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Preoperative plasma vitamin D in patients with localized colorectal cancer: Age-dependent association with inflammation, postoperative complications, and survival

  • Troels G. Dolin
    Correspondence
    Corresponding author. Department of Medicine, Herlev and Gentofte Hospital, Borgmester Ib Juuls Vej 1, DK 2730, Herlev.
    Affiliations
    Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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  • Ib J. Christensen
    Affiliations
    Department of Gastrointestinal Surgery, Copenhagen University Hospital – Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Denmark
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  • Cecilia M. Lund
    Affiliations
    Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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  • Stig E. Bojesen
    Affiliations
    Department of Clinical Biochemistry, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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  • Jakob Lykke
    Affiliations
    Department of Gastrointestinal Surgery, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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  • Dorte L. Nielsen
    Affiliations
    Department of Oncology, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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  • Jim S. Larsen
    Affiliations
    Department of Oncology, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark
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  • Julia S. Johansen
    Affiliations
    Department of Medicine, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Department of Oncology, Copenhagen University Hospital – Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark

    Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Published:September 10, 2022DOI:https://doi.org/10.1016/j.ejso.2022.08.040

      Abstract

      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.

      Keywords

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