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可溶性 CD40 配体水平升高的结直肠癌患者缓解后生存时间缩短，维生素 D 补充可改善这一现象。

Reduced Relapse-Free Survival in Colorectal Cancer Patients with Elevated Soluble CD40 Ligand Levels Improved by Vitamin D Supplementation.

机构信息

Division of Molecular Epidemiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan.

Biometrics and Data Sciences, Bristol-Myers Squibb K.K., 1-2-1 Otemachi Chiyoda-ku, Tokyo 100-0004, Japan.

出版信息

Nutrients. 2023 Oct 13;15(20):4361. doi: 10.3390/nu15204361.

DOI:10.3390/nu15204361

PMID:37892436

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10609672/

Abstract

Although elevated serum levels of soluble CD40 ligand (sCD40L) were reported in patients with cancer, the importance of high sCD40L levels in clinical oncology remains unknown. We conducted a post hoc analysis of the AMATERASU randomized clinical trial of vitamin D3 supplementation (2000 IU/day) in patients with digestive tract cancer to assess its significance. Serum sCD40L levels were measured by ELISA in 294 residual samples, and were divided into tertiles. In patients with colorectal cancer (CRC), 5-year relapse-free survival (RFS) rates in the middle and highest tertiles were 61.6% and 61.2%, respectively, which was significantly lower than 83.8% in the lowest tertile. A Cox proportional hazard analysis showed that the lowest tertile had a significantly lower risk of relapse or death than the highest tertile even with multivariate adjustment (hazard ratio (HR), 0.30; 95% confidence interval (CI), 0.11-0.80; = 0.016). In the subgroup of CRC patients with the highest tertile of sCD40L, the 5-year RFS rate in the vitamin D group was 77.9%, which was significantly higher than 33.2% in the placebo group (HR, 0.30; 95% CI, 0.11-0.81; = 0.018 [ 0.04]). In conclusion, elevated sCD40L might be a biomarker of poor prognosis in patients with CRC, but vitamin D supplementation might improve RFS in patients with high sCD40L.

摘要

虽然有报道称癌症患者血清可溶性 CD40 配体（sCD40L）水平升高，但高水平 sCD40L 在临床肿瘤学中的重要性仍不清楚。我们对 AMATERASU 维生素 D3 补充（2000IU/天）治疗消化道癌的随机临床试验进行了事后分析，以评估其意义。在 294 份残留样本中通过 ELISA 检测血清 sCD40L 水平，并将其分为三分位。在结直肠癌（CRC）患者中，中三分位和高三分位的 5 年无复发生存（RFS）率分别为 61.6%和 61.2%，明显低于低三分位的 83.8%。Cox 比例风险分析显示，即使进行多变量调整，低三分位的复发或死亡风险也明显低于高三分位（风险比（HR），0.30；95%置信区间（CI），0.11-0.80； = 0.016）。在 sCD40L 最高三分位的 CRC 患者亚组中，维生素 D 组的 5 年 RFS 率为 77.9%，明显高于安慰剂组的 33.2%（HR，0.30；95%CI，0.11-0.81； = 0.018[0.04]）。总之，升高的 sCD40L 可能是 CRC 患者预后不良的生物标志物，但维生素 D 补充可能改善高 sCD40L 患者的 RFS。