Association between Blood 25-Hydroxyvitamin D Levels and Survival in Colorectal Cancer Patients: An Updated Systematic Review and Meta-Analysis
by
Haifa Maalmi 1,2
, Viola Walter 1, Lina Jansen 1, Daniel Boakye 1, Ben Schöttker 1,2, Michael Hoffmeister 1 and Hermann Brenner 1,2,3,*
Haifa Maalmi 1,2, Viola Walter 1, Lina Jansen 1, Daniel Boakye 1, Ben Schöttker 1,2, Michael Hoffmeister 1 and Hermann Brenner 1,2,3,*
1
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, Heidelberg 69120, Germany
2
Network Aging Research (NAR), Heidelberg University, Bergheimer Strasse 20, Heidelberg 69115, Germany
3
German Cancer Consortium, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
*
Author to whom correspondence should be addressed.
Nutrients 2018, 10(7), 896; https://doi.org/10.3390/nu10070896
Received: 20 June 2018 / Revised: 6 July 2018 / Accepted: 11 July 2018 / Published: 13 July 2018
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.
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Keywords:
vitamin D; mortality; colorectal cancer; cohort studies; meta-analysis; dose-response
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Maalmi, H.; Walter, V.; Jansen, L.; Boakye, D.; Schöttker, B.; Hoffmeister, M.; Brenner, H. Association between Blood 25-Hydroxyvitamin D Levels and Survival in Colorectal Cancer Patients: An Updated Systematic Review and Meta-Analysis. Nutrients 2018, 10, 896.
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