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Changing 25-hydroxyvitamin D3 levels may predict poorer melanoma survival
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Variations to 25-hydroxyvitamin D3 levels during follow-up independently predicted poor prognosis in patients with melanoma, according to the results of a cohort study.
However, 25-hydroxyvitamin D3, or 25(OH)D3, levels at diagnosis did not serve as an independent prognostic biomarker. Previous associations between 25(OH)D3 serum concentrations at diagnosis and poor prognosis appear to be based on insufficient evidence, according to the researchers.
Philippe Saiag, MD, PhD, professor of dermatology at University of Versailles in France, and colleagues conducted a prospective study to determine the prognostic value of 25(OH)D3 at diagnosis and at follow-up.
The analysis included data from 1,171 patients (mean age, 54.2 years; interquartile range, 41-67) with invasive melanoma from the MelanCohort. Researchers measured 25(OH)D3 serum by mass spectrometry and standardized the data based on month drawn, age, sex and BMI.
They used Cox proportional models to ascertain the role of 25(OH)D3 levels and risk for relapse after adjusting for age, sex, BMI and American Joint Committee on Cancer (AJCC) stage.
Overall, 25(OH)D3 levels at diagnosis (median, 49 nmol/L) inversely correlated with prognostic factors such as AJCC stage, Breslow’s thickness and ulceration (P < .001 for all), but not risk for relapse.
However, the researchers found that changes to 25(OH)D3 levels at follow-up significantly predicted poorer outcomes.
Using a third quartile of average change per year (–0.30 to 4.60 nmol/L per year) as a reference point, researchers calculated HRs for increased risk for relapse based on changes less than –5.25 nmol/L per year (HR = 1.94; 95% CI, 1.36-2.76), –5.25 to –0.3 nmol/L per year (HR = 1.23; 95% CI, 0.85-1.78) –0.3 to 4.6 nmol/L per year (HR = 1.61; 95% CI, 1.14-2.28) and 4.6 nmol/L per year or greater (HR = 2.11; 95% CI, 1.5-2.95).
After performing sensitivity analyses, the researchers observed no changes by AJCC stage, number of 25(OH)D3 level measures performed or 25(OH)D3 level at baseline. Further, they found no evidence of reverse causation.
OS analyses yielded similar results — baseline 25(OH)D3 levels did not significantly affect OS, whereas changing levels did.
“The analysis of 25(OH)D3 serum level in this prospective cohort of carefully followed-up patients with melanoma enabled us to confirm an already described association between low 25(OH)D3 serum level at diagnosis and prognostic factors, such as higher Breslow’s thickness or higher AJCC melanoma stage, and to the best of our knowledge for the first time, to investigate the role of its variations during follow-up,” Saiag and colleagues wrote. “As expected by the associations at diagnosis, in crude analysis, low 25(OH)D3 levels were associated with poorer DFS and OS. However, as soon as proper adjustments were used … this association totally disappeared. … Although the baseline value of standardized 25(OH)D3 serum level was not an independent prognostic marker, its variation through time was.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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