High Parathyroid Hormone Rather than Low Vitamin D Is Associated with Reduced Event-Free Survival in Childhood Cancer

Abstract

Background: Vitamin D deficiency is linked to poor cancer analyzed and hazard ratios (HR) were calculated for the entire outcomes but the impact of its consequence, elevated para- cohort and six cancer subgroups. thyroid hormone (PTH), remains understudied. PTH recep- Results: PTH and 25OHD values were available for 1,286 patients tor activation influences cancer progression in vitro, yet the (731 male). Higher PTH associated with inferior EFS in primary effect of elevated PTH on pediatric cancer survival is malignant brain tumors [HR, 1.80 (1.19–2.72)], embryonal maligunexamined. nancies [HR, 2.20 (1.1–4.43)], and lymphatic malignancies [HR 1.98 Methods: This retrospective study examines associations (1.05–3.72)]. Vitamin D deficiency associated with inferior EFS in between PTH, 25-OH vitamin D (25OHD), and event-free embryonal malignancies [HR 2.41 (1.24–4.68)]. In a multivariate survival (EFS) and overall survival (OS) in patients with pedi- Cox model, only higher PTH remained significant for inferior EFS. atric cancer. Laboratory data from 4,349 patients (0–18 years) at Conclusions: Elevated PTH may indicate adverse outcomes in a tertiary pediatric cancer unit were analyzed for the highest certain pediatric cancers. PTH and lowest 25OHD levels at diagnosis and the following Impact: This study identifies elevated parathyroid hormone 5 years. Data on relapse, secondary malignancies, and mortality as a potential marker for poor outcomes in patients with pewere stratified by PTH levels above/below the cohort median diatric cancer, emphasizing the need for adequate vitamin D (47 pg/mL) and 25OHD levels ≤30 nmol/L. EFS and OS were and calcium management.