Preoperative plasma vitamin D in patients with localized colorectal cancer: Age-dependent association with inflammation, postoperative complications, and survival
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Introduction: Aging is often associated with low-grade chronic inflammation and a senescent immune system. Vitamin D is a regulator of immune function, and low plasma vitamin D is associated with poor health. The association between plasma vitamin D and inflammatory biomarkers and risk of postoperative complications and survival in patients with colorectal cancer (CRC) is unknown. Our aim was to investigate these associations and how they are influenced by age. Materials and methods: Circulating vitamin D and the inflammatory biomarkers C-reactive protein (CRP), interleukin (IL)-6, and YKL-40 were measured in 398 patients with stage I–III CRC preoperatively. Older patients (≥70 years, n = 208) were compared to younger patients (<70 years, n = 190). The relation between vitamin D and complications and high inflammatory biomarker levels was presented by odds ratios ([OR], 95% confidence interval [CI]). Associations with survival were presented with hazard ratios ([HR], 95% CI). Results: Plasma vitamin D was higher in older patients than in younger patients (75 vs. 67 nmol/L, P = 0.001). High vitamin D was associated with low plasma CRP in younger patients (OR = 0.35, 95% CI 0.17–0.76), but not in older patients (OR = 0.93, 0.49–1.76). High vitamin D in older patients with CRC was associated with reduced risk of major complications (OR = 0.52, 0.28–0.95). This was not found in younger patients (OR = 1.47, 0.70–3.11). Deficient vitamin D (<25 nmol/L) was associated with short overall survival compared to sufficient (>50 nmol/L) irrespective of age (HR = 3.39, 1.27–9.37, P = 0.02). Conclusion: For patients with localized CRC, high vitamin D levels before resection were associated with reduced risk of high inflammatory biomarkers for younger patients and reduced risk of major postoperative complications for older patients. Vitamin D deficiency was associated with reduced survival regardless of age.
|Tidsskrift||European Journal of Surgical Oncology|
|Status||Udgivet - 2023|
The VELUX foundation (Grant project number 00018310) (salary to TGD and CML) and the Beckett Foundation (Grant project number 19-2-4330) (YKL-40 ELISA kits).We thank all patients for their participation in the study. We also thank Tina Bak Sandberg, Maria Kolbech Johansen and Junko Strauss for recruiting the patients before surgery at the Department of Surgery, Herlev and Gentofte Hospital. Consultant Shoab Afzal is acknowledged for his valuable discussion regarding the vitamin D analysis. We thank Mathias Gramkow, MD, for data collection and Astrid Zedlitz Johansen for data collection and curation. “The Bio- and Genome Bank Denmark (Danish Cancer Biobank)” is acknowledged for their assistance with processing and storage of the serum samples. The Department of Oncology, Copenhagen University Hospital - Herlev and Gentofte is thanked for funding of the IL-6 ELISA kits.
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology