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![Bezug D. Timerman, M. McEnery-Stonelake, C. Joyce et al. Ein Vitamin-D-Mangel ist mit einer schlechteren Prognose beim metastasierten Melanom verbunden. Oncotarget. 2017;8(4):6873-6882. Studienziel Um zu bestimmen, ob Vitamin-D-Mangel und -Sättigung mit dem Melanom-Ergebnis assoziiert sind. Patienten mit 25-Hydroxyvitamin D3 (25[OH]D3) < 21 ng/ml wurde empfohlen, 8 Wochen lang 50.000 IE Vitamin D3 pro Woche einzunehmen und dann mit 4.000 IE pro Woche fortzufahren. Entwurf Retrospektive monozentrische Studie von Krankenakten von Januar 2007 bis Juni 2013. Teilnehmer Aufzeichnungen von 252 Personen mit einem 25(OH)D3-Spiegel, der innerhalb von 1 Jahr nach der histopathologischen Diagnose eines Melanoms aufgezeichnet wurde, wurden in die Studie …](https://natur.wiki/cache/images/SIBO-and-Anti-Inflammatories-Boswellia-Curcumin-jpg-webp-1100.webp)
Relation
D. Timerman, M. McEnery-Stonelake, C. Joyce, et al. Vitamin D deficiency is associated with a worse prognosis in metastatic melanoma.Oncotarget. 2017;8(4):6873-6882.
Study objective
To determine whether vitamin D deficiency and saturation are associated with melanoma outcome. Patients with 25-hydroxyvitamin D3 (25[OH]D3) < 21 ng/mL were recommended to take 50,000 IU of vitamin D3 per week for 8 weeks and then continue with 4,000 IU per week.
Draft
Retrospective single-center study of medical records from January 2007 to June 2013.
Participant
Records of 252 individuals with a 25(OH)D3 level recorded within 1 year of histopathological diagnosis of melanoma were included in the study. Individual and melanoma characteristics such as age, sex, Breslow thickness, ulceration, stage, mitotic rate, and lactate dehydrogenase (LDH) levels were obtained from medical records. The subgroup analysis included 168 patients with a subsequent 25(OH)D3 level recorded at any time point (ie, patients with more than 1 vitamin D level in their records).
Study parameters assessed
Vitamin D deficiency status was based on current Endocrine Society practice guidelines. For comparison, the analysis included effects of changes in 25(OH)D3 levels on survival.
Primary outcome measures
Vitamin D levels, markers of melanoma growth (LDH levels, mitotic growth, ulceration, stage) and survival/death.
Key insights
Patients who died were more likely to have vitamin D deficiency (<21 ng/ml;P=0.012), LDH>240 U/L (P50 years;P=0.007), higher level (P<0.001), ulceration (P=0.001) and higher mitotic rate (P= 0.001) compared to those who were alive at the end of the study or lost to follow-up. Patients with vitamin D deficiency (<21 ng/mL) were more likely to have higher stage disease (P=0.01) and higher mortality (P=0.012). Patients with metastatic melanoma who were deficient and took vitamin D but did not achieve an increase in serum levels of ≥ 20 ng/dL had a worse prognosis (hazard ratio [HR]: 4.68; 95% confidence interval [CI]: 1.05-20.88) than those who were vitamin D-replete and a had a vitamin D increase of >20 ng/ml. Overall, these results suggest that initial vitamin D deficiency and inadequate replenishment are associated with a worse prognosis in patients with metastatic melanoma.
Practice implications
Melanoma diagnoses in the United States increased by 3.1% per year from 1992 to 2004.1The lifetime risk of melanoma in the United States is 1 in 39 for Caucasian men and 1 in 58 for Caucasian women.2The increased risk of this often fatal skin cancer has spurred research into both prevention and treatment.
There is much debate about the relationship between vitamin D and cancer, including melanoma.3-5This study confirms previous studies that found lower serum 25(OH)D levels were associated with increased risk of melanoma, greater Breslow thickness, and worse overall survival.6and this 25(OH)D level during follow-up was an independent prognostic marker.7However, the association between vitamin D and melanoma risk is confounded by other studies showing no association between vitamin D levels and mortality and by studies showing an increased incidence of melanoma in patients with high vitamin D levels.8.9However, in this context, it is important to consider that the risk of melanoma is related to repeated overexposure to ultraviolet B (UVB) radiation (sunburn blistering) rather than cumulative lifelong exposure.
Overall, these results suggest that initial vitamin D deficiency and inadequate repletion are associated with a worse prognosis in patients with metastatic melanoma.
Given that patients with melanoma are advised to avoid sun exposure and take supplemental vitamin D, this study provides an evidence base for such a recommendation. One of these reviewers (Traub) published a study showing that a repletion strategy of 10,000 IU vitamin D3 for 3 months is safe and effective.10
The authors of the study reviewed here suggest that serum 25(OH)D, because it is associated with a robust immune response, could be considered a marker of immunosufficiency in patients with metastatic melanoma. It is also known that UV radiation, especially the UVB range, has an immunosuppressive effect on the skin. DNA damage caused by UVB is not only a carcinogen but also a major trigger of UV-induced immunosuppression.11
We were unable to verify the sources and dosage of vitamin D supplements taken by study participants. We also recognize that large prospective clinical trials of patients with melanoma receiving vitamin D supplementation are necessary to demonstrate a causal relationship.
The key takeaway is that we should maintain 25(OH)D3 levels for all patients with melanoma and supplement with vitamin D3 to saturation for those who are deficient. We should maintain satiety with 2,000 to 4,000 IU daily. Use the same strategy in patients with a history of melanoma to prevent recurrence.