title: Association of Vitamin D Levels With Outcome in Patients With Melanoma After Adjustment For C-Reactive Protein.
abstract: To evaluate for an association between 25-hydroxyvitamin D levels (vitamin D) and outcome measures in patients with melanoma after evaluation is controlled for systemic inflammatory response (SIR) on the basis of simultaneous C-reactive protein (CRP) measurement.
  
  
  
  Plasma samples from 1,042 prospectively observed patients with melanoma were assayed for vitamin D and CRP. The associations of demographics and CRP with vitamin D were determined, followed by a determination of the association between vitamin D and stage and outcome measures from the date of blood draw. The vitamin D level was considered sufficient if it was 30 to 100 ng/mL. Kaplan-Meier and Cox regression analyses were performed.
  
  
  
  The median vitamin D level was 25.0 ng/mL. The median follow-up time was 7.1 years. A lower vitamin D was associated with the blood draw during fall/winter months (P < .001), older age (P = .001), increased CRP (P < .001), increased tumor thickness (P < .001), ulcerated tumor (P = .0105), and advanced melanoma stage (P = .0024). On univariate analysis, lower vitamin D was associated with poorer overall (OS; P < .001), melanoma-specific survival (MSS; P = .0025), and disease-free survival (DFS; P = .0466). The effect of vitamin D on these outcome measures persisted after adjustment for CRP and other covariates. Multivariable hazards ratios per unit decrease of vitamin D were 1.02 for OS (95% CI, 1.01 to 1.04; P = .0051), 1.02 for MSS (95% CI, 1.00 to 1.04; P = .048), and 1.02 for DFS (95% CI, 1.00 to 1.04; P = .0427).
  
  
  
  Lower vitamin D levels in patients with melanoma were associated with poorer outcomes. Although lower vitamin D was strongly associated with higher CRP, the associations of lower vitamin D with poorer OS, MSS, and DFS were independent of this association. Investigation of mechanisms responsible for these associations may be of value to patients with melanoma.
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Shenying
authors.initials: S
authors.lastname: Fang
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Dawen
authors.initials: D
authors.lastname: Sui
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Yuling
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Huey
authors.initials: H
authors.lastname: Liu
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Yi-Ju
authors.initials: YJ
authors.lastname: Chiang
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Merrick I
authors.initials: MI
authors.lastname: Ross
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Gershenwald
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Janice N
authors.initials: JN
authors.lastname: Cormier
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Royal
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Anthony
authors.initials: A
authors.lastname: Lucci
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wargo
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Mimi I
authors.initials: MI
authors.lastname: Hu
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Julie M
authors.initials: JM
authors.lastname: Gardner
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: John D
authors.initials: JD
authors.lastname: Reveille
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Roland L
authors.initials: RL
authors.lastname: Bassett
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Qingyi
authors.initials: Q
authors.lastname: Wei
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Amos
authors.affiliation: Shenying Fang, Dawen Sui, Yuling Wang, Huey Liu, Yi-Ju Chiang, Merrick I. Ross, Jeffrey E. Gershenwald, Janice N. Cormier, Richard E. Royal, Anthony Lucci, Jennifer Wargo, Mimi I. Hu, Julie M. Gardner, Roland L. Bassett, and Jeffrey E. Lee, The University of Texas MD Anderson Cancer Center; John D. Reveille, The University of Texas Health Science Center at Houston, Houston, TX; Qingyi Wei, Duke University School of Medicine, Durham, NC; and Christopher I. Amos, Dartmouth College, Lebanon, NH jelee@mdanderson.org.
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D018572:Disease-Free Survival; D006801:Humans; D008545:Melanoma / Q000097:blood* / Q000401:mortality / Q000473:pathology; D008875:Middle Aged; D016016:Proportional Hazards Models; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood
chemical_list: D014807:Vitamin D; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D