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European Journal of Epidemiology
Published in: European Journal of Epidemiology 11/2017

01-11-2017 | MORTALITY

Relationship of very low serum 25-hydroxyvitamin D3 levels with long-term survival in a large cohort of colorectal cancer patients from Germany

Authors: Haifa Maalmi, Viola Walter, Lina Jansen, Jenny Chang-Claude, Robert W. Owen, Alexis Ulrich, Ben Schöttker, Michael Hoffmeister, Hermann Brenner

Published in: European Journal of Epidemiology | Issue 11/2017

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Abstract

To investigate the association of serum 25-hydroxyvitamin D (25(OH)D3) with survival in a large prospective cohort study of colorectal cancer (CRC) patients. The study population consisted of 2,910 patients diagnosed with CRC between 2003 and 2010 who participated in the DACHS study, a multicenter study from Germany with comprehensive long-term follow-up. 25(OH)D3 was determined in serum samples collected shortly after cancer diagnosis by High Performance Liquid Chromatography-Electro Spray Ionization-Mass Spectrometry. Analyses of survival outcomes were performed using Cox regression with comprehensive adjustment for relevant confounders. The majority (59%) of CRC patients were vitamin D deficient (serum 25(OH)D3 levels <30 nmol/L). During a median follow-up of 4.8 years, 787 deaths occurred, 573 of which were due to CRC. Compared to patients in the highest 25(OH)D3 quintile (>45.20 nmol/L), those in the lowest 25(OH)D3 quintile (<11.83 nmol/L) had a strongly increased mortality. Adjusted hazard ratios (95% Confidence Interval) were 1.78 (1.39–2.27), 1.65 (1.24–2.21), 1.32 (1.03–1.71) and 1.48 (1.18–1.85) for all-cause mortality, CRC-specific mortality, recurrence-free and disease-free survival, respectively. Subgroup analyses did not show any significant effect modification across strata defined by sex, age, stage, body mass index, or the late entry. Dose–response analyses showed a strong inverse relationship between serum 25(OH)D3 levels and survival endpoints at 25(OH)D3 levels <30 nmol/L, and no association with mortality at higher 25(OH)D3 levels. Vitamin D deficiency is highly prevalent in CRC patients and a strong independent predictor of poor prognosis. The possibility of enhancing CRC prognosis by vitamin D supplementation, ideally combined with outdoor physical activity, should be evaluated by randomized controlled trials focusing on patients with vitamin D deficiency.
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Metadata
Title
Relationship of very low serum 25-hydroxyvitamin D3 levels with long-term survival in a large cohort of colorectal cancer patients from Germany
Authors
Haifa Maalmi
Viola Walter
Lina Jansen
Jenny Chang-Claude
Robert W. Owen
Alexis Ulrich
Ben Schöttker
Michael Hoffmeister
Hermann Brenner
Publication date
01-11-2017
Publisher
Springer Netherlands
Published in
European Journal of Epidemiology / Issue 11/2017
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI
https://doi.org/10.1007/s10654-017-0298-z

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