Stenehjem Jo Steinson, Grimsrud Tom K, Rees Judith R, Vos Linda, Babigumira Ronnie, Veierød Marit B, Robsahm Trude Eid
Department of Research, Cancer Registry of Norway, Oslo, Norway.
New Hampshire State Cancer Registry, Lebanon, New Hampshire, USA.
BMJ Open. 2017 Jun 21;7(6):e014829. doi: 10.1136/bmjopen-2016-014829.
The incidence and mortality rates of cutaneous melanoma (CM) are increasing among fair-skinned populations worldwide. Ultraviolet radiation (UVR) is the principal risk factor for CM, but is also the main source of 25-hydroxyvitamin D (25(OH)D), which has been associated with reduced risk and better prognosis of some cancer types. However, both low and high 25(OH)D levels have been associated with increased risk of CM. Obesity as measured by body mass index (BMI) is associated with risk of several cancers and has also been suggested as a risk factor for CM, and may also be related to insufficient 25(OH)D and/or high leptin levels. Moreover, contracting a CM diagnosis has been associated with increased risk of developing second cancer. We aim to study whether low prediagnostic serum levels of 25(OH)D, high prediagnostic levels of BMI and high serum leptin levels influence CM incidence, Breslow thickness and CM mortality, and risk of second cancer and survival after a CM diagnosis.
Cohort and nested case-control studies will be carried out using the population-based Janus Serum Bank Cohort (archival prediagnostic sera, BMI, smoking and physical activity), with follow-up from 1972 to 2014. Additional data will be received from the Cancer Registry of Norway, the national Cause of Death Registry, Statistics Norway (education and occupation) and exposure matrices of UVR. Time-to-event regression models will be used to analyse the cohort data, while the nested case-control studies will be analysed by conditional logistic regression. A multilevel approach will be applied when incorporating group-level data.
The project is approved by the Regional Committee for Medical Research Ethics and is funded by the Norwegian Cancer Society. Results will be published in peer-reviewed journals, at scientific conferences and in the news media.
在全球皮肤白皙的人群中，皮肤黑色素瘤（CM）的发病率和死亡率正在上升。紫外线辐射（UVR）是CM的主要危险因素，但也是25-羟基维生素D（25(OH)D）的主要来源，而25(OH)D与某些癌症类型的风险降低和预后改善有关。然而，低水平和高水平的25(OH)D都与CM风险增加有关。以体重指数（BMI）衡量的肥胖与多种癌症的风险相关，也被认为是CM的一个危险因素，并且可能还与25(OH)D不足和/或高瘦素水平有关。此外，确诊CM与患第二种癌症的风险增加有关。我们旨在研究诊断前血清25(OH)D水平低、诊断前BMI水平高和血清瘦素水平高是否会影响CM发病率、 Breslow厚度和CM死亡率，以及CM诊断后的第二种癌症风险和生存率。
将使用基于人群的雅努斯血清库队列（存档的诊断前血清、BMI、吸烟和身体活动情况）进行队列研究和巢式病例对照研究，随访时间为1972年至2014年。还将从挪威癌症登记处、国家死亡原因登记处、挪威统计局（教育和职业）以及UVR暴露矩阵获取额外数据。将使用事件发生时间回归模型分析队列数据，而巢式病例对照研究将通过条件逻辑回归进行分析。纳入组水平数据时将采用多水平方法。
该项目已获得地区医学研究伦理委员会的批准，并由挪威癌症协会资助。研究结果将发表在同行评审期刊、科学会议和新闻媒体上。
