J Breast Cancer.  2018 Jun;21(2):134-141. 10.4048/jbc.2018.21.2.134.

Association between Changes in Serum 25-Hydroxyvitamin D Levels and Survival in Patients with Breast Cancer Receiving Neoadjuvant Chemotherapy

• Kim JS
• Haule CC
• Kim JH
• Lim SM
• Yoon KH
• Kim JY
• Park HS
• Park S
• Kim SI
• Cho YU
• Park BW

• KMID: 2413931
• DOI: http://doi.org/10.4048/jbc.2018.21.2.134

Abstract

PURPOSE
We investigated the changes in serum 25-hydroxyvitamin D (25[OH]D) levels before and after neoadjuvant chemotherapy (NCT) and the associations with pathologic complete response (pCR) and survival in patients with breast cancer.
METHODS
Serum 25(OH)D concentrations were measured pre- and post-NCT in 374 patients between 2010 and 2013. Based on a cutoff of 20 ng/mL, patients were categorized into "either sufficient" or "both deficient" groups. The associations with clinicopathological data, including pCR and survival, were analyzed using multivariable analyses.
RESULTS
Patients with either pre- or post-NCT sufficient 25(OH)D levels accounted for 23.8%, and the overall pCR rate was 25.9%. Most patients showed 25(OH)D deficiency at diagnosis and 65.8% showed decreased serum levels after NCT. Changes in 25(OH)D status were associated with postmenopause status, rural residence, baseline summer examination, and molecular phenotype, but not pCR. No association between survival and 25(OH)D status was found, including in the subgroup analyses based on molecular phenotypes.
CONCLUSION
Most Korean patients with breast cancer showed vitamin D deficiency at diagnosis and a significant decrease in the serum concentration after NCT. No association with oncologic outcomes was found. Therefore, although optimal management for vitamin D deficiency is urgent for skeletal health, further research is warranted to clearly determine the prognostic role of vitamin D in patients with breast cancer who are candidates for NCT.

Keyword

Breast neoplasms; Neoadjuvant therapy; Survival; Treatment outcome; Vitamin D

MeSH Terms

Breast Neoplasms*
Breast*
Diagnosis
Drug Therapy*
Humans
Neoadjuvant Therapy
Phenotype
Polymerase Chain Reaction
Postmenopause
Treatment Outcome
Vitamin D
Vitamin D Deficiency
Vitamin D

Figure

• 

  Figure 1 Kaplan-Meier curves according to 25-hydroxyvitamin D (25[OH]D) status. Disease-free survival (A) and overall survival (B) curves are presented. The green line denotes patients with either sufficient 25(OH)D level at baseline or after neoadjuvant chemotherapy (NCT) and the blue line represents those with deficient 25(OH)D levels at both baseline and after NCT.

• 

  Figure 2 Changes in the 25-hydroxyvitamin D (25[OH]D) levels during neoadjuvant chemotherapy (NCT) stratified by molecular phenotype. Spaghetti plots showing the serum 25(OH)D levels at baseline and after completion of NCT in the luminal A-like (A), luminal B-like (B), human epidermal growth factor receptor 2 (HER2)-enriched (C), and triple-negative breast cancer (TNBC) (D) phenotypes. The red line exhibits patients who achieved a pathologic complete response (pCR) and the blue line denotes those who did not achieve a pCR after NCT.SD=standard deviation.

• 

  Figure 3 Kaplan-Meier curves according to the 25-hydroxyvitamin D (25[OH] D) status stratified by molecular phenotype. Disease-free survival (A, C, E, and G) and overall survival (B, D, F, and H) curves are presented in the luminal A-like (A and B), luminal B-like (C and D), human epidermal growth factor receptor 2 (HER2)-enriched (E and F), and triple-negative breast cancer (G and H) phenotypes. The green line shows patients with either sufficient 25(OH)D level at baseline or after neoadjuvant chemotherapy (NCT) and the blue line exhibits those with deficient 25(OH)D at both baseline and after NCT.

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