Robsahm Trude Eid, Tretli Steinar, Torjesen Peter Abusdal, Babigumira Ronnie, Schwartz Gary G
The Cancer Registry of Norway, Institute of Population-based Cancer Research, Oslo, Norway.
The Hormone Laboratory, Department of Endocrinology, Oslo University Hospital Health Authority, Oslo, Norway.
Clin Epidemiol. 2019 Aug 8;11:695-705. doi: 10.2147/CLEP.S207230. eCollection 2019.
Circulating 25-hydroxyvitamin D (25-OHD) levels have been inversely associated with cancer death, but the nature of this relationship is unclear. We investigated this association using repeated measurements of serum 25-OHD.
Pre-diagnostic serum samples were collected in population health surveys in Norway (1973-2004). Participants who subsequently developed cancer (1984-2004) provided a second serum sample at the time of cancer diagnosis. Samples were stored in the Janus Serum Bank. Repeated samples existed from 202 breast cancers, 193 lung cancers, 124 lymphomas, and 37 colon cancers. Serum 25-OHD was measured via competitive radioimmunoassay. Cox regression models assessed associations between 25-OHD and cancer-specific death (case fatality) through 2012, given as hazard ratios (HRs) with 95% confidence intervals (CIs).
The median time between pre-diagnostic and diagnostic samples was 14.4 years. The median 25-OHD levels were 63.3 and 62.5 nmol/L, respectively. During follow-up, 313 cancer deaths occurred. Compared to low pre-diagnostic 25-OHD levels (<46 nmol/L), higher levels (≥46 nmol/L) had significantly lower HRs (39-54%) of case fatality. This result was also seen for the diagnostic samples. Donors who had both samples at high (≥62 nmol/L) levels had 59% lower HR of case fatality, compared to those for whom both samples were at low levels (<46 nmol/L). Furthermore, versus a decline in serum 25-OHD (median -22.4 nmol/L) from pre-diagnostic to diagnostic samples, a rise (median 22.3 nmol/L) was associated with lower case fatality (HR 0.57, 95% CI 0.43-0.75).
Our findings suggest a causal relationship between vitamin D and cancer case fatality.
循环25-羟基维生素D（25-OHD）水平与癌症死亡呈负相关，但其关系性质尚不清楚。我们通过重复测量血清25-OHD来研究这种关联。
在挪威的人群健康调查（1973 - 2004年）中收集诊断前血清样本。随后患癌的参与者（1984 - 2004年）在癌症诊断时提供了第二份血清样本。样本储存在雅努斯血清库中。对202例乳腺癌、193例肺癌、124例淋巴瘤和37例结肠癌患者有重复样本。通过竞争性放射免疫测定法测量血清25-OHD。Cox回归模型评估了2012年前25-OHD与癌症特异性死亡（病例死亡率）之间的关联，以风险比（HRs）和95%置信区间（CIs）表示。
诊断前样本与诊断样本之间的中位时间为14.4年。25-OHD的中位水平分别为63.3和62.5 nmol/L。随访期间，发生了313例癌症死亡。与诊断前低水平的25-OHD（<46 nmol/L）相比，较高水平（≥46 nmol/L）的病例死亡率HRs显著降低（39 - 54%）。诊断样本也出现了这一结果。两份样本均处于高水平（≥62 nmol/L）的捐赠者与两份样本均处于低水平（<46 nmol/L）的捐赠者相比，病例死亡率HR低59%。此外，与从诊断前样本到诊断样本血清25-OHD下降（中位 - 22.4 nmol/L）相比，上升（中位22.3 nmol/L）与较低的病例死亡率相关（HR 0.57，95% CI 0.43 - 0.75）。
我们的研究结果表明维生素D与癌症病例死亡率之间存在因果关系。
