TY - JOUR
T1 - Circulating 25-hydroxyvitamin D up to 3 decades prior to diagnosis in relation to overall and organ-specific cancer survival
AU - Weinstein, Stephanie J.
AU - Mondul, Alison M.
AU - Yu, Kai
AU - Layne, Tracy M.
AU - Abnet, Christian C.
AU - Freedman, Neal D.
AU - Stolzenberg-Solomon, Racheal Z.
AU - Lim, Unhee
AU - Gail, Mitchell H.
AU - Albanes, Demetrius
N1 - Publisher Copyright:
© 2018, This is a U.S. government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection.
PY - 2018/11/1
Y1 - 2018/11/1
N2 - While vitamin D has been associated with improved overall cancer survival in some investigations, few have prospectively evaluated organ-specific survival. We examined the accepted biomarker of vitamin D status, serum 25-hydroxyvitamin D [25(OH)D], and cancer survival in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Of 4616 cancer cases with measured serum 25(OH)D, 2884 died of their cancer during 28 years of follow-up and 1732 survived or died of other causes. Proportional hazards regression estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between pre-diagnostic 25(OH)D and overall and site-specific survival. Serum 25(OH)D was significantly lower among cases who subsequently died from their malignancy compared with those who did not (medians 34.7 vs. 36.5 nmol/L, respectively; p = 0.01). Higher 25(OH)D was associated with lower overall cancer mortality (HR = 0.76, 95% CI 0.67–0.85 for highest vs. lowest quintile, p-trend < 0.0001). Higher 25(OH)D was related to lower mortality from the following site-specific malignancies: prostate (HR = 0.74, 95% CI 0.55–1.01, p-trend = 0.005), kidney (HR = 0.59, 95% CI 0.35–0.98, p-trend = 0.28), and melanoma (HR = 0.39, 95% CI 0.20–0.78, p-trend = 0.01), but increased mortality from lung cancer (HR = 1.28, 95% CI 1.02–1.61, p-trend = 0.19). Improved survival was also suggested for head and neck, gastric, pancreatic, and liver cancers, though not statistically significantly, and case numbers for the latter two organ sites were small. Higher 25(OH)D status years prior to diagnosis was related to improved survival for overall and some site-specific cancers, associations that should be examined in other prospective populations that include women and other racial-ethnic groups.
AB - While vitamin D has been associated with improved overall cancer survival in some investigations, few have prospectively evaluated organ-specific survival. We examined the accepted biomarker of vitamin D status, serum 25-hydroxyvitamin D [25(OH)D], and cancer survival in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study. Of 4616 cancer cases with measured serum 25(OH)D, 2884 died of their cancer during 28 years of follow-up and 1732 survived or died of other causes. Proportional hazards regression estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between pre-diagnostic 25(OH)D and overall and site-specific survival. Serum 25(OH)D was significantly lower among cases who subsequently died from their malignancy compared with those who did not (medians 34.7 vs. 36.5 nmol/L, respectively; p = 0.01). Higher 25(OH)D was associated with lower overall cancer mortality (HR = 0.76, 95% CI 0.67–0.85 for highest vs. lowest quintile, p-trend < 0.0001). Higher 25(OH)D was related to lower mortality from the following site-specific malignancies: prostate (HR = 0.74, 95% CI 0.55–1.01, p-trend = 0.005), kidney (HR = 0.59, 95% CI 0.35–0.98, p-trend = 0.28), and melanoma (HR = 0.39, 95% CI 0.20–0.78, p-trend = 0.01), but increased mortality from lung cancer (HR = 1.28, 95% CI 1.02–1.61, p-trend = 0.19). Improved survival was also suggested for head and neck, gastric, pancreatic, and liver cancers, though not statistically significantly, and case numbers for the latter two organ sites were small. Higher 25(OH)D status years prior to diagnosis was related to improved survival for overall and some site-specific cancers, associations that should be examined in other prospective populations that include women and other racial-ethnic groups.
KW - Cancer
KW - Mortality
KW - Prospective cohort
KW - Survival analysis
KW - Vitamin D
UR - http://www.scopus.com/inward/record.url?scp=85051529923&partnerID=8YFLogxK
U2 - 10.1007/s10654-018-0428-2
DO - 10.1007/s10654-018-0428-2
M3 - Article
C2 - 30073448
AN - SCOPUS:85051529923
SN - 0393-2990
VL - 33
SP - 1087
EP - 1099
JO - European Journal of Epidemiology
JF - European Journal of Epidemiology
IS - 11
ER -