Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Yamadaoka 2-2 (E2), Suita, Osaka, 565-0871, Japan.
Department of Surgery, Yao Municipal Hospital, Ryugecho 1-3-1, Yao, Osaka, 581-0069, Japan.
Ann Surg Oncol. 2017 Nov;24(12):3715-3724. doi: 10.1245/s10434-017-6040-y. Epub 2017 Aug 28.
Pancreatic ductal adenocarcinoma (PDAC) is a lethal neoplasm that spreads to surrounding tissue or distant sites. This study investigated distant metastases in PDAC patients with or without preoperative chemoradiation therapy (CRT), focusing on vitamin D levels and bone density.
This study included 146 patients with PDAC who underwent surgery from 2007 to 2014. Bone density was evaluated using computed tomography, and the preoperative vitamin D level was calculated by enzyme-linked immunosorbent assay (ELISA) for patients with available plasma (48 cases).
When the patients were divided into two groups according to the change in bone density, the group with decreased bone density had a shorter distant metastasis-free survival time (DMFS) after surgery than the other group (p < 0.05). Low vitamin D was a weak predictor of DMFS, but the difference was not significant (p = 0.08), perhaps because of the sample size. Multivariate analysis indicated three significant factors associated with distant metastasis: a decrease in bone density (hazard ratio [HR], 2.17; p = 0.04), normalization of the Dupan-2 value after surgery (hazard ratio [HR], 0.39; p = 0.02), and completion of adjuvant chemotherapy (HR, 0.29; p < 0.01). Univariate analysis showed that a low vitamin D concentration (<20 pg/ml) was a risk factor (p = 0.04) for bone density change. Multivariate analysis found that preoperative CRT was the only factor associated (±, OR, 5.8; p = 0.04) with bone density change, suggesting that preoperative CRT significantly decreases bone density in patients with insufficient vitamin D.
Patients treated with preoperative CRT tend to have impaired bone density, which is a predictor of distant metastasis. Thus, vitamin D supplementation may decrease distant metastasis.
胰腺导管腺癌（PDAC）是一种致命的肿瘤，会扩散到周围组织或远处部位。本研究调查了接受或未接受术前放化疗（CRT）的 PDAC 患者的远处转移情况，重点关注维生素 D 水平和骨密度。
本研究纳入了 2007 年至 2014 年间接受手术的 146 例 PDAC 患者。通过计算机断层扫描评估骨密度，对有可用血浆的 48 例患者，采用酶联免疫吸附试验（ELISA）计算术前维生素 D 水平。
当根据骨密度变化将患者分为两组时，术后骨密度降低组的远处无复发生存时间（DMFS）较短（p<0.05）。低维生素 D 是 DMFS 的一个较弱预测因素，但差异无统计学意义（p=0.08），这可能是由于样本量较小。多变量分析表明，与远处转移相关的三个显著因素是：骨密度降低（风险比[HR]，2.17；p=0.04）、术后 Dupan-2 值正常化（HR，0.39；p=0.02）和辅助化疗完成（HR，0.29；p<0.01）。单变量分析显示，维生素 D 浓度低（<20pg/ml）是骨密度变化的危险因素（p=0.04）。多变量分析发现，术前 CRT 是与骨密度变化相关的唯一因素（±，OR，5.8；p=0.04），提示术前 CRT 显著降低了维生素 D 不足患者的骨密度。
接受术前 CRT 治疗的患者往往存在骨密度受损，这是远处转移的预测因素。因此，补充维生素 D 可能会减少远处转移。
