目的 探讨25-羟维生素D［25-hydroxyvitamin D，25-(OH)D］与儿童肾母细胞瘤的相关性及对疾病预后的评估价值。 方法 选取2018年1月—2022年12月收治的肾母细胞瘤患儿50例为肾母细胞瘤组，根据患儿术后病理类型，分为预后良好亚组（38例）和预后不良亚组（12例）。纳入同期体检的健康儿童50例为健康对照组。分析比较各组的血肌酐、25-(OH)D等水平。采用Spearman秩相关分析探讨25-(OH)D与儿童肾母细胞瘤治疗疗效反应的相关性，采用多因素logistic回归分析探讨影响儿童肾母细胞瘤预后的危险因素。 结果 肾母细胞瘤组血肌酐、25-(OH)D水平低于健康对照组（P<0.05）。预后不良亚组肿瘤直径、肿瘤分期为Ⅲ~Ⅳ比例、转移比例高于预后良好亚组，血肌酐、25-(OH)D水平低于预后良好亚组（P<0.05）。Spearman秩相关分析显示，血清25-(OH)D水平与儿童肾母细胞瘤治疗疗效反应呈负相关（rs=-0.685，P<0.001）。多因素logistic回归分析显示，肿瘤直径≥10 cm、肿瘤分期为Ⅲ~Ⅳ、存在转移及25-(OH)D<19 ng/mL与儿童肾母细胞瘤预后不良密切相关（P<0.05）。血清25-(OH)D水平评估儿童肾母细胞瘤预后的曲线下面积为0.805（95%CI：0.706~0.903，P<0.001），约登指数为0.512，最佳截断值为1.764 ng/mL，灵敏度、特异度分别为0.938、0.575。 结论 25-(OH)D水平与儿童肾母细胞瘤预后存在显著相关性，可以通过判断25-(OH)D判断预后。
Abstract
Objective To study the correlation between 25-hydroxyvitamin D [25-(OH)D] and nephroblastoma in children and its value in assessing the prognosis of the disease. Methods A total of 50 children with nephroblastoma who were admitted from January 2018 to December 2022 were included as the nephroblastoma group, and according to the postoperative pathological type, they were divided into a good prognosis group with 38 children and a poor prognosis group with 12 children. A total of 50 healthy children who underwent physical examination during the same period of time served as the healthy control group. The above groups were compared in terms of serum creatinine and 25-(OH)D level. A Spearman correlation analysis was used to investigate the correlation between serum 25-(OH)D level and therapeutic effect reaction. A multivariate logistic regression analysis was used to identify the risk factors affecting the prognosis of nephroblastoma in children. Results The nephroblastoma group had significantly lower levels of serum creatinine and 25-(OH)D than the healthy control group (P<0.05). Compared with the good prognosis group, the poor prognosis group had a significantly larger tumor diameter, a significantly higher proportion of children with stage III-IV tumors, a significantly higher rate of tumor metastasis, and significantly lower serum levels of creatinine and 25-(OH)D (P<0.05). The Spearman correlation analysis showed that serum 25-(OH)D level was negatively correlated with therapeutic effect reaction (rs=-0.685, P<0.001). The multivariate logistic regression analysis showed that tumor diameter ≥10 cm, stage III-IV tumors, presence of tumor metastasis, and 25-(OH)D <19 ng/mL were closely associated with the poor prognosis of nephroblastoma in children (P<0.05). Serum 25-(OH)D level had an area under the curve of 0.805 (95%CI: 0.706-0.903, P<0.001) in evaluating the prognosis of nephroblastoma in children, with a Youden index of 0.512, a sensitivity of 0.938, and a specificity of 0.575 at the optimal cut-off value of 1.764 ng/mL. Conclusions There is a significant correlation between 25-(OH)D level and the prognosis of nephroblastoma in children, and 25-(OH)D can be used for prognosis prediction.
关键词
25-羟维生素D /
肾母细胞瘤 /
预后评估价值 /
儿童
Key words
25-Hydroxyvitamin D /
Nephroblastoma /
Prognostic value /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
1 管敏莉, 李凯. 基于SEER数据库分析肾母细胞瘤的临床特点及预后[J]. 中华小儿外科杂志, 2021, 42(12): 1101-1106. DOI: 10.3760/cma.j.cn421158-20200428-00299.
2 Verma N, Kumar A. Clinicoepidemiological profile and outcome of children with Wilms tumor in a developing country[J]. J Pediatr Hematol Oncol, 2016, 38(7): e213-e216. PMID: 27299590. DOI: 10.1097/MPH.0000000000000603.
3 Onuigbo WIB. Comparative approach to the epidemiology of Wilm's tumor[J]. Arch Cancer Res, 2016, 4(1): 48. DOI: 10.21767/2254-6081.100048.
4 钟秋连, 黄华艺. 维生素D结合蛋白与肿瘤的关系研究进展[J]. 中华检验医学杂志, 2014, 37(11): 828-831. DOI: 10.3760/cma.j.issn.1009-9158.2014.11.008.
5 何梦洁, 邹艳, 黄李春, 等. 2018年浙江省成人维生素D营养状况及影响因素[J]. 卫生研究, 2022, 51(5): 844-848. DOI: 10.19813/j.cnki.weishengyanjiu.2022.05.028.
6 Gregorio BM. Editorial comment: dietary and circulating vitamin D and risk of renal cell carcinoma: a meta-analysis of observational studies[J]. Int Braz J Urol, 2021, 47(4): 745-746. PMID: 33848066. PMCID: PMC8321487. DOI: 10.1590/S1677-5538.IBJU.2020.0417.1.
7 Bersanelli M, Vaglio A, Sverzellati N, et al. Potential role of hypovitaminosis D in renal cell carcinoma patients treated with immune-checkpoint inhibitors[J]. J Clin Oncol, 2017, 35(7_suppl): 50. DOI: 10.1200/JCO.2017.35.7_suppl.50.
8 中华预防医学会儿童保健分会. 中国儿童维生素A、维生素D临床应用专家共识[J]. 中国儿童保健杂志, 2021, 29(1): 110-116. DOI: 10.11852/zgetbjzz2020-2118.
9 梁海燕, 许帅, 黄洋阅, 等. 胚芽型肾母细胞瘤的临床特点和预后相关因素分析[J]. 中华泌尿外科杂志, 2022, 43(8): 587-592. DOI: 10.3760/cma.j.cn112330-20210406-00174.
10 徐基昕, 段勇涛, 李彦格, 等. 基于儿童肾母细胞瘤-2016诊疗规范的单中心疗效分析(附38例)[J]. 现代肿瘤医学, 2022, 30(4): 685-689. DOI: 10.3969/j.issn.1672-4992.2022.04.025.
11 解鲁璐, 董岿然. 肾母细胞瘤复发的诊疗进展[J]. 中华小儿外科杂志, 2020, 41(6): 571-576. DOI: 10.3760/cma.j.cn421158-20190528-00377.
12 Grant WB. Vitamin D status may explain racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era[J]. Cancer, 2016, 122(24): 3892-3893. PMID: 27627191. DOI: 10.1002/cncr.30344.
13 Rose TL, Milowsky MI. Reply to vitamin D status may explain racial disparities in survival among patients with advanced renal cell carcinoma in the targeted therapy era[J]. Cancer, 2016, 122(24): 3893. PMID: 27627047. DOI: 10.1002/cncr.30343.
14 Darling AL, Abar L, Norat T. WCRF-AICR continuous update project: systematic literature review of prospective studies on circulating 25-hydroxyvitamin D and kidney cancer risk[J]. J Steroid Biochem Mol Biol, 2016, 164: 85-89. PMID: 26454157. DOI: 10.1016/j.jsbmb.2015.10.001.
15 Lin G, Ning L, Gu D, et al. Examining the association of circulating 25-hydroxyvitamin D with kidney cancer risk: a meta-analysis[J]. Int J Clin Exp Med, 2015, 8(11): 20499-20507. PMID: 26884966. PMCID: PMC4723811.
16 Grant WB. Differences in 25-hydroxyvitamin D concentrations may explain the black-white differences in chronic kidney disease and risk of renal cell carcinoma[J]. Epidemiology, 2015, 26(4): e48-e49. PMID: 25899998. DOI: 10.1097/EDE.0000000000000309.
17 Joh HK, Giovannucci EL, Bertrand KA, et al. Predicted plasma 25-hydroxyvitamin D and risk of renal cell cancer[J]. FASEB J, 2013, 27(S1): 622.15. DOI: 10.1096/fasebj.27.1_supplement.622.15.
18 Helzlsouer KJ, Gallicchio L. Shedding light on serum vitamin D concentrations and the risk of rarer cancers[J]. Anticancer Agents Med Chem, 2013, 13(1): 65-69. PMID: 23094922. DOI: 10.2174/1871520611307010065.
19 Karami S, Brennan P, Navratilova M, et al. Vitamin D pathway genes, diet, and risk of renal cell carcinoma[J]. Int J Endocrinol, 2010, 2010: 879362. PMID: 20049159. PMCID: PMC2798114. DOI: 10.1155/2010/879362.
20 Karami S, Brennan P, Rosenberg PS, et al. Analysis of SNPs and haplotypes in vitamin D pathway genes and renal cancer risk[J]. PLoS One, 2009, 4(9): e7013. PMID: 19753122. PMCID: PMC2737618. DOI: 10.1371/journal.pone.0007013.
21 Nagakura K, Nakamura H, Hayakawa M, et al. An inhibitory effect of 1 alpha, 25-dihydroxyvitamin D3 on the growth of the receptor-containing human renal carcinoma cell lines[J]. Nihon Hinyokika Gakkai Zasshi, 1985, 76(12): 1901-1908. PMID: 3012170. DOI: 10.5980/jpnjurol1928.76.12_1901.
22 Dormoy V, Béraud C, Lindner V, et al. Vitamin D3 triggers antitumor activity through targeting hedgehog signaling in human renal cell carcinoma[J]. Carcinogenesis, 2012, 33(11): 2084-2093. PMID: 22843547. DOI: 10.1093/carcin/bgs255.
23 Lambert JR, Eddy VJ, Young CD, et al. A vitamin D receptor-alkylating derivative of 1α,25-dihydroxyvitamin D3 inhibits growth of human kidney cancer cells and suppresses tumor growth[J]. Cancer Prev Res (Phila), 2010, 3(12): 1596-1607. PMID: 21149334. PMCID: PMC3059596. DOI: 10.1158/1940-6207.CAPR-10-0122.
24 齐飞波, 张晓玲, 王慧琴, 等. 维生素D受体基因Fok Ⅰ和CDX2位点多态性与肾癌的关系研究[J]. 国际泌尿系统杂志, 2015, 35(6): 814-817. DOI: 10.3760/cma.j.issn.1673-4416.2015.06.005.
25 林光正, 谢栋栋, 王毅, 等. 25-羟维生素D水平与肾癌发病的相关性分析[J]. 安徽医学, 2017, 38(11): 1392-1394. DOI: 10.3969/j.issn.1000-0399.2017.11.007.
基金
新疆维吾尔自治区天山创新团队计划项目（2020D14027）。
PDF(645 KB)
