血清25-羟基维生素D浓度与前列腺癌风险：前列腺癌预防试验的结果
Serum 25-hydroxyvitamin D concentrations and risk of prostate cancer: results from the Prostate Cancer Prevention Trial.
作者信息
Schenk Jeannette M, Till Cathee A, Tangen Catherine M, Goodman Phyllis J, Song Xiaoling, Torkko Kathleen C, Kristal Alan R, Peters Ulrike, Neuhouser Marian L
机构信息
Fred Hutchinson Cancer Research Center, Cancer Prevention Program;
SWOG, Statistical Center;
出版信息
Cancer Epidemiol Biomarkers Prev. 2014 Aug;23(8):1484-93. doi: 10.1158/1055-9965.EPI-13-1340.
BACKGROUND
Epidemiologic studies have reported inconsistent associations of vitamin D and prostate cancer risk; however, few have adequately controlled for detection bias related to prostate-specific antigen (PSA) screening, and the results of many studies may be affected by occult prostate cancers among controls.
METHODS
Data for this nested case-control analysis (n = 1,695 cases/1,682 controls) are from the Prostate Cancer Prevention Trial. Baseline serum was analyzed for 25-hydroxyvitamin D [25(OH)D]. The presence or absence of cancer was subsequently determined by prostate biopsy. Polytomous logistic regression models were used to estimate associations of 25(OH)D with risk of total, Gleason 2-6, Gleason 7, and Gleason 8-10 prostate cancer. Results are presented for placebo and finasteride arms separately and combined.
RESULTS
There were no associations of serum 25(OH)D with total prostate cancer risk. For Gleason 2-6 cancers, results were inconsistent across treatment arms with a suggestion of increased risk in the placebo arm only; however, there was no dose-response relationship. For Gleason 8-10 prostate cancers, 25(OH)D concentrations were associated with a linear decrease in risk among combined treatment arms [quartile 4 vs. 1: OR, 0.55; 95% confidence interval (CI), 0.32-0.94; P(trend) = 0.04]. These findings were somewhat stronger among men ≥65 versus 55-64 years at baseline (quartile 4 vs. 1: OR, 0.40; 95% CI, 0.18-0.88 vs. OR, 0.73; 95% CI, 0.35-1.52, respectively; P(interaction) = 0.52).
CONCLUSIONS
Higher serum 25(OH)D may modestly increase risk of Gleason 2-6 disease and more substantially reduce risk of Gleason 8-10 prostate cancer.
IMPACT
Vitamin D may have different effects for different stages of prostate cancers.
背景
流行病学研究报告了维生素D与前列腺癌风险之间的关联并不一致；然而，很少有研究能充分控制与前列腺特异性抗原（PSA）筛查相关的检测偏倚，而且许多研究的结果可能受到对照组中隐匿性前列腺癌的影响。
方法
这项巢式病例对照分析（n = 1695例病例/1682例对照）的数据来自前列腺癌预防试验。对基线血清进行25-羟基维生素D [25(OH)D]分析。随后通过前列腺活检确定是否存在癌症。采用多分类逻辑回归模型来估计25(OH)D与总前列腺癌、Gleason 2-6级、Gleason 7级和Gleason 8-10级前列腺癌风险之间的关联。分别呈现安慰剂组和非那雄胺组以及合并组的结果。
结果
血清25(OH)D与总前列腺癌风险之间无关联。对于Gleason 2-6级癌症，各治疗组的结果不一致，仅安慰剂组有风险增加的迹象；然而，不存在剂量反应关系。对于Gleason 8-10级前列腺癌，在合并治疗组中，25(OH)D浓度与风险呈线性降低相关[四分位数4与1相比：比值比（OR），0.55；95%置信区间（CI），0.32 - 0.94；P（趋势）= 0.04]。在基线时年龄≥65岁的男性中，这些发现比55 - 64岁的男性更强（四分位数4与1相比：OR，0.40；95% CI，0.18 - 0.88与OR，0.73；95% CI，0.35 - 1.52，分别；P（交互作用）= 0.52）。
结论
较高的血清25(OH)D可能适度增加Gleason 2-6级疾病的风险，并更显著地降低Gleason 8-10级前列腺癌的风险。
影响
维生素D对前列腺癌的不同阶段可能有不同影响。
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