Selenium and Vitamin E for Prevention of Non–Muscle-Invasive Bladder Cancer Recurrence and Progression

安慰剂 医学 维生素E 维生素 内科学 随机化 胃肠病学 临床试验 外科 病理 生物 抗氧化剂 冶金 替代医学 材料科学 生物化学
作者
Richard T. Bryan,Sarah Pirrie,Ben Abbotts,Shanna Maycock,Vinnie During,Carolyn Lewis,Margaret Grant,Deborah Bird,Adam J. Devall,D. Michael A. Wallace,Nicholas D. James,Lucinda Billingham,Maurice P. Zeegers,Kar Keung Cheng,Gun Choudry,Sikander Khwaja,Ken Desai,Kieran Jefferson,L. A. EMTAGE,Aniruddha Chakravarti,Michael Foster,B Dev Sarmar,Christopher J. Luscombe,D. Michael A. Wallace,Nicholas James,Peter Cooke,Krzysztof Kadow,John Parkin,Adel Makar
出处
期刊:JAMA network open [American Medical Association]
卷期号:6 (10): e2337494-e2337494 被引量:8
标识
DOI:10.1001/jamanetworkopen.2023.37494
摘要

Selenium and vitamin E have been identified as promising agents for the chemoprevention of recurrence and progression of non-muscle-invasive bladder cancer.To determine whether selenium and/or vitamin E may prevent disease recurrence in patients with newly diagnosed NMIBC.This multicenter, prospective, double-blinded, placebo-controlled, 2 × 2 factorial randomized clinical trial included patients with newly diagnosed NMIBC recruited from 10 secondary or tertiary care hospitals in the UK. A total of 755 patients were screened for inclusion; 484 did not meet the inclusion criteria, and 1 declined to participate. A total of 270 patients were randomly assigned to 4 groups (selenium plus placebo, vitamin E plus placebo, selenium plus vitamin E, and placebo plus placebo) in a double-blind fashion between July 17, 2007, and October 10, 2011. Eligibility included initial diagnosis of NMIBC (stages Ta, T1, or Tis); randomization within 12 months of first transurethral resection was required.Oral selenium (200 μg/d of high-selenium yeast) and matched vitamin E placebo, vitamin E (200 IU/d of d-alfa-tocopherol) and matched selenium placebo, selenium and vitamin E, or placebo and placebo.Recurrence-free interval (RFI) on an intention-to-treat basis (analyses completed on November 28, 2022).The study randomized 270 patients (mean [SD] age, 68.9 [10.4] years; median [IQR] age, 69 [63-77] years; 202 male [75%]), with 65 receiving selenium and vitamin E placebo, 71 receiving vitamin E and selenium placebo, 69 receiving selenium and vitamin E, and 65 receiving both placebos. Median overall follow-up was 5.5 years (IQR, 5.1-6.1 years); 228 patients (84%) were followed up for more than 5 years. Median treatment duration was 1.5 years (IQR, 0.9-2.5 years). The study was halted because of slow accrual. For selenium (n = 134) vs no selenium (n = 136), there was no difference in RFI (hazard ratio, 0.92; 95% CI, 0.65-1.31; P = .65). For vitamin E (n = 140) vs no vitamin E (n = 130), there was a statistically significant detriment to RFI (hazard ratio, 1.46; 95% CI, 1.02-2.09; P = .04). No significant differences were observed for progression-free interval or overall survival time with either supplement. Results were unchanged after Cox proportional hazards regression modeling to adjust for known prognostic factors. In total, 1957 adverse events were reported; 85 were serious adverse events, and all were considered unrelated to trial treatment.In this randomized clinical trial of selenium and vitamin E, selenium supplementation did not reduce the risk of recurrence in patients with NMIBC, but vitamin E supplementation was associated with an increased risk of recurrence. Neither selenium nor vitamin E influenced progression or overall survival. Vitamin E supplementation may be harmful to patients with NMIBC, and elucidation of the underlying biology is required.isrctn.org Identifier: ISRCTN13889738.
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