Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
Andrologia. 2022 Jul;54(6):e14410. doi: 10.1111/and.14410. Epub 2022 Feb 28.
We hypothesized that controversial results regarding the epidemiological relationship between circulating 25-hydroxyvitamin D, 25(OH)D, and risk of prostate cancer (PCA) incidence are partly due to competing risks. To test the hypothesis, we studied associations across 25(OH)D, PCA and death in 2578 middle-aged men belonging to the Kuopio Ischaemic Heart Disease Risk Factor Study. The men were free of cancer at baseline, and the mean (SD) follow-up time was 23.3 (9.1) years. During this period, 296 men had a PCA diagnosis, and 1448 men died without the PCA diagnosis. The absolute risk of developing PCA was highest in the highest 25(OH)D tertile (15%), whereas that of death was highest in the lowest 25(OH)D tertile (67%). A competing risk analysis showed that belonging to the highest 25(OH)D tertile increased the risk of PCA incidence and improved survival with the respective hazard ratios (HR) of 1.35 (95% CI = 1.07-1.70) and 0.79 (95% CI = 0.71-0.89). Adjusting for 10 covariates together with 25(OH)D did not significantly change the results, but the respective adjusted HRs for PCA and death were 1.20 and 0.87. To conclude, the competing risk analysis did not eliminate the direct relationship between 25(OH)D and PCA but rather strengthened it.
我们假设，关于循环 25-羟维生素 D（25(OH)D）与前列腺癌（PCA）发病率之间的流行病学关系的有争议的结果部分归因于竞争风险。为了验证这一假设，我们研究了属于库奥皮奥缺血性心脏病风险因素研究的 2578 名中年男性中的 25(OH)D、PCA 和死亡之间的关联。这些男性在基线时无癌症，平均（SD）随访时间为 23.3（9.1）年。在此期间，296 名男性被诊断出患有 PCA，1448 名男性死于 PCA 诊断前。最高 25(OH)D 三分位数（15%）的男性发生 PCA 的绝对风险最高，而最低 25(OH)D 三分位数（67%）的男性死于任何原因的绝对风险最高。竞争风险分析表明，属于最高 25(OH)D 三分位数会增加 PCA 发病风险并改善生存，相应的风险比（HR）分别为 1.35（95%CI=1.07-1.70）和 0.79（95%CI=0.71-0.89）。同时调整 10 个协变量和 25(OH)D 并没有显著改变结果，但 PCA 和死亡的相应调整后 HR 分别为 1.20 和 0.87。总之，竞争风险分析并没有消除 25(OH)D 与 PCA 之间的直接关系，反而加强了这种关系。
