Wesa Kathleen M, Segal Neil H, Cronin Angel M, Sjoberg Daniel D, Jacobs Gria N, Coleton Marci I, Fleisher Martin, Dnistrian Ann M, Saltz Leonard B, Cassileth Barrie R
a Memorial Sloan Kettering Cancer Center, Integrative Medicine Service , New York , New York , USA.
Nutr Cancer. 2015;67(3):424-30. doi: 10.1080/01635581.2015.998838. Epub 2015 Feb 3.
Higher serum 25-hydroxy vitamin D [25(OH)D] levels are associated with decreased colorectal cancer (CRC) incidence. In this retrospective study of Stage IV CRC patients, we evaluate whether 25(OH)D levels at diagnosis correlate with survival. Stored sera from carcinoembryonic antigen (CEA) measurements obtained between February 2005 and March 2006 were screened. The first 250 patients with CEA ± 30 days of Stage IV CRC diagnosis were included. Serum 25(OH)D levels were determined and categorized as adequate ≥ 30 ng/mL, or deficient <30 ng/mL. Multivariable Cox regression models controlling for albumin and Eastern Cooperative Oncology Group performance status were used to investigate whether higher 25(OH)D levels were associated with prolonged survival. A total of 207 patients (83%) were vitamin D-deficient (median = 21 ng/mL), with deficiencies significantly more likely among non-Hispanic black patients (P = 0.009). Higher levels were associated with prolonged survival in categorical variable analysis: adequate vs. deficient, hazard ratio = 0.61, 95% confidence interval = 0.38-0.98, P = 0.041. A majority of newly diagnosed Stage IV CRC patients are vitamin D-deficient. Our data suggest that higher 25(OH)D levels are associated with better overall survival. Clinical trials to determine whether aggressive vitamin D repletion would improve outcomes for vitamin D-deficient CRC patients are warranted.
血清25-羟基维生素D[25(OH)D]水平升高与结直肠癌(CRC)发病率降低相关。在这项针对IV期CRC患者的回顾性研究中，我们评估诊断时的25(OH)D水平是否与生存率相关。对2005年2月至2006年3月期间进行癌胚抗原(CEA)检测时储存的血清进行筛查。纳入最初250例IV期CRC诊断后CEA检测时间±30天的患者。测定血清25(OH)D水平，并将其分类为充足(≥30 ng/mL)或缺乏(<30 ng/mL)。使用控制白蛋白和东部肿瘤协作组体能状态的多变量Cox回归模型来研究较高的25(OH)D水平是否与生存期延长相关。共有207例患者(83%)维生素D缺乏(中位数=21 ng/mL)，非西班牙裔黑人患者中维生素D缺乏的可能性显著更高(P = 0.009)。在分类变量分析中，较高水平与生存期延长相关：充足组与缺乏组，风险比= 0.61，95%置信区间= 0.38 - 0.98，P = 0.041。大多数新诊断的IV期CRC患者维生素D缺乏。我们的数据表明，较高的25(OH)D水平与更好的总生存期相关。有必要进行临床试验以确定积极补充维生素D是否会改善维生素D缺乏的CRC患者的预后。
