Rouphael Carol, Kamal Afrin, Sanaka Madhusudhan R, Thota Prashanthi N
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States.
Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States.
World J Gastrointest Oncol. 2018 Jan 15;10(1):23-30. doi: 10.4251/wjgo.v10.i1.23.
Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Current evidence suggests a protective role of vitamin D in colon cancer. The effect of vitamin D on esophageal cancer remains controversial. Multiple studies investigated the association between vitamin D and esophageal cancer, employing different modes of assessment of vitamin D status such as serum 25-hydroxyvitamin D levels, vitamin D dietary intake or exposure to ultraviolet B (UVB) radiation. Genetic variations of the vitamin D receptor (VDR) gene and VDR expression in esophageal specimens have also been investigated. Ecological studies evaluating exposure to UVB radiation yielded an inverse correlation with esophageal cancer. When vitamin D dietary intake was assessed, direct association with esophageal cancer was observed. However, circulating 25-hydroxyvitamin D concentrations showed inconsistent results. In this review article, we present a detailed summary of the current data on the effects of vitamin D on various histological subtypes of esophageal cancer and their precursor lesions. Well-powered prospective studies with accurate measurement of vitamin D status are needed before chemoprevention with vitamin D is recommended, as current evidence does not support a chemopreventive role of vitamin D against esophageal cancer. Future studies looking at the incidence of esophageal cancer in patients with pre-cancerous lesions (Barrett's esophagus and squamous cell dysplasia) receiving vitamin D supplementation are needed.
由于维生素D对肿瘤分化、凋亡及细胞增殖抑制具有多种生物学效应，它已成为一种颇具前景的抗癌剂。目前的证据表明维生素D在结肠癌中具有保护作用。维生素D对食管癌的影响仍存在争议。多项研究调查了维生素D与食管癌之间的关联，采用了不同的维生素D状态评估方式，如血清25-羟基维生素D水平、维生素D饮食摄入量或紫外线B（UVB）辐射暴露量。维生素D受体（VDR）基因的遗传变异以及食管标本中的VDR表达也已得到研究。评估UVB辐射暴露的生态学研究得出其与食管癌呈负相关。当评估维生素D饮食摄入量时，观察到其与食管癌呈直接关联。然而，循环25-羟基维生素D浓度的结果并不一致。在这篇综述文章中，我们详细总结了目前关于维生素D对食管癌各种组织学亚型及其前驱病变影响的数据。在推荐用维生素D进行化学预防之前，需要开展有充分统计学效力且能准确测量维生素D状态的前瞻性研究，因为目前的证据并不支持维生素D对食管癌具有化学预防作用。未来需要研究补充维生素D的癌前病变（巴雷特食管和鳞状细胞发育异常）患者的食管癌发病率。
