Shu Chi, Yang Qian, Huang Jun, Xie Xuan, Li Hong, Wu Hong, Wang Xin, Chen Xin, Xie Yuping, Zhou Yanhong, He Yazhou, Xu Chuan
Department of General Surgery, Division of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Oncology and Cancer Institute, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
Int J Surg. 2024 Dec 1;110(12):8126-8135. doi: 10.1097/JS9.0000000000002142.
Biological evidence has revealed antitumor effect of vitamin D, but whether it could predict the response to neoadjuvant chemotherapy (NAC) in breast cancer (BC) patients remains inconclusive. The aim was to investigate the association between pretreatment vitamin D level and response to NAC and subsequent survival outcomes in BC patients.
The authors systematically searched the Medline, Embase, Cochrane Library, and Web of Science databases and clinical trial registries to identify relevant articles from inception to 8 October 2024. Eligible studies investigating the associations between pretreatment plasma vitamin D and response to NAC in BC patients were selected according to the predefined criteria, with the study characteristics extracted by two reviewers. The primary outcome was pathological complete response (pCR), while overall pathological response and event-free survival (EFS) were adopted as secondary outcomes. Summary effect estimates of odds ratios (ORs) or hazard ratios (HRs) with 95% CIs were pooled using a random-effects model. Subgroup and sensitivity analyses were performed based on study characteristics and methodological quality.
Six retrospective cohort studies involving 1291 BC patients were included. The authors observed a significant association between pretreatment vitamin D deficiency and 50% increased odds of non-pCR after NAC (OR=1.50, 95% CI: 1.11-2.03, P=0.008) with no heterogeneity (I2=0%). The authors also identified a significant association of vitamin D with the overall pathological response (OR=1.33, 95% CI: 1.01-1.75, P=0.046). A similar association with EFS (HR=1.27, 95% CI: 0.92-1.75, P=0.139) was also noted although the effect estimate was not statistically significant. Sensitivity analyses based on methodological quality showed consistent findings.
Pretreatment vitamin D deficiency is associated with an inferior response to NAC in BC patients. Our meta-analysis advocates further prospective studies with large sample sizes before vitamin D supplementation could be administered to improve NAC response and subsequent prognosis of BC patients.
生物学证据显示维生素D具有抗肿瘤作用，但它能否预测乳腺癌（BC）患者对新辅助化疗（NAC）的反应仍尚无定论。本研究旨在探讨BC患者治疗前维生素D水平与NAC反应及后续生存结局之间的关联。
作者系统检索了Medline、Embase、Cochrane图书馆和Web of Science数据库以及临床试验注册库，以确定从数据库建立至2024年10月8日的相关文章。根据预定义标准，选择符合条件的研究，这些研究调查了BC患者治疗前血浆维生素D与NAC反应之间的关联，由两名审阅者提取研究特征。主要结局为病理完全缓解（pCR），而总体病理反应和无事件生存期（EFS）作为次要结局。采用随机效应模型汇总优势比（OR）或风险比（HR）及其95%置信区间（CI）的汇总效应估计值。基于研究特征和方法学质量进行亚组分析和敏感性分析。
纳入了6项涉及1291例BC患者的回顾性队列研究。作者观察到，治疗前维生素D缺乏与NAC后非pCR几率增加50%之间存在显著关联（OR = 1.50，95% CI：1.11 - 2.03，P = 0.008），且无异质性（I² = 0%）。作者还发现维生素D与总体病理反应之间存在显著关联（OR = 1.33，95% CI：1.01 - 1.75，P = 0.046）。尽管效应估计值无统计学意义，但也注意到与EFS存在类似关联（HR = 1.27，95% CI：0.92 - 1.75，P = 0.139）。基于方法学质量的敏感性分析显示结果一致。
治疗前维生素D缺乏与BC患者对NAC反应较差有关。我们的荟萃分析主张在给予维生素D补充剂以改善BC患者的NAC反应和后续预后之前，进一步开展大样本量的前瞻性研究。
