維他命D值和非黑色素瘤皮膚癌有關


  【24drs.com】根據線上發表於8月15日皮膚科學誌(Archives of Dermatology)的健康維持組織世代(HMO)研究結果,非黑色素瘤皮膚癌(nonmelanoma skin cancer,NMSC)隨著個人的維他命D值增加,但是紫外線(UV)輻射曝露是可能的干擾因素。
  
  密西根州底特律亨利福特醫院皮膚科Melody J. Eide醫師等人寫道,NMSC的發生率(包括基底細胞癌[basal cell carcinoma,BCC]和麟狀細胞癌[squamous cell carcinoma,SCC]),在過去數十年間上升,特別是年輕婦女。曝露於日曬和皮膚癌的流行病學證據有被明確建立,UV射線曝露被視為是NMSC的一個重要風險因素,特別是SCC。有關維他命D值和皮膚癌的關聯並不一致。
  
  研究目標是評估血清中25-hydroxyvitamin D (25-OHD)值和NMSC風險的關聯,研究對象是1997-2001年間、HMO的3,223名白人病患,就診要求提供骨質疏鬆或低骨密度之建議。首先,測量維他命D值,足夠的維他命D值定義為開始時的血清25-OHD值為30 ng/mL以上(若要換算成nanomoles/L,則乘上2.496),若低於15 ng/mL則視為維他命D不足。
  
  使用保戶資料確認1997-2009年間的NMSC診斷案例,以及首次出現特定疾病的結果,和完整的追蹤人年資料;根據病歷回顧確認組織學亞型和解剖位置。
  
  總共有2,257名病患屬於維他命D不足,966人屬於維他命D充足,平均9.8 年追蹤期間內,診斷有NMSC的240名病患中,49人有SCC、163人有BCC,28人患有這兩種疾病;維他命D值超過15 ng/mL和NMSC有正相關(未校正勝算比[OR]為1.7;95%信心區間[CI]為1.04 - 2.7),校正其他風險因素並不會取消這個關聯(校正OR為1.8;95% CI為1.1 - 2.9)。
  
  至於25-OHD值也發現有類似的正相關,但是未達統計上的顯著意義。NMSC發生在較少UV曝露的解剖位置(校正OR為2.2;95% CI為0.7 - 7.0),包括SCC (校正OR為3.2;95% CI為0.4 - 24.0)和BCC都是,不過,BCC的估計風險值比較低(校正OR為1.7;95% CI為0.5 - 5.8)。
  
  研究作者寫道,開始時血清25-OHD值增加和NMSC風險增加有顯著關聯,這是正相關,不過在UV射線曝露較少的身體部位就不顯著,UV射線曝露依舊是可能的干擾因素。維他命D、UV、和NMSC的複雜關聯,使傳統的流行病研究無法仔細測量累積的UV曝露量。
  
  研究限制包括僅限單一研究機構,研究對象大多為女性且都是白人,缺乏其他重要的NMSC風險因素,有限的研究樣本,僅在研究開始時使用單一種血清25-OHD測量獲得數據,缺乏有關維他命D補充品的資料。
  
  研究作者結論表示,在未來,應進行可代表一般人的前瞻世代分析,最好有UV射線曝露之估計、風險因素、飲食和維他命D補充品資訊,這些對進一步說明維他命D和NMSC的複雜關聯相當重要。
  
  資料來源:http://www.24drs.com/professional/list/content.asp?x_idno=6600&x_classno=0&x_chkdelpoint=Y
  

Vitamin D Levels Linked to Nonmelanoma Skin Cancer

By Laurie Barclay, MD
Medscape Medical News

August 19, 2011 — The risk for nonmelanoma skin cancer (NMSC) is increased with the individual's level of vitamin D, but ultraviolet (UV) radiation exposure is a likely confounder, according to the results of a health maintenance organization (HMO) cohort study reported Online First August 15 in the Archives of Dermatology.

"The incidence of NMSC, which includes both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), has been rising over the past decades, especially in young women," write Melody J. Eide, MD, MPH, from the Department of Dermatology at the Henry Ford Hospital in Detroit, Michigan, and colleagues. "Epidemiological evidence has established a clear association between exposure to solar radiation and skin cancer, and UV exposure is recognized as an important risk factor for NMSC, especially SCC....Evidence of the association of vitamin D levels with skin cancer has been inconsistent."

The goal of the study was to evaluate the association of serum 25-hydroxyvitamin D (25-OHD) levels with the risk for NMSC in an HMO cohort of 3223 white patients seen from 1997 to 2001 for advice regarding osteoporosis or low bone density. At the first visit, vitamin D levels were measured. A sufficient vitamin D level was defined as a baseline serum 25-OHD level of 30 ng/mL or more (to convert to nanomoles per liter, multiply by 2.496), and a deficient vitamin D level was defined as less than 15 ng/mL.

Claims data allowed determination of NMSC cases diagnosed between 1997 and 2009, as well as the first occurrence of specified disease outcome and complete person-years of follow-up since baseline. Histologic subtype and anatomic location were determined from medical record review.

There were 2257 patients with vitamin D insufficiency and 966 with vitamin D sufficiency. Of 240 patients diagnosed with NMSC, 49 had SCC, 163 had BCC, and 28 had both diseases during a mean follow-up of 9.8 years. Vitamin D levels exceeding 15 ng/mL were positively associated with NMSC (unadjusted odds ratio [OR], 1.7; 95% confidence interval [CI], 1.04 - 2.7). Adjustment for additional risk factors did not abolish this association (adjusted OR, 1.8; 95% CI, 1.1 - 2.9).

Similar positive associations were identified for 25-OHD levels, but these did not reach statistical significance. NMSC occurred on less UV-exposed anatomic locations (adjusted OR, 2.2; 95% CI, 0.7 - 7.0), both for SCC (adjusted OR, 3.2; 95% CI, 0.4 - 24.0) and for BCC. However, the risk estimate was lower for BCC (adjusted OR, 1.7; 95% CI, 0.5 - 5.8).

"An increased baseline serum 25-OHD level was significantly associated with an increased NMSC risk," the study authors write. "This association was positive, though nonsignificant on less UV-exposed body sites, and UV exposure remains a likely confounder. The complex and confounded relationship of vitamin D, UV, and NMSC makes classic epidemiological investigation difficult in the absence of carefully measured history of cumulative UV exposure."

Limitations of this study include setting at a single institution, predominantly female and all-white sample, lack of data on other important NMSC risk factors, limited study size, use of a single serum 25-OHD measurement obtained at the time of study enrollment, and lack of data on vitamin D supplementation.

"In the future, analysis of a prospective cohort that is representative of the general population, ideally with available UV-exposure estimates, risk factor, and dietary and supplemental vitamin D information, is essential to further elucidate the highly complex relationship between vitamin D and NMSC," the study authors conclude.

A Dermatology Foundation Career Development Award in Health Care Policy supported this study in part. The study authors have disclosed no relevant financial relationships.

Arch Dermatol.

    
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