Association of Vitamin D Levels With Outcome in Patients With Melanoma After Adjustment For C-Reactive Protein

作者：Fang Shenying; Sui Dawen; Wang Yuling; Liu Huey; Chiang Yi Ju; Ross Merrick I; Gershenwald Jeffrey E; Cormier Janice N; Royal Richard E; Lucci Anthony; Wargo Jennifer; Hu Mimi I; Gardner Julie M; Reveille John D; Bassett Roland L; Wei Qingyi; Amos Christopher I; Lee Jeffrey E^*

来源：Journal of Clinical Oncology, 2016, 34(15): 1741-+.

DOI：10.1200/JCO.2015.64.1357

Purpose
To evaluate for an association between 25-hydroxyvitamin D levels (vitamin D) and outcome measures in patients with melanoma after evaluation is controlled for systemic inflammatory response (SIR) on the basis of simultaneous C-reactive protein (CRP) measurement.
Materials and Methods
Plasma samples from 1,042 prospectively observed patients with melanoma were assayed for vitamin D and CRP. The associations of demographics and CRP with vitamin D were determined, followed by a determination of the association between vitamin D and stage and outcome measures from the date of blood draw. The vitamin D level was considered sufficient if it was 30 to 100 ng/mL. Kaplan-Meier and Cox regression analyses were performed.
Results
The median vitamin D level was 25.0 ng/mL. The median follow-up time was 7.1 years. A lower vitamin D was associated with the blood drawduring fall/winter months (P<.001), older age (P=.001), increased CRP (P<.001), increased tumor thickness (P<.001), ulcerated tumor (P=.0105), and advanced melanoma stage (P=.0024). On univariate analysis, lower vitamin Dwas associated with poorer overall (OS; P<.001), melanoma-specific survival (MSS; P=.0025), and disease-free survival (DFS; P=.0466). The effect of vitamin D on these outcome measures persisted after adjustment for CRP and other covariates. Multi-variable hazards ratios per unit decrease of vitamin D were 1.02 for OS (95% CI, 1.01 to 1.04; P=.0051), 1.02 for MSS (95% CI, 1.00 to 1.04; P=.048), and 1.02 for DFS (95% CI, 1.00 to 1.04; P=.0427).
Conclusion
Lower vitamin D levels in patients with melanoma were associated with poorer outcomes. Although lower vitamin D was strongly associated with higher CRP, the associations of lower vitamin D with poorer OS, MSS, and DFS were independent of this association. Investigation of mechanisms responsible for these associations may be of value to patients with melanoma.

• 出版日期2016-5-20