.55（95%CI，0.31 - 0.97；P = 0.037），没有剂量反应或U型关联的证据。
低维生素D浓度和高维生素D浓度均与前列腺癌风险增加相关，且对高级别疾病的影响更强。
预防前列腺癌的循环维生素D最佳范围可能较窄。对维生素D水平充足的男性进行补充可能有害。《癌症流行病学、生物标志物与预防》；23(8)；1494 - 504。©2014美国癌症研究协会。
