Abstract
Previous meta-analyses have shown an improved survival with higher blood 25-hydroxyvitamin D (25(OH)D) concentrations in patients with colorectal cancer (CRC). However, a number of much larger studies have been published since then. We provide an updated meta-analysis to synthesize current evidence. PubMed and Web of Science databases were systematically searched for eligible studies. The dose-response relationships and pooled hazard ratios for overall and CRC-specific survival comparing the highest versus the lowest categories of blood 25(OH)D concentrations were assessed. Subgroup analyses based on study geographic location, year of publication, sample size, length of follow-up time and stage were conducted to explore potential sources of heterogeneity. Overall, 11 original studies with a total of 7718 CRC patients were included. The dose-response meta-analysis showed an improvement in survival outcomes with increasing blood 25(OH)D concentrations. Pooled hazard ratios (95% confidence intervals) comparing highest versus lowest categories were 0.68 (0.55–0.85) and 0.67 (0.57–0.78) for overall and CRC-specific survival, respectively. Associations were more prominent among studies conducted in Europe, with larger sample sizes, and including stage I–IV patients. This updated meta-analysis reveals robust evidence of an association between higher blood 25(OH)D concentrations and better survival in CRC patients. The potential for enhancing prognosis of CRC patients by vitamin D supplementation should be explored by randomized trials.
Highlights
Colorectal cancer (CRC) is the fourth most common cause of cancer-related deaths globally, with more than 1.1 million cancer deaths expected by 2030 [1]
This interest started more than 30 years ago when the first ecological study reported an inverse association between solar radiation and colorectal cancer (CRC) mortality [2]
Most prospective observational studies that have investigated an association with prognosis in CRC patients found higher blood
Summary
Colorectal cancer (CRC) is the fourth most common cause of cancer-related deaths globally, with more than 1.1 million cancer deaths expected by 2030 [1]. The identification of modifiable prognostic factors is highly desirable to improve the management of CRC patients and prognosis. The role of vitamin D in CRC has been a topic of considerable interest. This interest started more than 30 years ago when the first ecological study reported an inverse association between solar radiation and CRC mortality [2]. Researchers attributed this association to the quantity of vitamin D synthesized in the skin after exposure to ultraviolet-B (UVB) radiation. Most prospective observational studies that have investigated an association with prognosis in CRC patients found higher blood
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