Baumann Michael, Dani Sergio Ulhoa, Dietrich Daniel, Hochstrasser Andreas, Klingbiel Dirk, Mark Michael Thomas, Riesen Walter F, Ruhstaller Thomas, Templeton Arnoud J, Thürlimann Beat
Institute for Clinical Chemistry and Haematology, St Gallen Cantonal Hospital, Switzerland.
Department of Medical Oncology and Haematology, St Gallen Cantonal Hospital, Switzerland.
Swiss Med Wkly. 2018 Jan 16;148:w14576. doi: 10.4414/smw.2018.14576. eCollection 2018.
Cholecalciferol (vitamin D3) is widely supplemented in breast cancer survivors because of the role of vitamin D in multiple health outcomes.
We conducted an observational study in 332 women in Eastern Switzerland with early, i.e., nonmetastatic breast cancer. Tumour-, patient-related and sociodemographic variables were recorded. Cholecalciferol intake and serum 25-hydroxyvitamin D (25(OH)D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) levels were measured at the first visit (baseline) and during a follow-up visit in a median of 210 days (range 87-857) after the first visit. Patients presenting 25(OH)D deficiency were advised to take cholecalciferol supplementation.
At baseline, 60 (18%) patients had 25(OH)D deficiency (≤50 nmol/l, ≤20 ng/l), and 70 (21%) had insufficiency (50-74 nmol/l, 20-29 ng/l). Out of 121 patients with ongoing cholecalciferol supplementation at baseline, 25(OH)D deficiency and insufficiency was observed in 9 (7%) and 16 (13%) patients, respectively, whereas out of 52 patients with no supplementation, 15 (29%) had deficiency and 19 (37%) had insufficiency. Only 85 (26%) patients had optimal 25(OH)D levels (75-100 nmol/l, 30-40 ng/l) at baseline. Seasonal variation was significant for 25(OH)D (p = 0.042) and 1,25(OH)2D (p = 0.001) levels. Living in a rural area was associated with a higher median 25(OH)D concentration as compared with living in an urban area (87 nmol/l, range 16-216 vs 72 nmol/l, range 17-162; p = 0.001). Regular sporting activity was positively associated with 25(OH)D (p = 0.045). Body mass index was inversely related to both 25(OH)D and 1,25(OH)2D (Spearman's rho = -0.24, p <0.001; rho = -0.23, p <0.001, respectively). The levels of 25(OH)D and 1,25(OH)2D were correlated (rho = 0.21, p <0.001). Age and bone mineral density had no significant correlation with the levels of 25(OH)D. Follow-up 25(OH)D was available for 230 patients, 44 (19%) of whom had 25(OH)D deficiency and 47 (21%) had insufficiency; 25 (41.6%) initially 25(OH)D-deficient patients attained sufficient 25(OH)D levels, whereas 33 (16.5%) patients with sufficient baseline 25(OH)D levels became deficient. Only 67 (30%) patients presented optimal 25(OH)D at the follow-up.
A remarkable fraction of the patients had serum 25(OH)D below (40%) or above (30%) optimal levels, and only around 30% of patients had optimal levels. Levels of 25(OH)D and 1,25(OH)2D increased on cholecalciferol supplementation, but the usual supplementation regimens were not adequate to bring 25(OH)D to the optimal range for a large proportion of patients.
EKSG 08/082/2B.
由于维生素D在多种健康结局中的作用，胆钙化醇（维生素D3）在乳腺癌幸存者中广泛应用。
我们对瑞士东部332例早期（即非转移性）乳腺癌女性进行了一项观察性研究。记录肿瘤、患者相关及社会人口统计学变量。在首次就诊（基线）时以及首次就诊后中位210天（范围87 - 857天）的随访就诊时，测量胆钙化醇摄入量、血清25 - 羟基维生素D（25(OH)D）和1,25 - 二羟基维生素D（1,25(OH)2D）水平。建议25(OH)D缺乏的患者补充胆钙化醇。
基线时，60例（18%）患者存在25(OH)D缺乏（≤50 nmol/l，≤20 ng/l），70例（21%）存在不足（50 - 74 nmol/l，20 - 29 ng/l）。在基线时持续补充胆钙化醇的121例患者中，分别有9例（7%）和16例（13%）患者存在25(OH)D缺乏和不足，而在未补充的52例患者中，15例（29%）存在缺乏，19例（37%）存在不足。基线时仅85例（26%）患者的25(OH)D水平处于最佳范围（75 - 100 nmol/l，30 - 40 ng/l）。25(OH)D（p = 0.042）和1,25(OH)2D（p = 0.001）水平存在显著季节变化。与居住在城市地区相比，居住在农村地区的患者25(OH)D中位浓度更高（87 nmol/l，范围16 - 216 vs 72 nmol/l，范围17 - 162；p = 0.001）。规律的体育活动与25(OH)D呈正相关（p = 0.045）。体重指数与25(OH)D和1,25(OH)2D均呈负相关（Spearman秩相关系数分别为 - 0.24，p <0.001；rho = - 0.23，p <0.00）。25(OH)D和1,25(OH)2D水平相关（rho = 0.21，p <0.001）。年龄和骨密度与25(OH)D水平无显著相关性。230例患者有随访时的25(OH)D数据，其中44例（19%）存在25(OH)D缺乏，47例（21%）存在不足；25例（41.6%）最初25(OH)D缺乏的患者达到了充足的25(OH)D水平，而33例（16.5%）基线25(OH)D水平充足的患者变为缺乏。随访时仅67例（30%）患者的25(OH)D处于最佳水平。
相当一部分患者的血清25(OH)D低于（40%）或高于（30%）最佳水平，只有约30%的患者处于最佳水平。补充胆钙化醇后25(OH)D和1,25(OH)2D水平升高，但通常的补充方案不足以使大部分患者的25(OH)D达到最佳范围。
EKSG 08/082/2B
