Calcium plus Vitamin D Supplementation and the Risk of Colorectal Cancer

Abstract Background Low circulating vitamin D levels are associated with poor colorectal cancer (CRC) survival. We assess whether vitamin D supplementation improves CRC survival outcomes. Methods PubMed and Web of Science were searched. Randomised controlled trial (RCTs) of vitamin D supplementation reporting CRC mortality were included. RCTs with high risk of bias were excluded from analysis. Random-effects meta-analysis models calculated estimates of survival benefit with supplementation. The review is registered on PROSPERO, registration number: CRD42020173397. Results Seven RCTs (n = 957 CRC cases) were identified: three trials included patients with CRC at outset, and four population trials reported survival in incident cases. Two RCTs were excluded from meta-analysis (high risk of bias; no hazard ratio (HR)). While trials varied in inclusion criteria, intervention dose and outcomes, meta-analysis found a 30% reduction in adverse CRC outcomes with supplementation (n = 815, HR = 0.70; 95% confidence interval (CI): 0.48–0.93). A beneficial effect was seen in trials of CRC patients (progression-free survival, HR = 0.65; 95% CI: 0.36–0.94), with suggestive effect in incident CRC cases from population trials (CRC-specific survival, HR = 0.76; 95% CI: 0.39–1.13). No heterogeneity or publication bias was noted. Conclusions Meta-analysis demonstrates a clinically meaningful benefit of vitamin D supplementation on CRC survival outcomes. Further well-designed, adequately powered RCTs are needed to fully evaluate benefit of supplementation in augmenting ‘real-life’ follow-up and adjuvant chemotherapy regimens, as well as determining optimal dosing.

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Low plasma vitamin D is associated with adverse colorectal cancer survival after surgical resection, independent of systemic inflammatory response

Gut ◽

10.1136/gutjnl-2018-317922 ◽

2019 ◽

Vol 69 (1) ◽

pp. 103-111 ◽

Cited By ~ 13

Author(s):

P G Vaughan-Shaw ◽

L Zgaga ◽

L Y Ooi ◽

E Theodoratou ◽

M Timofeeva ◽

...

Keyword(s):

Colorectal Cancer ◽

Vitamin D ◽

Inflammatory Response ◽

Surgical Resection ◽

Cancer Survival ◽

Randomised Trial ◽

Area Under The Curve ◽

Vitamin D Supplementation ◽

Systemic Inflammatory Response ◽

Plasma Vitamin

ObjectiveWe assessed the effect of surgical resection of colorectal cancer (CRC) on perioperative plasma vitamin D (25OHD) and C-reactive protein (CRP) level. We investigated the relationship between circulating vitamin D level and CRC survival.DesignWe sequentially sampled 92 patients undergoing CRC resection, and measured plasma 25OHD and CRP. For survival analyses, we assayed 25OHD and CRP in two temporally distinct CRC patient cohorts (n=2006, n=2100) and investigated the association between survival outcome, circulating vitamin D and systemic inflammatory response.ResultsSerial sampling revealed a postoperative fall (mean 17.3 nmol/L; p=3.6e-9) in plasma 25OHD (nadir days 1–2). CRP peaked 3–5 days postoperatively (143.1 mg/L; p=1.4e-12), yet the postoperative fall in 25OHD was independent of CRP. In cohort analyses, 25OHD was lower in the 12 months following operation (mean=48.8 nmol/L) than preoperatively (54.8 nmol/L; p=1.2e-5) recovering after 24 months (52.2 nmol/L; p=0.002). Survival analysis in American Joint Committee on Cancer stages I–III demonstrated associations between 25OHD tertile and CRC mortality (HR=0.69; 95% CI 0.46 to 0.91) and all-cause mortality (HR=0.68; 95% CI 0.50 to 0.85), and was independent of CRP. We observed interaction effects between plasma 25OHD and rs11568820 genotype (functional VDR polymorphism) with a strong protective effect of higher 25OHD only in patients with GG genotype (HR=0.51; 95% CI 0.21 to 0.81). We developed an online tool for predicted survival (https://apps.igmm.ed.ac.uk/mortalityCalculator/) that incorporates 25OHD with clinically useful predictive performance (area under the curve 0.77).ConclusionsCRC surgery induces a fall in circulating 25OHD. Plasma 25OHD level is a prognostic biomarker with low 25OHD associated with poorer survival, particularly in those with rs11568820 GG genotype. A randomised trial of vitamin D supplementation after CRC surgery has compelling rationale.

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Whether vitamin D supplementation protects against colorectal cancer risk remains an open question

European Journal of Cancer ◽

10.1016/j.ejca.2019.03.024 ◽

2019 ◽

Vol 115 ◽

pp. 1-3 ◽

Cited By ~ 3

Author(s):

P.G. Vaughan-Shaw ◽

L. Zgaga ◽

E. Theodoratou ◽

J.P. Blackmur ◽

M.G. Dunlop

Keyword(s):

Colorectal Cancer ◽

Vitamin D ◽

Cancer Risk ◽

Vitamin D Supplementation ◽

Colorectal Cancer Risk ◽

Open Question

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Calcium and/or vitamin D supplementation: could they affect your risks of colorectal cancer development or progression?

Annals of Translational Medicine ◽

10.21037/atm.2018.08.29 ◽

2018 ◽

Vol 6 (S1) ◽

pp. S4-S4

Author(s):

Lynnette R. Ferguson

Keyword(s):

Colorectal Cancer ◽

Vitamin D ◽

Vitamin D Supplementation ◽

Cancer Development

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Effects of vitamin D supplementation on depression in patients with colorectal cancer

10.21203/rs.2.22782/v1 ◽

2020 ◽

Author(s):

JianWen Duan ◽

YongSheng Chen ◽

WenFei Wu ◽

Cong Xiong ◽

ZuLiang Hu ◽

...

Keyword(s):

Colorectal Cancer ◽

Vitamin D ◽

Vitamin D3 ◽

Rating Scale ◽

Vitamin D Supplementation ◽

Hydroxyvitamin D ◽

Vitamin D3 Supplementation ◽

Healthy Control ◽

25 Hydroxyvitamin D ◽

Vitamin D 3

Abstract Background: The relation and possible mechnism of vitamin D supplementation on depression in colorectal cancer (CRC) patients was not clearly ; Objective: This study investigates the effect of vitamin D supplementation on depression in colorectal cancer (CRC) patients. Methods : We recruited 168 CRC patients and 168 healthy control subjects into this study. 17-item Hamilton Depression Rating Scale (HDRS-17) was used to assess depression. Results: We found that 25-hydroxyvitamin D (25(OH)D) concentrations were independently associated with depression among CRC patients. For the 45 depressed patients receiving vitamin D3 supplementation, depression scores decreased markedly with 25(OH)D concentrations increasing to normal. Conclusion: Therefore, we advise monitoring this indicator in CRC patients and supplementing with vitamin D 3 when their 25(OH)D concentrations are low.

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