Ottaiano Alessandro, Facchini Bianca Arianna, Iacovino Marialucia, Santorsola Mariachiara, Facchini Sergio, Di Mauro Giordana, Toscano Enrica, Montopoli Monica, Di Mauro Annabella, Quagliariello Vincenzo, Maurea Nicola, Vanni Gianluca, Bignucolo Alessia, Montella Liliana, Materazzo Marco, Roselli Mario, Buonomo Oreste Claudio, Berretta Massimiliano
Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via M. Semmola, 80131 Naples, Italy.
Division of Medical Oncology, Department of Precision Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy.
Cancers (Basel). 2024 Dec 17;16(24):4206. doi: 10.3390/cancers16244206.
Breast cancer remains the leading cause of cancer-related deaths among women despite advances in early detection. Neoadjuvant chemotherapy (NACT) is now standard for early-stage BC, with vitamin D (VD) emerging as a potential prognostic biomarker considering its positive pleiotropic effects. This review and meta-analysis assess the impact of baseline VD levels on outcomes in BC patients undergoing NACT. Inclusion criteria required patients to be over 18 years of age, have a pathologically confirmed BC diagnosis, and have their VD levels assessed prior to chemotherapy. Studies were included if they reported odds ratios (ORs) for response and/or hazard ratios (HRs) for PFS with 95% confidence intervals (CIs). A comprehensive literature search of PubMed/MEDLINE and Scopus/ELSEVIER (2014-2024) was conducted, and data were analyzed using fixed- and random-effects models, with Forest plots illustrating the results. Study quality and potential biases were assessed using the MINORS, NOS, and RoB2 scales, and statistical heterogeneity was evaluated with I statistics and funnel plots. Six studies were included in the analysis. All studies addressed stages II and III, with three also including stage I. The meta-analysis covered data from 722 patients regarding NACT response and 1033 patients for PFS. The results revealed a 22% reduction in the likelihood of non-response to NACT associated with adequate VD levels (low/deficient VD vs. high/sufficient VD; OR: 0.78; 95% CI: 0.30-1.25; = 0.001) and a 35% reduction in progression risk with sufficient baseline VD levels (low/deficient VD vs. high/sufficient VD; HR: 0.65; 95% CI: 0.33-0.97; < 0.001). These findings highlight the significance of maintaining adequate vitamin D levels in BC treatment and encourage further studies to unravel the role of VD on cancer biology.
尽管早期检测技术有所进步，但乳腺癌仍是女性癌症相关死亡的主要原因。新辅助化疗（NACT）目前是早期乳腺癌的标准治疗方法，鉴于维生素D（VD）具有积极的多效性作用，它正成为一种潜在的预后生物标志物。本综述和荟萃分析评估了基线VD水平对接受NACT的乳腺癌患者预后的影响。纳入标准要求患者年龄超过18岁，经病理确诊为乳腺癌，并在化疗前评估其VD水平。如果研究报告了反应的比值比（OR）和/或无进展生存期（PFS）的风险比（HR）以及95%置信区间（CI），则纳入研究。对PubMed/MEDLINE和Scopus/ELSEVIER（2014 - 2024年）进行了全面的文献检索，并使用固定效应模型和随机效应模型分析数据，森林图展示结果。使用MINORS、NOS和RoB2量表评估研究质量和潜在偏倚，并通过I统计量和漏斗图评估统计异质性。分析纳入了六项研究。所有研究均涉及II期和III期，其中三项还包括I期。荟萃分析涵盖了722例患者关于NACT反应的数据和1033例患者关于PFS的数据。结果显示，与充足的VD水平相关的NACT无反应可能性降低了22%（低/缺乏VD与高/充足VD；OR：0.78；95% CI：0.30 - 1.25； = 0.001），基线VD水平充足时进展风险降低了35%（低/缺乏VD与高/充足VD；HR：0.65；95% CI：0.33 - 0.97； < 0.001）。这些发现突出了在乳腺癌治疗中维持充足维生素D水平的重要性，并鼓励进一步研究以阐明VD在癌症生物学中的作用。
