Negative Impact of 25-hydroxyvitamin D Deficiency on Breast Cancer Survival

Background: Low 25-hydroxyvitamin D [25(OH)D] levels in serum are associated with breast cancer risk. This study was conducted to determine the impact of 25(OH)D deficiency on survival of breast cancer patients. Methods: In a retrospective cohort study of 303 patients diagnosed with breast cancer during 2011-2012 at the National Cancer Institute Thailand, all cases were followed up for 7 years. The 25(OH)D was measured by high-performance liquid chromatography (HPLC). Clinical and pathological data were collected. The Chi-square test, Kaplan-Meier and Cox regression model were used to assess the association between 25(OH)D levels and risk of death. Results: Of the 303 cases aged between 24 and 78 years 51 (16.8%) died during follow-up from any cause. The mean 25(OH)D levels was 25.1±7.54 ng/ml (8.2 – 61.0 ng/ml). Thirty-three patients (10.9%) were stratified as inadequate or deficient group (<16 ng/ml) with mean survival time of 60.65 months compared to 76.24 months in insufficient or sufficient group (≥16 ng/ ml). Multivariate analysis adjusted for age, body mass index, stage, lymph node metastases, and immunohistochemical (IHC) findings (ER, PgR, HER-2, Ki-67 and P53) showed that patients with low 25(OH)D levels (<16 ng/ml) at diagnosis had a significantly higher risk of death (hazard ratio = 2.5-2.9) than the group with high 25(OH)D levels (≥16 ng/ ml). Conclusion: A concentration of 25(OH)D below 16 ng/ml was found to be independently associated with poor survival in breast cancer patients, regardless of age, lymph node status, stage or breast cancer subtype. An investigation of potential benefit of 25(OH)D supplements appears warranted.     

Prognostic Significance of Serum Vitamin D Levels in Egyptian Females with Breast Cancer

I read with great interest the paper published  by Ismail et al. in your journal entitled “Prognostic significance of serum vitamin d levels in Egyptian females with breast cancer” (Ismail et al., 2018).  While I really thank the authors for addressing a very controversial and challenging topic, I have few points to address. The association, or the link, between vitamin-D deficiency and cancer in general, breast in particular, is old and controversial, at best! Several studies had linked Vitamin-D deficiency with increasing risk of having breast cancer (Crew KD et al., 2009),  worse pathological features (Peppone L J et al., 2012) advanced stage at presentation and even poor treatment outcome (Chiba A, et al., 2017). Additionally, several studies had supported the vitamin D-cancer prevention hypothesis. (Grant WB, 2018).   However, many of such studies suffered methodology problems! Vitamin-D deficiency and breast cancer are both very common and such association may happen. Though many studies described a correlation between Vitamin-D concentration  and disease stage; researchers questioned such association. Authors of one study (Jacobs ET, et al., 2016) cited by the authors, concluded that "though their study confirmed previous work regarding the correlates of vitamin-D concentrations, it does not provide support for an association between vitamin D status and breast cancer stage”. In this study, 50 women with primary invasive, non-metastatic breast cancer were tested  for vitamin-D level at diagnosis, before any cancer treatment. Fifteen (30.0%) patients were found to be vitamin-D deficient. All  patients were followed up for a median of 30 months. It is hard to believe that a study that involved only 50 patients with only 15 of them  had  vitamin-D deficiency,  recruited over a period of 4 years  in one of the busiest national cancer centers with a median follow up of only  30 months can jump to such major conclusions. Reviewing the  data presented in Table-2 of the current study, in a different way than presented,  clearly shows major differences between both study groups (attached table). Compared to those with normal vitamin-D level, deficient patients had larger tumor size (46.7% vs. 2.9%), more advanced-stage disease at presentation ( 53.3% vs. 2.9%), had tumors with higher grade (33.3% vs. 2.9%), hormone-receptor negative (73.3% vs. 51.4%) and HER-2 positive ( 86.7% vs. 40.0%). All these pathological features are well-established poor prognostic features and associated with poor disease-free and overall survival. It is also difficult to assume that low vitamin-D levels in a very small number of patients (n= 15) was the reason behind all such poor prognostic  features. The multivariate analysis presented in the study showed that progesterone receptor status was the only factor independently affecting overall survival. Additionally, authors found out that stage II had worse survival compared to stage I with HR 4.8 (p = 0.042) while stage III compared to stage I had HR of 1.7 (p = 0.577). Such findings raised many questions about the validity of the final conclusions. As such, I believe that the conclusions made by the authors that vitamin D deficiency had a negative effect on overall and disease-free survival in their 15 vitamin-D deficient breast cancer patients is not supported and should not be stated based on this study. Given the huge amount of literature on this topic, I really doubt that a large prospective study can be carried out to further address this issue.     

25-羟基维生素D与结直肠癌关系的Meta分析

目的 探讨25-羟基维生素D水平与结直肠癌的关系,为结直肠癌的防治和病因探索提供证据。方法 检索MEDLINE、EMBASE等大型数据库中2003至2013年发表的有关25-羟基维生素D水平与结直肠癌关系的前瞻性研究文献。采用Meta分析方法,应用Stata11.0软件评价25-羟基维生素D水平与结直肠癌的关系。结果 （1）血液25-羟基维生素D水平最高组与最低组在结直肠癌组与对照组间比较差异有统计学意义（RR= 0.79,95%CI: 0.65~0.95）。（2）地区亚组分析显示,血液25-羟基维生素D水平最高组与最低组间比较差异均无统计学意义。美洲组RR=0.78（95%CI: 0.60~1.02）,欧洲组RR=0.77（95%CI: 0.56~1.06）,亚洲组RR=0.89（95%CI: 0.52~1.50）。（3）Egger’s检验法检验无统计学意义（P>0.05）,Begg’s漏斗图基本对称,所以没有显著的发表偏倚。结论 血液25-羟基维生素D水平与结直肠癌存在联系,补充维生素D对结直肠癌的预防和治疗有一定意义。     

乳腺癌患者血清HSP70和维生素D水平的变化及其临床意义

目的 探讨乳腺癌(BC)HSP70和维生素D水平的变化及其临床意义.方法 42例BC患者作为BC组,30例同期健康体检妇女为健康组.检测两组血清HSP70和维生素D水平,并分析其与患者无疾病进展生存期(DFS)及5年生存率(5YSR)的关系.结果 BC组治疗前后的血清维生素D水平均低于健康组,血清HSP70水平则高于健康组;与治疗前比较,BC组治疗后的血清维生素D水平升高,血清HSP70水平则降低(P<0.05).BC患者血清HSP70水平与其DFS和5YSR均呈负相关(γ=-0.738,-0.748,P<0.05),BC患者血清维生素D水平与其DFS和5YSR则均呈正相关(γ=0.742,0.792,P<0.05).结论 BC患者血清维生素D水平较低而血清HSP70水平较高,且均与其预后相关,可能作为BC患者预后评估的参考指标.     

Serum 25(OH)D concentration,common variants of the VDR gene and lung cancer occurrence

The first aim of our study was to examine the association between common variants in VDR [rs2228570 (FokI), rs1544410 (BsmI), rs7975232 (ApaI), rs731236 (TaqI) and rs11568820 (Cdx2)] and lung cancer risk in the Polish population. Genotyping and statistical analysis which included Chi‐square test with Yates correction and haplotype frequency analysis were performed on a series of 840 consecutively collected lung cancer patients and 920 healthy controls. The second aim was to evaluate the link between serum 25(OH)D concentration and the number of lung cancers in a subgroup of 200 patients. A separate control group that consisted of 400 matched (by age, sex, smoking habits and the season of blood collection) healthy individuals was used to avoid posterior adjustment on the matched variables. Statistical analysis with the use of Chi‐square test with Yates was performed. We found no statistically significant difference in the distribution of the allels of studied VDR variants among cases and controls. A statistically significant over‐representation of VDR haplotypes: rs731236_A + rs1544410_T [odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.11–5.32, p < 0.001], rs731236_G + rs1544410_T (OR = 1.54, 95% CI = 1.31–1.81, p < 0.001) and rs731236_G + rs1544410_C (OR = 0.04, 95% CI = 0.03–0.07, p < 0.001) was detected. We found a tendency toward an increased number of lung cancers among individuals with low serum levels of 25(OH)D. To answer the question, whether VDR can be regarded as lung cancer susceptibility gene and low 25(OH)D serum levels is associated with lung cancer occurrences, additional, multicenter study needs to be performed.     

Circulating 25-Hydroxy Vitamin D Relative to Vitamin D Receptor Polymorphism after Vitamin D3 Supplementation in Breast Cancer Women: A Randomized,Double-Blind Controlled Clinical Trial

Objective: The influence of vitamin D receptor (VDR) genetic variation on serum 25-hydroxyvitamin D levels [25(OH)D] after vitamin D3 supplementation remains unclear. We aimed to investigate changes of 25(OH)D in a randomized, double-blind, placebo-controlled clinical trial, according to VDR genotype, after provision of vitamin D3 to breast cancer cases for a 2-month period. Methods: Participants were assigned to two treatment arms: placebo (n = 28) and vitamin D3 supplementation (n =28). The supplementation group received 50,000 IU of vitamin D every week for 2 months. Blood samples were collected at baseline and after intervention to measure serum 25(OH) D3. Genotypes were assessed for FokI, BsmI, ApaI, and TaqI polymorphisms. Results: After eight weeks supplementation, the rvention group showed a significant increase in the serum concentration of 25(OH) D3 (28±2.6 to 39±3.5; p=0.004). Subjects were then classified into twelve subgroups according to different VDR genotypes. Subjects with ff/Ff, TT/Tt, and Bb genotypes had significantly higher increases in serum 25(OH)D compared to those with FF, tt, and BB/bb genotypes post-intervention. Serum vitamin D3 levels with the AA genotype were lower than with aa/ Aa. No differences were found among other subgroups. Conclusion: Vitamin D3 supplementation increases serum 25(OH)D in women with breast cancer. Serum vitamin D3 in TT/Tt, ff/Ff, and Bb carriers was more responsive to vitamin D supplementation than in those with FF/ff and tt genotypes. Other subgroups might gain less from vitamin D3 supplementation.     

Association Between Alterations in the Serum 25-Hydroxyvitamin D Status During Follow-Up and Breast Cancer Patient Prognosis

Background: Serum vitamin D status can affect the prognosis of breast cancer patients. Our aim was todetermine the association between alterations in the 25-hydroxyvitamin D [25(OH)D] status during follow-upand the prognosis of breast cancer patients. Additionally, we evaluated the association between the 25(OH)Dstatus at the time of diagnosis and the prognosis using a detailed age and stage categorization. Materials andMethods: Four hundred and sixty-nine Korean breast cancer patients were included. We collected patientclinicopathological data, including their serum 25(OH)D concentration at diagnosis and at the annual followupuntil 4 years after diagnosis. The patients were divided according to their 25(OH)D status at diagnosis intoa deficient (<20 ng/ml) and a non-deficient (≥20 ng/ml) group. At follow-up, patients were categorized into thefour following groups according to 25(OH)D status alterations: persistently deficient, improved, deterioratedand persistently non-deficient. Results: At diagnosis, 118 patients were classified into the deficient group and 351into the non-deficient group. After a median follow-up period of 85.8±31.0 months, the patients with advancedstagedisease or an older age in the non-deficient group showed a significantly better survival compared with thedeficient group. Furthermore, at the 1-year follow-up of 25(OH)D status, the persistently non-deficient group andthe improved group had better survival compared with the other two groups. Conclusions: Our results suggestthat maintaining an optimal 25(OH)D status at diagnosis and during the 1-year follow-up period is importantfor improving breast cancer patient survival.     

Emerging role of vitamin D in colorectal cancer

Colorectal cancer is a common cancer and the fourth leading cause of death in Korea. The incidence and mortality of colorectal cancer varies according to risk factors, such as age, family history, genetic history, food habits, and physical activities. Some studies have focused on the association between vitamin D and colorectal cancer. Today, there is growing evidence that high vitamin D intake and a plasma level of 25(OH)D3 reduce the incidence of colorectal cancer by modifying cancer angiogenesis, cell apoptosis, differentiation, and proliferation. Taken together, these results suggest that vitamin D supplementation alone, or in combination with anti-cancer agents, might reduce the incidence of colorectal cancer. In this review, we discuss the function and mechanism of vitamin D including the effect of vitamin D on colorectal cancer.     

The epidemiology of vitamin D and cancer incidence and mortality: A review (United States)

In vitro and animal studies indicate that vitamin D may have anti-cancer benefits, including against progression and metastasis, against a wide spectrum of cancers. Supporting an anti-cancer effect of vitamin D is the ability of many cells to convert 25(OH)D, the primary circulating form of vitamin D, into 1,25(OH)₂D, the most active form of this vitamin. No epidemiologic studies have directly measured vitamin D concentrations or intakes on risk of total cancer incidence or mortality. However, higher rates of total cancer mortality in regions with less UV-B radiation, and among African-Americans and overweight and obese people, each associated with lower circulating vitamin D, are compatible with a benefit of vitamin D on mortality. In addition, poorer survival from cancer in individuals diagnosed in the months when vitamin D levels are lowest suggests a benefit of vitamin D against late stages of carcinogenesis. The only individual cancer sites that have been examined directly in relation to vitamin D status are colorectal, prostate and breast cancers. For breast cancer, some data are promising for a benefit from vitamin D but are far too sparse to support a conclusion. The evidence that higher 25(OH)D levels through increased sunlight exposure or dietary or supplement intake inhibit colorectal carcinogenesis is substantial. The biologic evidence for an anti-cancer role of 25(OH)D is also strong for prostate cancer, but the epidemiologic data have not been supportive. Although not entirely consistent, some studies suggest that higher circulating 1,25(OH)₂D may be more important than 25(OH)D for protection against aggressive, poorly-differentiated prostate cancer. A possible explanation for these divergent results is that unlike colorectal tumors, prostate cancers lose the ability to hydroxylate 25(OH)D to 1,25(OH)₂D, and thus may rely on the circulation as the main source of 1,25(OH)₂D. The suppression of circulating 1,25(OH)₂D levels by calcium intake could explain why higher calcium and milk intakes appear to increase risk of advanced prostate cancer. Given the potential benefits from vitamin D, further research should be a priority.     

Vitamin D Receptor Poly(A) Microsatellite Polymorphism and 25-Hydroxyvitamin D Serum Levels: Association with Susceptibility to Breast Cancer

Purpose

According to previous studies, vitamin D exhibits protective effects against breast cancer via the vitamin D receptor (VDR). There is growing evidence that breast cancer incidence is associated with various polymorphisms of the VDR gene. This study investigates the association of VDR poly(A) microsatellite variants with 25-hydroxyvitamin D (25(OH)D) serum levels and breast cancer risk.

Methods

Polymorphism analysis was performed on a total of 261 blood samples, which were collected from 134 women with breast cancer and 127 controls. Single strand conformation polymorphism was assessed by polymerase chain reaction in combination with sequencing to detect poly(A) lengths for each sample. The vitamin D levels of samples were determined by electrochemiluminescence.

Results

The poly(A) variant L allele frequency was significantly higher in cancer patients than in controls (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.16-2.57; p=0.006). Thus, carriers of the L allele (LS and LL genotypes) have a higher risk for breast cancer (OR, 1.86; 95% CI, 1.13-3.05; p=0.013). A larger increase in the risk for breast cancer was found in individuals with the L carrier genotype and lowered 25(OH)D levels.

Conclusion

The results primarily suggest that VDR gene polymorphism in the poly(A) microsatellite is associated with 25(OH)D levels and that it can affect the breast cancer risk in the female population from northern Iran.     

Serum Vitamin D Levels Affect Pathologic Complete Response in Patients Undergoing Neoadjuvant Systemic Therapy for Operable Breast Cancer

Introduction

There has been increasing interest in the potential benefit of vitamin D in improving breast cancer outcome. Preclinical studies suggest that vitamin D enhances chemotherapy-induced cell death. We investigated the impact of serum vitamin D levels during neoadjuvant chemotherapy (NAC) on the rates of achieving pathologic complete response (pCR) after breast cancer NAC.

Correlation between Serum 25-Hydroxyvitamin D Levels and Gastric Cancer: A Systematic Review and Meta-Analysis

The purpose of this meta-analysis was to evaluate the relationship between serum 25-hydroxyvitamin D[25(OH)D] levels and gastric cancer. PubMed, Embase, Cochrane Library, Web of Science, The China Academic Journals full-text database, Wanfang Database of Chinese Academic Journals, VIP Chinese Science and Technology Periodicals database, and Chinese Biomedical Literature database were systematically searched. Case-control studies on the correlation between serum 25-hydroxyvitamin D levels and gastric cancer were retrieved, and the data extracted were analyzed. The results of 9 case-control studies containing 671 patients showed that serum 25(OH)D levels in the gastric cancer group were lower than those in the control group (weighted mean difference (WMD) = −8.90, 95% confidence interval (CI): −11.5, −6.32, p < 0.01); the risk of vitamin D deficiency in the gastric cancer group was higher than that in the control group (Odds ratio = 3.09, 95% CI: 1.96, 4.87, p < 0.01). The serum 25(OH)D levels in patients with well and moderately differentiated gastric cancer were higher than those in patients with poorly differentiated gastric cancer (WMD = −3.58, 95% CI: −6.41, −0.74, p = 0.01). Thus, low levels of vitamin D may increase the risk of gastric cancer. Systematic review registration: PROSPERO CRD42022327942.     

Association of Vitamin D Level with Clinicopathological Features in Breast Cancer

A population-based relationship between low vitamin D status and increased cancer risk is now generallyaccepted. However there were only few studies reported on prognostic impact. To determine the effect of lowvitamin D on progression of breast cancer, we conducted a cross-sectional analysis of vitamin D levels and clinicopathologicalcharacteristics in 200 cases of breast cancer diagnosed during 2011-2012 at the National CancerInstitute of Thailand. Vitamin D levels were measured by high-performance liquid chromatography (HPLC). Clinical and pathological data were accessed to examine prognostic effects of vitamin D. We found that themean vitamin D level was 23.0±6.61 ng/ml. High vitamin D levels (≥32 ng/ml) were detected in 7% of patients,. low levels (<32 ng/ml) in 93% Mean vitamin D levels for stages 1-4 were 26.1±6.35, 22.3±6.34, 22.2±6.46 and21.3±5.42 ng/ml respectively (P=0.016) and 24.1 and 21.3 ng/ml for lymph node negative and positive cases(P=0.006). Low vitamin D level (<32 ng/ml) was significantly found in majority of cases with advanced stage ofthe disease (P=0.036), positive node involvement (P=0.030) and large tumors (P=0.038). Our findings suggestthat low and decreased level of vitamin D might correlate with progression and metastasis of breast cancer.     

Serum 25-hydroxyvitamin D levels and survival in colorectal and breast cancer patients: Systematic review and meta-analysis of prospective cohort studies

AimTo estimate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and survival among colorectal and breast cancer patients.MethodsWe performed a comprehensive literature search of prospective cohort studies assessing the association of serum 25(OH)D levels with survival in colorectal and breast cancer patients. Study characteristics and results were extracted and dose–response relationships were graphically displayed in a standardised manner. Meta-analyses using random effects models were performed to estimate pooled hazard ratios.ResultsThe systematic search yielded five studies including 2330 colorectal cancer patients and five studies including 4413 breast cancer patients all of which compared mortality across two to five categories of 25(OH)D levels. Among colorectal cancer patients, pooled hazard ratios (95% confidence intervals) comparing highest with lowest categories were 0.71 (0.55–0.91) and 0.65 (0.49–0.86) for overall and disease-specific mortality, respectively. For breast cancer patients, the corresponding pooled estimates were 0.62 (0.49–0.78) and 0.58 (0.38–0.84), respectively. No significant evidence of heterogeneity between studies was observed.ConclusionHigher 25(OH)D levels (>75 nmol/L) were associated with significantly reduced mortality in patients with colorectal and breast cancer. Randomised controlled trials are needed to evaluate whether vitamin D supplementation can improve survival in colorectal and breast cancer patients with low vitamin D status (25(OH)D < 50 nmol/L) at diagnosis and before treatment.     

Vitamin D Levels in Patients with Breast Cancer: Importance of Dressing Style

Background: Vitamin D deficiency is a potentially modifiable risk factor that may be targeted for breast cancer(BC) prevention. It may also be related to prognosis after diagnosis and treatment. The aim of our study was todetermine the prevalence of vitamin D deficiency as measured by serum 25-hydroxy vitamin D (25-OHD) levelsin patients with BC and to evaluate its correlations with life-style and treatments. Materials and Methods: Thisstudy included 186 patients with stage 0-III BC treated in our breast center between 2010-2013. The correlationbetween serum baseline 25-OHD levels and supplement usage, age, menopausal status, diabetes mellitus, usageof bisphosphonates, body-mass index (BMI), season, dressing style, administration of systemic treatments andradiotherapy were investigated. The distribution of serum 25-OHD levels was categorized as deficient (<10ng/ml), insufficient (10-24 ng/ml), and sufficient (25-80 ng/ml). Results: The median age of the patients was 51 years(range: 27-79 years) and 70% of them had deficient/insufficient 25-OHD levels. On univariate analysis, vitaminD deficiency/insufficiency was more common in patients with none or low dose vitamin D supplementation at thebaseline, high BMI (≥25), no bisphosphonate usage, and a conservative dressing style. On multivariate analysis,none or low dose vitamin D supplementation, and decreased sun-exposure due to a conservative dressing stylewere found as independent factors increasing risk of vitamin D deficiency/insufficiency 28.7 (p=0.002) and 13.4(p=0.003) fold, respectively. Conclusions: The prevalence of serum 25-OHD deficiency/insufficiency is high in ourBC survivors. Vitamin D status should be routinely evaluated for all women, especially those with a conservativedressing style, as part of regular preventive care, and they should take supplemental vitamin D.     

血清25-羟基维生素D3及钙水平与胃癌的关系

目的 探讨血清25-(OH)D3及钙（Ca²⁺）水平与胃癌的关系。方法 选取郑州大学第一附属医院经病理确诊为慢性浅表性胃炎（对照组）患者63例,胃癌（病例组）患者118例。采用酶联免疫吸附法（ELISA）测定入选对象血清25-(OH)D3水平,离子选择性电极（ISE）电位法测定入选对象血清Ca²⁺水平。结果 病例组外周血25-(OH)D3水平显著低于对照组（t=15.07,P=0.000）,而其血清Ca水平与对照组比较,差异无统计学意义（t=1.109,P=0.269）,病例组内血清25-(OH)D3水平与Ca²⁺之间呈正相关（r=0.706,P=0.000）。外周血25-(OH)D3水平在不同细胞分化程度的胃癌组间差异有统计学意义（F=3.356,P=0.038）。胃癌经手术治疗后,术后外周血25-(OH) D3水平高于术前,差异有统计学意义（t=−8.017,P=0.000）。但胃癌淋巴结转移与无淋巴结转移组间血清25-(OH)D3水平无统计学意义（t=0.061,P=0.952）。结论 血清 25-(OH)D3水平可能与胃癌的发生、发展相关,手术治疗后其水平明显升高,可用于监测胃癌患者病情变化、预测预后。     

Prognostic Significance of Serum Vitamin D Levels in Egyptian Females with Breast Cancer

Objective: To determine the frequency and prognostic significance of vitamin D deficiency in Egyptian womenwith breast cancer (BC). Methods: This prospective study included 50 women with primary invasive, non-metastaticBC. The serum level of 25-hydroxy vitamin D [25(OH)D was measured by ELISA at diagnosis, before any cancertreatment. Vitamin D deficiency was defined as 25(OH) Dmonths (range: 18-48). Results: The median level of 25(OH)D was 29.0 ng/mL (range: 10.0-55.0 ng/mL). Fifteenpatients (30%) had vitamin D deficiency, which was positively associated with larger tumor size (p < 0.001), highergrade (p = 0.014), advanced stage (p = 0.001), lymph node positivity (p = 0.012), and HER2/neureceptor expression(p = 0.002). It was also linked with worse overall survival (OS) and disease free survival (DFS) (p = 0.026, andp = 0.004, respectively). On multivariate analysis, DFS was independently affected by vitamin D deficiency withan HR of 2.8 (95% CI: 1.6-7.0, p = 0.022) and advanced stage, i.e. stage II had worse survival compared to stage I withan HR of 4.8 (95%CI: 1.1-21.7, p = 0.042). Conclusion: Vitamin D deficiency had a negative effect on overall anddisease-free survival in our breast cancer cases, being related to tumor size, stage, grade, nodal status and HER2/neureceptor expression.     

Vitamin D and breast cancer

In addition to its role in calcium homeostasis and bone health, vitamin D has also been reported to have anticancer activities against many cancer types, including breast cancer. The discovery that breast epithelial cells possess the same enzymatic system as the kidney, allowing local manufacture of active vitamin D from circulating precursors, makes the effect of vitamin D in breast cancer biologically plausible. Preclinical and ecologic studies have suggested a role for vitamin D in breast cancer prevention. Inverse associations have also been shown between serum 25-hydroxyvitamin D level (25(OH)D) and breast cancer development, risk for breast cancer recurrence, and mortality in women with early-stage breast cancer. Clinical trials of vitamin D supplementation, however, have yielded inconsistent results. Regardless of whether or not vitamin D helps prevent breast cancer or its recurrence, vitamin D deficiency in the U.S. population is very common, and the adverse impact on bone health, a particular concern for breast cancer survivors, makes it important to understand vitamin D physiology and to recognize and treat vitamin D deficiency. In this review, we discuss vitamin D metabolism and its mechanism of action. We summarize the current evidence of the relationship between vitamin D and breast cancer, highlight ongoing research in this area, and discuss optimal dosing of vitamin D for breast cancer prevention.     

乳腺良恶性疾病患者血栓弹力图检测价值

[目的]用血栓弹力图(TEG)和传统的凝血功能检测对乳腺良恶性疾病患者的凝血功能进行测定,评估TEG的检测价值.[方法]对268例乳腺癌(实验组)和45例乳腺良性病变患者(对照组)进行TEG检测和凝血四项检测[血浆凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)和纤维蛋白原(Fib)],同时计数血小板(PLT)及测定D-二聚体(D-dimer),根据各项参数了解其凝血状态.[结果]传统凝血功能检测结果:实验组的PT明显缩短,PLT、Fib与D-二聚体水平较对照组有明显增高(P＜0.05),而APTT、TT与对照组相比无统计学差异(P＞0.05).TEG检测结果中,实验组各个参数测量值水平和对照组相比:R值没有明显差异(P＞0.05),Angle值接近显著性差异(P=0.055),K值明显减小,MA值和CI值明显增大(P＜0.05),支持实验组血液的高凝状态;从测量数值超出正常范围的高凝例数来看,K值和CI值在两组比较中有显著性差异(P＜0.05);R值、Angle值、MA值两组中没有显著性差异(P＞0.05).[结论]乳腺癌患者相比良性病变患者血液高凝的表现较为明显,TEG可用来监测患者围术期凝血功能,预防血栓栓塞并发症的发生.