Vitamin D status after colorectal cancer diagnosis and patient survival according to immune response to tumour

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PMID: 30219720
Journal: European journal of cancer (Oxford, England : 1990) (volume: 103, issue: , 2018 11;103:98-107)
Published: 2018-09-13

Authors:
Hamada T, Liu L, Nowak JA, Mima K, Cao Y, Ng K, Twombly TS, Song M, Jung S, Dou R, Masugi Y, Kosumi K, Shi Y, da Silva A, Gu M, Li W, Keum N, Wu K, Nosho K, Inamura K, Meyerhardt JA, Nevo D, Wang M, Giannakis M, Chan AT, Giovannucci EL, Fuchs CS, Nishihara R, Zhang X, Ogino S

ABSTRACT

BACKGROUND: High-level plasma 25-hydroxyvitamin D [25(OH)D] has been associated with lower colorectal cancer incidence and mortality. Considering evidence indicating immunomodulatory effects of vitamin D, we hypothesised that survival benefits from high systemic vitamin D level might be stronger for colorectal carcinoma with lower immune response to tumour.

METHODS: Using 869 colon and rectal cancer cases within the Nurses‘ Health Study and Health Professionals Follow-up Study, we assessed the prognostic association of postdiagnosis 25(OH)D score [derived from diet and lifestyle variables to predict plasma 25(OH)D level] in strata of levels of histopathologic lymphocytic reaction. The Cox proportional hazards regression model was adjusted for potential confounders, including microsatellite instability, CpG island methylator phenotype, LINE-1 methylation, PTGS2 (cyclooxygenase-2) expression and KRAS, BRAF and PIK3CA mutations.

RESULTS: The association of postdiagnosis 25(OH)D score with colorectal cancer-specific mortality differed by levels of peritumoural lymphocytic reaction (p = 0.001). Multivariable-adjusted mortality hazard ratios for a quintile-unit increase of 25(OH)D score were 0.69 [95% confidence interval (CI), 0.54-0.89] in cases with negative/low peritumoural lymphocytic reaction, 1.08 (95% CI, 0.93-1.26) in cases with intermediate peritumoural reaction and 1.25 (95% CI, 0.75-2.09) in cases with high peritumoural reaction. The survival association of the 25(OH)D score did not significantly differ by Crohn’s-like lymphoid reaction, intratumoural periglandular reaction or tumour-infiltrating lymphocytes.

CONCLUSIONS: The association between the 25(OH)D score and colorectal cancer survival is stronger for carcinomas with lower peritumoural lymphocytic reaction. Our results suggesting interactive effects of vitamin D and immune response may contribute to personalised dietary and lifestyle intervention strategies.

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