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Circulating Vitamin D and Overall Survival in Breast Cancer Patients: A Dose-Response Meta-Analysis of Cohort Studies.
Integr Cancer Ther 2018; 17(2):217-225IC

Abstract

Studies have shown that vitamin D could have a role in breast cancer survival; however, the evidence of the relationship between patients' vitamin D levels and their survival has been inconsistent. This meta-analysis explores possible dose-response relationships between vitamin D levels and overall survival by allowing for differences in vitamin D levels among populations of the various studies. Studies relating vitamin D (25-OH-D [25-hydroxyvitamin D]) levels in breast cancer patients with their survival were identified by searching PubMed and Embase. A pooled HR (hazard ratio) comparing the highest with the lowest category of circulating 25-OH-D levels were synthesized using the Mantel-Haenszel method under a fixed-effects model. A two-stage fixed-effects dose-response model including both linear (a log-linear dose-response regression) and nonlinear (a restricted cubic spline regression) models were used to further explore possible dose-response relationships. Six studies with a total number of 5984 patients were identified. A pooled HR comparing the highest with the lowest category of circulating 25-OH-D levels under a fixed-effects model was 0.67 (95% confidence interval = 0.56-0.79, P < .001). Utilizing a dose-response meta-analysis, the pooled HR for overall survival in breast cancer patients was 0.994 (per 1 nmol/L), Pfor linear trend < .001. At or above a 23.3 nmol/L threshold, for a 10 nmol/L, 20 nmol/L, or 25 nmol/L increment in circulating 25-OH-D levels, the risk of breast cancer overall mortality decreased by 6%, 12%, and 14%, respectively. There was no significant nonlinearity in the relationship between overall survival and circulating 25-OH-D levels. Our findings suggest that there is a highly significant linear dose-response relationship between circulating 25-OH-D levels and overall survival in patients with breast cancer. However, better designed prospective cohort studies and clinical trials are needed to further confirm these findings.

Authors+Show Affiliations

1 Sichuan University, Chengdu, Sichuan, People's Republic of China.2 University of Adelaide, Adelaide, South Australia, Australia.1 Sichuan University, Chengdu, Sichuan, People's Republic of China.1 Sichuan University, Chengdu, Sichuan, People's Republic of China.

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

28589744

Citation

Hu, Kejia, et al. "Circulating Vitamin D and Overall Survival in Breast Cancer Patients: a Dose-Response Meta-Analysis of Cohort Studies." Integrative Cancer Therapies, vol. 17, no. 2, 2018, pp. 217-225.
Hu K, Callen DF, Li J, et al. Circulating Vitamin D and Overall Survival in Breast Cancer Patients: A Dose-Response Meta-Analysis of Cohort Studies. Integr Cancer Ther. 2018;17(2):217-225.
Hu, K., Callen, D. F., Li, J., & Zheng, H. (2018). Circulating Vitamin D and Overall Survival in Breast Cancer Patients: A Dose-Response Meta-Analysis of Cohort Studies. Integrative Cancer Therapies, 17(2), pp. 217-225. doi:10.1177/1534735417712007.
Hu K, et al. Circulating Vitamin D and Overall Survival in Breast Cancer Patients: a Dose-Response Meta-Analysis of Cohort Studies. Integr Cancer Ther. 2018;17(2):217-225. PubMed PMID: 28589744.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Circulating Vitamin D and Overall Survival in Breast Cancer Patients: A Dose-Response Meta-Analysis of Cohort Studies. AU - Hu,Kejia, AU - Callen,David Frederick, AU - Li,Jiayuan, AU - Zheng,Hong, Y1 - 2017/06/07/ PY - 2017/6/8/pubmed PY - 2019/2/5/medline PY - 2017/6/8/entrez KW - breast cancer KW - dose-response meta-analysis KW - dose-response relationship KW - meta-analysis KW - overall survival KW - vitamin D SP - 217 EP - 225 JF - Integrative cancer therapies JO - Integr Cancer Ther VL - 17 IS - 2 N2 - Studies have shown that vitamin D could have a role in breast cancer survival; however, the evidence of the relationship between patients' vitamin D levels and their survival has been inconsistent. This meta-analysis explores possible dose-response relationships between vitamin D levels and overall survival by allowing for differences in vitamin D levels among populations of the various studies. Studies relating vitamin D (25-OH-D [25-hydroxyvitamin D]) levels in breast cancer patients with their survival were identified by searching PubMed and Embase. A pooled HR (hazard ratio) comparing the highest with the lowest category of circulating 25-OH-D levels were synthesized using the Mantel-Haenszel method under a fixed-effects model. A two-stage fixed-effects dose-response model including both linear (a log-linear dose-response regression) and nonlinear (a restricted cubic spline regression) models were used to further explore possible dose-response relationships. Six studies with a total number of 5984 patients were identified. A pooled HR comparing the highest with the lowest category of circulating 25-OH-D levels under a fixed-effects model was 0.67 (95% confidence interval = 0.56-0.79, P < .001). Utilizing a dose-response meta-analysis, the pooled HR for overall survival in breast cancer patients was 0.994 (per 1 nmol/L), Pfor linear trend < .001. At or above a 23.3 nmol/L threshold, for a 10 nmol/L, 20 nmol/L, or 25 nmol/L increment in circulating 25-OH-D levels, the risk of breast cancer overall mortality decreased by 6%, 12%, and 14%, respectively. There was no significant nonlinearity in the relationship between overall survival and circulating 25-OH-D levels. Our findings suggest that there is a highly significant linear dose-response relationship between circulating 25-OH-D levels and overall survival in patients with breast cancer. However, better designed prospective cohort studies and clinical trials are needed to further confirm these findings. SN - 1552-695X UR - https://www.unboundmedicine.com/medline/citation/28589744/Circulating_Vitamin_D_and_Overall_Survival_in_Breast_Cancer_Patients:_A_Dose_Response_Meta_Analysis_of_Cohort_Studies_ L2 - http://journals.sagepub.com/doi/full/10.1177/1534735417712007?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -