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Chemotherapy is linked to severe vitamin D deficiency in patients with colorectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Preclinical and clinical evidence support an association between vitamin D deficiency and an increased risk of colorectal cancer. Normal vitamin D status has been linked to favorable health outcomes ranging from decreased risk of osteoporosis to improved cancer mortality. We performed a retrospective study to assess the impact of metastatic disease and chemotherapy treatment on vitamin D status in patients with colorectal cancer residing in Western New York.

Materials and methods

Patients, 315, with colorectal cancer treated in a single institute were assayed for 25-OH vitamin D. The association of age, gender, primary disease site and stage, body mass index, and chemotherapy with vitamin D status was investigated.

Results

Vitamin D deficiency was common among participants with a median 25-OH vitamin D level of 21.3 ng/ml (optimal range 32–100 ng/ml). Primary site of disease and chemotherapy status were associated with very low 25-OH vitamin D levels (≤15 ng/ml) on multivariate analysis. Patients receiving chemotherapy and patients with a rectal primary were 3.7 and 2.6-fold more likely to have severe vitamin D deficiency on multivariate analysis than nonchemotherapy patients and colon cancer primary patients, respectively.

Conclusions

Chemotherapy is associated with a significant increase in the risk of severe vitamin D deficiency. Patients with colorectal cancer, especially those receiving chemotherapy, should be considered for aggressive vitamin D replacement strategies.

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Notes

  1. http://www.labcorp.com/datasets/labcorp/html/chapter/mono/sr004600.htm, last accessed on January 05, 2008

References

  1. Garland CF, Garland FC (1980) Do sunlight and vitamin D reduce the likelihood of colon cancer? Int J Epidemiol 9(3):227–231

    Article  PubMed  CAS  Google Scholar 

  2. Holick M (2007) Vitamin D Deficiency. NEJM 357:266–281

    Article  PubMed  CAS  Google Scholar 

  3. Garland CF et al (1989) Serum 25-hydroxyvitamin D and colon cancer: eight-year prospective study. Lancet 2(8673):1176–1178

    Article  PubMed  CAS  Google Scholar 

  4. Tangrea J et al (1997) Serum levels of vitamin D metabolites and the subsequent risk of colon and rectal cancer in Finnish men. Cancer Causes Control 8(4):615–625

    Article  PubMed  CAS  Google Scholar 

  5. Feskanich D et al (2004) Plasma vitamin D metabolites and risk of colorectal cancer in women. Cancer Epidemiol Biomarkers Prev 13(9):1502–1508

    PubMed  CAS  Google Scholar 

  6. Wactawski-Wende J et al (2006) Calcium plus vitamin D supplementation and the risk of colorectal cancer. N Engl J Med 354(7):684–696

    Article  PubMed  CAS  Google Scholar 

  7. Wu K et al (2007) A nested case-control study of plasma 25-hydroxyvitamin D concentrations and risk of colorectal cancer. J Natl Cancer Inst 99(14):1120–1129

    Article  PubMed  CAS  Google Scholar 

  8. Niv Y et al (1999) In colorectal carcinoma patients, serum vitamin D levels vary according to stage of the carcinoma. Cancer 86(3):391–397

    Article  PubMed  CAS  Google Scholar 

  9. Levine AJ et al (2001) Serum 25-hydroxyvitamin D, dietary calcium intake, and distal colorectal adenoma risk. Nutr Cancer 39(1):35–41

    Article  PubMed  CAS  Google Scholar 

  10. Grau MV et al (2003) Vitamin D, calcium supplementation, and colorectal adenomas: results of a randomized trial. J Natl Cancer Inst 95(23):1765–1771

    PubMed  CAS  Google Scholar 

  11. Zhou W et al (2007) Circulating 25-hydroxyvitamin d levels predict survival in early-stage non-small-cell lung cancer patients. J Clin Oncol 25(5):479–485

    Article  PubMed  CAS  Google Scholar 

  12. Hollis BW (2005) Circulating 25-hydroxyvitamin D levels indicative of vitamin D sufficiency: implications for establishing a new effective dietary intake recommendation for vitamin D. J Nutr 135(2):317–322

    PubMed  CAS  Google Scholar 

  13. Thomas MG et al (1999) Vitamin D receptor expression in colorectal cancer. J Clin Pathol 52(3):181–183

    Article  PubMed  CAS  Google Scholar 

  14. Meggouh F et al (1990) Evidence of 1,25-dihydroxyvitamin D3-receptors in human digestive mucosa and carcinoma tissue biopsies taken at different levels of the digestive tract, in 152 patients. J Steroid Biochem 36(1–2):143–147

    Article  PubMed  CAS  Google Scholar 

  15. Cross HS et al (1996) Vitamin D receptor and cytokeratin expression may be progression indicators in human colon cancer. Anticancer Res 16(4B):2333–2337

    PubMed  CAS  Google Scholar 

  16. Evans SR et al (1998) Vitamin D receptor expression as a predictive marker of biological behavior in human colorectal cancer. Clin Cancer Res 4(7):1591–1595

    PubMed  CAS  Google Scholar 

  17. Matusiak D et al (2005) Expression of vitamin D receptor and 25-hydroxyvitamin D3-1{alpha}-hydroxylase in normal and malignant human colon. Cancer Epidemiol Biomarkers Prev 14(10):2370–2376

    Article  PubMed  CAS  Google Scholar 

  18. Kallay E et al (2001) Characterization of a vitamin D receptor knockout mouse as a model of colorectal hyperproliferation and DNA damage. Carcinogenesis 22(9):1429–1435

    Article  PubMed  CAS  Google Scholar 

  19. Kallay E et al (2002) Vitamin D receptor activity and prevention of colonic hyperproliferation and oxidative stress. Food Chem Toxicol 40(8):1191–1196

    Article  PubMed  CAS  Google Scholar 

  20. Holt PR et al (2006) Calcium plus vitamin D alters preneoplastic features of colorectal adenomas and rectal mucosa. Cancer 106(2):287–296

    Article  PubMed  CAS  Google Scholar 

  21. Holt PR et al (2002) Colonic epithelial cell proliferation decreases with increasing levels of serum 25-hydroxy vitamin D. Cancer Epidemiol Biomarkers Prev 11(1):113–119

    PubMed  CAS  Google Scholar 

  22. Miller EA et al (2007) Calcium, dietary, and lifestyle factors in the prevention of colorectal adenomas. Cancer 109(3):510–517

    Article  PubMed  CAS  Google Scholar 

  23. Peters U et al (2001) Vitamin D, calcium, and vitamin D receptor polymorphism in colorectal adenomas. Cancer Epidemiol Biomarkers Prev 10(12):1267–1274

    PubMed  CAS  Google Scholar 

  24. Gorham ED et al (2007) Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med 32(3):210–216

    Article  PubMed  Google Scholar 

  25. Braun MM et al (1995) Colon cancer and serum vitamin D metabolite levels 10–17 years prior to diagnosis. Am J Epidemiol 142(6):608–611

    PubMed  CAS  Google Scholar 

  26. Ng K et al (2008) Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer. J Clin Oncol 26(18):2984–2991

    Article  PubMed  CAS  Google Scholar 

  27. Boscoe FP, Schymura MJ (2006) Solar ultraviolet-B exposure and cancer incidence and mortality in the United States, 1993–2002. BMC Cancer 6:264

    Article  PubMed  CAS  Google Scholar 

  28. Otani T et al (2007) Plasma vitamin D and risk of colorectal cancer: the Japan Public Health Center-Based Prospective Study. Br J Cancer 97(3):446–451

    Article  PubMed  CAS  Google Scholar 

  29. Sinicrope FA et al (2006) Microsatellite instability accounts for tumor site-related differences in clinicopathologic variables and prognosis in human colon cancers. Am J Gastroenterol 101(12):2818–2825

    Article  PubMed  CAS  Google Scholar 

  30. Camps J et al (2006) Genome-wide differences between microsatellite stable and unstable colorectal tumors. Carcinogenesis 27(3):419–428

    Article  PubMed  CAS  Google Scholar 

  31. Edmonston TB et al (2000) Colorectal carcinomas with high microsatellite instability: defining a distinct immunologic and molecular entity with respect to prognostic markers. Hum Pathol 31(12):1506–1514

    Article  PubMed  CAS  Google Scholar 

  32. Adams JS et al (2007) Vitamin D in defense of the human immune response. Ann N Y Acad Sci 1117:94–105

    Article  PubMed  CAS  Google Scholar 

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Acknowledgment

This study was partly supported by a Mentored Scholar Award Grant by the American Cancer Society to MGF.

There are no financial conflicts to report.

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Correspondence to Marwan G. Fakih.

Additional information

This manuscript was presented in part at GI ASCO 2007.

All authors have read and approved the manuscript.

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Fakih, M.G., Trump, D.L., Johnson, C.S. et al. Chemotherapy is linked to severe vitamin D deficiency in patients with colorectal cancer. Int J Colorectal Dis 24, 219–224 (2009). https://doi.org/10.1007/s00384-008-0593-y

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  • DOI: https://doi.org/10.1007/s00384-008-0593-y

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