17 juli 2014: ik heb onderaan het abstract van de studie: Plasma Vitamin D Concentration Influences Survival Outcome After a Diagnosis of Colorectal Cancer, welke tegen betaling is in te zien toegevoegd.

Een omschrijving en de betekenis van deze studie staat hieronder.

19 maart 2014: Bron: European Journal of Cancer

Vitamine D zorgt voor significant minder risico op overlijden aan darmkanker. Het blijkt dat wanneer de 25-hydroxyvitamin D waarden in het bloed hoog (normaal) zijn deze ervoor kunnen zorgen dat patiënten met darmkanker een minder risico op overlijden aan alle oorzaken heeft (tot wel 29%) en zelfs tot 39% voor het risico op overlijden aan darmkanker specifiek in vergelijking met mensen met darmkanker waarvan hun 25-hydroxyvitamin D waarden in het bloed te laag zijn.

Dit blijkt uit een meta-analyse van 5 studies met totaal 2330 darmkankerpatienten. De resultaten van het effect van vitamine D bij borstkankerpatienten is in diezelfde 5 studies ook onderzocht met ook vergelijkbare resultaten en die studie staat hier onder borstkanker op kanker-actueel.

Volgens onderzoekers blijken 65% van de darmkankerpatiënten in de USA een vitamine D tekort te hebben. Bij borstkankerpatienten ligt dat lager maar is het vitamine D tekort nog altijd 39%.

Hoe de vitamine D precies werkt durf ik niet te vertalen in het Nederlands maar dit schrijven de onderzoekers van het Dana-Farber Cancer Institute erover:

The hypothesis that vitamin D status is related to colorectal cancer has received strong experimental support over the past two decades, based on the almost ubiquitous expression in colon cancer cells of the vitamin D receptor (VDR)8,9 and 1-a-hydroxylase (CYP27B1),10 which converts plasma 25-hydroxyvitamin D3 [25(OH)D] into 1,25-dihyroxycholecalciferol [1,25(OH)2D], the active metabolite. Binding of VDR by 1,25(OH)2D leads to transcriptional control of target genes, resulting in induction of differentiation and apoptosis,11,12 and inhibition of proliferation,13 angiogenesis,14,15 and metastatic potential.16,17

Hier een schematische weergave van 1 studie met 304 darmkankerpatiënten over de overlevingskansen gerelateerd aan de vitamine D bloedwaarden, waarbij een verschil van 48% in positieve zin op het effect van de behandeling van darmkanker bij 304 darmkankerpatiënten:

Figure. Plasma 25(OH)D and Survival in 304 Colorectal Cancer Patients (NHS/HPFS)

 Plasma 25(OH)D and Survival in 304 Colorectal Cancer
Patients (NHS/HPFS)

Adjusted for age, gender, stage, grade, site, year of diagnosis, season of blood draw, BMI, and post-diagnosis physical activity. (Ng K, et al. J Clin Oncol. 2008;26:2984-2991.)



Het volledige studierapport van de meta-analyse: Serum 25-hydroxyvitamin D levels and survival in colorectal and breast cancer patients: Systematic review and meta-analysis of prospective cohort studies is tegen betaling in te zien.

Hier het abstract van de studie met een referentielijst:    

Higher vitamin D serum levels (25 (OH) D) (>75nmol/L) were associated with significantly reduced mortality in patients with colorectal cancer

Eur J Cancer. 2014 Feb 27. pii: S0959-8049(14)00124-5. doi: 10.1016/j.ejca.2014.02.006. [Epub ahead of print]

Serum 25-hydroxyvitamin D levels and survival in colorectal and breast cancer patients: Systematic review and meta-analysis of prospective cohort studies.

Author information

  • 1German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
  • 2German Cancer Research Center (DKFZ), Division of Clinical Epidemiology and Aging Research, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany; German Cancer Consortium (DKTK), Heidelberg, Germany. Electronic address: h.brenner@dkfz.de.

Abstract

AIM:

To estimate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and survival among colorectal and breast cancer patients.

METHODS:

We performed a comprehensive literature search of prospective cohort studies assessing the association of serum 25(OH)D levels with survival in colorectal and breast cancer patients. Study characteristics and results were extracted and dose-response relationships were graphically displayed in a standardised manner. Meta-analyses using random effects models were performed to estimate pooled hazard ratios.

RESULTS:

The systematic search yielded five studies including 2330 colorectal cancer patients and five studies including 4413 breast cancer patients all of which compared mortality across two to five categories of 25(OH)D levels. Among colorectal cancer patients, pooled hazard ratios (95% confidence intervals) comparing highest with lowest categories were 0.71 (0.55-0.91) and 0.65 (0.49-0.86) for overall and disease-specific mortality, respectively. For breast cancer patients, the corresponding pooled estimates were 0.62 (0.49-0.78) and 0.58 (0.38-0.84), respectively. No significant evidence of heterogeneity between studies was observed.

CONCLUSION:

Higher 25(OH)D levels (>75nmol/L) were associated with significantly reduced mortality in patients with colorectal and breast cancer. Randomised controlled trials are needed to evaluate whether vitamin D supplementation can improve survival in colorectal and breast cancer patients with low vitamin D status (25(OH)D<50nmol/L) at diagnosis and before treatment.

Copyright © 2014 Elsevier Ltd. All rights reserved.

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Plasma Vitamin D Concentration Influences Survival Outcome After a Diagnosis of Colorectal Cancer

©American Society of Clinical Oncology

JCO JCO.2013.54.5947

Plasma Vitamin D Concentration Influences Survival Outcome After a Diagnosis of Colorectal Cancer

  1. Malcolm G. Dunlop

+ Author Affiliations

  1. Lina Zgaga, Susan M. Farrington, Farhat V.N. Din, Li Yin Ooi, Dominik Glodzik, Albert Tenesa, Harry Campbell, and Malcolm G. Dunlop, University of Edinburgh and Western General Hospital; Evropi Theodoratou and Harry Campbell, University of Edinburgh, Edinburgh; Albert Tenesa, University of Edinburgh, Roslin; Susan Johnston, Glasgow Royal Infirmary, Glasgow, United Kingdom; Lina Zgaga, Trinity College Dublin, Dublin, Ireland.
  1. Corresponding author: Malcolm G. Dunlop, MD, Medical Research Council Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, United Kingdom; e-mail: malcolm.dunlop@igmm.ed.ac.uk.
  1. L.Z. and E.T. contributed equally to this work.

Abstract

Purpose We investigated whether the plasma level of 25-hydroxyvitamin D (25-OHD) after a diagnosis of colorectal cancer (CRC) influences survival outcome.

Patients and Methods We prospectively studied 1,598 patients with stage I to III CRC. We sought association between plasma 25-OHD and stage-specific survival and tested for interaction between 25-OHD level and variation at the vitamin D receptor (VDR) gene locus. Blood was sampled postoperatively, and plasma was assayed for 25-OHD by liquid chromatography-tandem mass spectrometry. VDR polymorphisms (rs1544410, rs10735810, rs7975232, rs11568820) were genotyped, and haplotypes were inferred by using BEAGLE software. We tested for association between survival and 25-OHD, VDR genotype/haplotype, and after applying a VDR genotype–25-OHD interaction term. We conducted Kaplan-Meier survival analysis and used Cox proportional hazards models to estimate adjusted hazard ratios (HRs).

Results We found strong associations between plasma 25-OHD concentration and CRC-specific (P = .008) and all-cause mortality (P = .003). Adjusted HRs were 0.68 (95% CI, 0.50 to 0.90) and 0.70 (95% CI, 0.55 to 0.89), respectively (highest v lowest 25-OHD tertile), particularly in stage II disease (HR, 0.44; P = .004 for CRC-specific mortality). We detected gene-environment interactions between 25-OHD concentration and rs11568820 genotype for CRC-specific (P = .008) and all-cause (P = .022) mortality, number of protective alleles (P = .004 and P = .018, respectively), and GAGC haplotype at the VDR locus for all-cause mortality (P = .008).

Conclusion In patients with stage I to III CRC, postoperative plasma vitamin D is associated with clinically important differences in survival outcome, higher levels being associated with better outcome. We observed interactions between 25-OHD level and VDR genotype, suggesting a causal relationship between vitamin D and survival. The influence of vitamin D supplementation on CRC outcome will require further investigation


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