Haykal Tarek, Samji Varun, Zayed Yazan, Gakhal Inderdeep, Dhillon Harsukh, Kheiri Babikir, Kerbage Josiane, Veerapaneni Vijaysai, Obeid Michele, Danish Rizwan, Bachuwa Ghassan
Department of Internal Medicine, Hurley Medical Center, Flint, MI, USA.
College of Human Medicine, Michigan State University, East Lansing, MI, USA.
J Community Hosp Intern Med Perspect. 2019 Dec 14;9(6):480-488. doi: 10.1080/20009666.2019.1701839. eCollection 2019.
: In the USA cancer is the second leading cause of mortality, as such, primary prevention of cancer is a major public health concern. Vitamin D supplementation has been studied as a primary prevention method for multiple diseases including cardiovascular disease, osteoporosis, diabetes mellitus and cancer. The role of Vitamin D as primary prevention of cancer is still controversial. With fast emergence of large randomized controlled trials (RCTs) in that regards, we aimed to evaluate the efficacy of Vitamin D supplementation as primary prophylaxis for cancer. : A comprehensive electronic database search was conducted for all RCTs where comparison of Vitamin D supplementation versus placebo for the prevention of any type of disease with at least 3 years of Vitamin D supplementation was used and where cancer incidence or mortality was reported. The primary outcome was cancer-related mortality and cancer incidence. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) using a random-effects model at the longest follow-up. : We included 10 RCTs with 79,055 total patients, mean age of 68.07 years, a female percentage of 78.02% and a minimum follow-up of 4 years and more. Vitamin D was associated with significant reduction of cancer-related mortality compared with placebo (RR 0.87; 95% CI: 0.79-0.96; P = 0.05: I = 0%). Compared with placebo, Vitamin D was not associated with significant reduction of cancer incidence (RR: 0.96; 95% CI: 0.86-1.07; P = 0.46; I = 31%). : With inclusion of studies, which did not primarily examine vitamin D for the purpose of preventing cancer or reducing cancer mortality our meta-analysis highlights that the use of vitamin D supplementation for primary prevention of cancer is encouraged as it does possibly decrease cancer-related mortality once cancer is diagnosed; however, it has no role or effect on cancer incidence.
在美国，癌症是第二大死因，因此，癌症的一级预防是主要的公共卫生问题。维生素D补充剂已被作为包括心血管疾病、骨质疏松症、糖尿病和癌症在内的多种疾病的一级预防方法进行研究。维生素D作为癌症一级预防的作用仍存在争议。随着这方面大型随机对照试验（RCT）的迅速出现，我们旨在评估维生素D补充剂作为癌症一级预防措施的疗效。：对所有RCT进行了全面的电子数据库检索，这些试验比较了维生素D补充剂与安慰剂对任何类型疾病的预防效果，维生素D补充时间至少为3年，且报告了癌症发病率或死亡率。主要结局是癌症相关死亡率和癌症发病率。我们在最长随访期使用随机效应模型计算风险比（RRs）和95%置信区间（CIs）。：我们纳入了10项RCT，共有79,055名患者，平均年龄68.07岁，女性比例78.02%，最短随访时间为4年及以上。与安慰剂相比，维生素D与癌症相关死亡率的显著降低相关（RR 0.87；95% CI：0.79 - 0.96；P = 0.05：I² = 0%）。与安慰剂相比，维生素D与癌症发病率的显著降低无关（RR：0.96；95% CI：0.86 - 1.07；P = 0.46；I² = 31%）。：由于纳入了并非主要为预防癌症或降低癌症死亡率而研究维生素D的研究，我们的荟萃分析强调，鼓励使用维生素D补充剂进行癌症的一级预防，因为一旦诊断出癌症，它可能确实会降低癌症相关死亡率；然而，它对癌症发病率没有作用或影响。
