title: Serum 25-hydroxyvitamin D and postmenopausal breast cancer survival: a prospective patient cohort study.
abstract: BACKGROUND
  Vitamin D has been postulated to be involved in cancer prognosis. Thus far, only two studies reported on its association with recurrence and survival after breast cancer diagnosis yielding inconsistent results. Therefore, the aim of our study was to assess the effect of post-diagnostic serum 25-hydroxyvitamin D [25(OH)D] concentrations on overall survival and distant disease-free survival.
  
  
  METHODS
  We conducted a prospective cohort study in Germany including 1,295 incident postmenopausal breast cancer patients aged 50-74 years. Patients were diagnosed between 2002 and 2005 and median follow-up was 5.8 years. Cox proportional hazards models were stratified by age at diagnosis and season of blood collection and adjusted for other prognostic factors. Fractional polynomials were used to assess the true dose-response relation for 25(OH)D.
  
  
  RESULTS
  Lower concentrations of 25(OH)D were linearly associated with higher risk of death (hazard ratio (HR) = 1.08 per 10 nmol/L decrement; 95% confidence interval (CI), 1.00 to 1.17) and significantly higher risk of distant recurrence (HR = 1.14 per 10 nmol/L decrement; 95%CI, 1.05 to 1.24). Compared with the highest tertile (≥ 55 nmol/L), patients within the lowest tertile (< 35 nmol/L) of 25(OH)D had a HR for overall survival of 1.55 (95%CI, 1.00 to 2.39) and a HR for distant disease-free survival of 2.09 (95%CI, 1.29 to 3.41). In addition, the association with overall survival was found to be statistically significant only for 25(OH)D levels of blood samples collected before start of chemotherapy but not for those of samples taken after start of chemotherapy (P for interaction = 0.06).
  
  
  CONCLUSIONS
  In conclusion, lower serum 25(OH)D concentrations may be associated with poorer overall survival and distant disease-free survival in postmenopausal breast cancer patients.
authors.affiliation: Division of Cancer Epidemiology, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany. a.vrieling@dkfz-heidelberg.de
authors.forename: Alina
authors.initials: A
authors.lastname: Vrieling
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hein
authors.forename: Sascha
authors.initials: S
authors.lastname: Abbas
authors.forename: Andreas
authors.initials: A
authors.lastname: Schneeweiss
authors.forename: Dieter
authors.initials: D
authors.lastname: Flesch-Janys
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000097:blood* / Q000401:mortality*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005858:Germany; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000378:metabolism*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D014807:Vitamin D; C104450:25-hydroxyvitamin D