Chen Peizhan, Cao Yiwen, Duan Xiaohua, Li Jingquan, Zhao Weili, Wang Hui
State Key Laboratory of Oncogenes and Related Genes, Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 20025, PR China.
State Key Laboratory of Medical Genomics, Shanghai Institute of Hematology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
Clin Nutr. 2021 Jan;40(1):157-165. doi: 10.1016/j.clnu.2020.04.040. Epub 2020 May 11.
BACKGROUNDS & AIMS: Vitamin D insufficiency is associated with worse clinical outcomes in multiple cancer types; however, its roles in diffuse large B-cell lymphoma (DLBCL) patients are still unclear. Here, we aimed to determine the prognostic values of circulating total 25(OH)D and bioavailable 25(OH)D levels in DLBCL patients.
A total of 332 newly diagnosed DLBCL patients were recruited. The plasma total 25(OH)D and bioavailable 25(OH)D levels at diagnosis were determined, and their associations with the clinical characteristics and the prognosis of patients were evaluated. The predictive values of clinical characteristics and 25(OH)D levels in the responses to R-CHOP treatments in DLBCL patients were also assessed.
Of the patients, 92.8% had insufficient vitamin D status (<30 ng/mL). Patients with higher plasma bioavailable 25(OH)D were associated with better progression-free survival (PFS, multivariate adjusted-HR = 0.72, 95% CI = 0.38-1.35, P = 0.301, Tertile 2 vs. 1; multivariate adjusted-HR = 0.39, 95% CI = 0.20-0.79, P = 0.009, Tertile 3 vs. 1) and overall survival (OS, multivariate adjusted-HR = 0.89, 95% CI = 0.39-2.02, P = 0.777, Tertile 2 vs. 1; multivariate adjusted-HR = 0.21, 95% CI = 0.07-0.65, P = 0.007, Tertile 3 vs. 1). Meanwhile, higher plasma total 25(OH)D level was significantly associated with better PFS but not OS in DLBCL patients. Besides, DLBCL patients with higher total or bioavailable 25(OH)D levels were more sensitive to the R-CHOP regimen treatments.
The bioavailable 25(OH)D level may serve as a novel prognostic biomarker in DLBCL patients.
维生素D缺乏与多种癌症类型较差的临床结局相关；然而，其在弥漫性大B细胞淋巴瘤（DLBCL）患者中的作用仍不明确。在此，我们旨在确定DLBCL患者循环总25(OH)D和生物可利用25(OH)D水平的预后价值。
共招募了332例新诊断的DLBCL患者。测定诊断时血浆总25(OH)D和生物可利用25(OH)D水平，并评估它们与患者临床特征和预后的相关性。还评估了临床特征和25(OH)D水平对DLBCL患者R-CHOP治疗反应的预测价值。
患者中，92.8%的维生素D状态不足（<30 ng/mL）。血浆生物可利用25(OH)D水平较高的患者无进展生存期（PFS，多变量调整后风险比=0.72，95%置信区间=0.38-1.35，P=0.301，第2三分位数与第1三分位数相比；多变量调整后风险比=0.39，95%置信区间=0.20-0.79，P=0.009，第3三分位数与第1三分位数相比）和总生存期（OS，多变量调整后风险比=0.89，95%置信区间=0.39-2.02，P=0.777，第2三分位数与第1三分位数相比；多变量调整后风险比=0.21，95%置信区间=0.07-0.65，P=0.007，第3三分位数与第1三分位数相比）更好。同时，较高的血浆总25(OH)D水平与DLBCL患者更好的PFS显著相关，但与OS无关。此外，总25(OH)D或生物可利用25(OH)D水平较高的DLBCL患者对R-CHOP方案治疗更敏感。
生物可利用25(OH)D水平可能作为DLBCL患者一种新的预后生物标志物。
