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Dose-Response Relationship between Serum Retinol Levels and Survival in Patients with Colorectal Cancer: Results from the DACHS Study

1
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
2
Network Aging Research (NAR), Heidelberg University, Bergheimer Strasse 20, 69115 Heidelberg, Germany
3
Medical Faculty Heidelberg, University of Heidelberg, 69120 Heidelberg, Germany
4
Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 460, 69120 Heidelberg, Germany
5
Department of General, Visceral and Transplantation Surgery, University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
6
Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany
7
German Cancer Consortium, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(4), 510; https://doi.org/10.3390/nu10040510
Received: 24 March 2018 / Revised: 6 April 2018 / Accepted: 13 April 2018 / Published: 19 April 2018
(This article belongs to the Special Issue Nutrition and Colorectal Cancer)
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Abstract

Current knowledge on the role of retinol in the prognosis of patients with colorectal cancer (CRC) is very limited. We investigated the association of serum retinol levels with survival outcomes in a large cohort of 2908 CRC patients from Germany. Retinol concentrations were determined in serum collected shortly after diagnosis by mass spectrometry. Associations between serum retinol levels and survival outcomes were assessed using multivariable Cox regression and dose-response analyses. The joint association of serum retinol and serum 25-hydroxyvitamin D3 (25(OH)D3) with survival outcomes was also examined. During a median follow-up of 4.8 years, 787 deaths occurred, 573 of which were due to CRC. Dose-response curves showed an inverse relationship between serum retinol levels and survival endpoints in the range of <2.4 µmol/L, but no associations at higher levels. Low (<1.2 µmol/L) versus high (≥2.4 µmol/L) serum retinol levels were associated with poorer overall survival (Hazard ratio (HR) = 1.46, 95% confidence interval (CI) = 1.19–1.78, P-trend = 0.0003) and CRC-specific survival (HR = 1.69, 95% CI = 1.33–2.15, P-trend < 0.0001). Joint presence of low serum retinol (<1.2 µmol/L) and low 25(OH)D3 (<30 nmol/L) was associated with a particularly strong decrease in overall and CRC-specific survival. Low serum retinol levels were identified as a predictor of poor survival in CRC patients, in particular when co-occurring with low serum concentrations of 25(OH)D3. The clinical implications of these findings require further investigation. View Full-Text
Keywords: colorectal neoplasms; mortality; vitamin A; vitamin D; dose-response relationship colorectal neoplasms; mortality; vitamin A; vitamin D; dose-response relationship
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Maalmi, H.; Walter, V.; Jansen, L.; Owen, R.W.; Ulrich, A.; Schöttker, B.; Chang-Claude, J.; Hoffmeister, M.; Brenner, H. Dose-Response Relationship between Serum Retinol Levels and Survival in Patients with Colorectal Cancer: Results from the DACHS Study. Nutrients 2018, 10, 510.

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