SNFGE SNFGE
 
Thématique :
- Cancer colorectal (CCR)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Pas encore
 
 
Nom du veilleur :
Professeur Thomas APARICIO
Coup de coeur :
 
 
Gut
  2019/04  
 
  2019 Apr. pii: gutjnl-2018-317922.  
  doi: 10.1136/gutjnl-2018-317922.  
 
  Low plasma vitamin D is associated with adverse colorectal cancer survival after surgical resection, independent of systemic inflammatory response.  
 
  Vaughan-Shaw PG, Zgaga L, Ooi LY, Theodoratou E, Timofeeva M, Svinti V, Walker M, O'Sullivan F, Ewing A, Johnston S, Din FVN, Campbell H, Farrington SM, Dunlop MG  
  https://www.ncbi.nlm.nih.gov/pubmed/?term=Low+plasma+vitamin+D+is+associated+with+adverse+colorectal+cancer+survival+after+surgical+resection%2C+independent+of+systemic+inflammatory+response.  
 
 

Abstract

OBJECTIVE:

We assessed the effect of surgical resection of colorectal cancer (CRC) on perioperative plasma vitamin D (25OHD) and C-reactive protein (CRP) level. We investigated the relationship between circulating vitamin D level and CRC survival.

DESIGN:

We sequentially sampled 92 patients undergoing CRC resection, and measured plasma 25OHD and CRP. For survival analyses, we assayed 25OHD and CRP in two temporally distinct CRC patient cohorts (n=2006, n=2100) and investigated the association between survival outcome, circulating vitamin D and systemic inflammatory response.

RESULTS:

Serial sampling revealed a postoperative fall (mean 17.3 nmol/L; p=3.6e-9) in plasma 25OHD (nadir days 1-2). CRP peaked 3-5 days postoperatively (143.1 mg/L; p=1.4e-12), yet the postoperative fall in 25OHD was independent of CRP. In cohort analyses, 25OHD was lower in the 12 months following operation (mean=48.8 nmol/L) than preoperatively (54.8 nmol/L; p=1.2e-5) recovering after 24 months (52.2 nmol/L; p=0.002). Survival analysis in American Joint Committee on Cancer stages I-III demonstrated associations between 25OHD tertile and CRC mortality (HR=0.69; 95% CI 0.46 to 0.91) and all-cause mortality (HR=0.68; 95% CI 0.50 to 0.85), and was independent of CRP. We observed interaction effects between plasma 25OHD and rs11568820 genotype (functional VDR polymorphism) with a strong protective effect of higher 25OHD only in patients with GG genotype (HR=0.51; 95% CI 0.21 to 0.81). We developed an online tool for predicted survival(https://apps.igmm.ed.ac.uk/mortalityCalculator/) that incorporates 25OHD with clinically useful predictive performance (area under the curve 0.77).

CONCLUSIONS:

CRC surgery induces a fall in circulating 25OHD. Plasma 25OHD level is a prognostic biomarker with low 25OHD associated with poorer survival, particularly in those with rs11568820 GG genotype. A randomised trial of vitamin D supplementation afterCRC surgery has compelling rationale.

 

 
Question posée
 
Le niveau de vitamine D plasmatique a-t-il une valeur pronostique après résection d’un adénocarcinome colique ?
 
Question posée
 
Oui.
 
Commentaires

De nombreuses études ont déjà suggéré l’impact négatif d’une carence en vitamine D dans la carcinogénèse colique et chez les patients atteints d’un adénocarcinome colorectal. Cette étude est un nouvel argument pour faire une étude interventionnelle de supplémentation en vitamine D, cette fois-ci après résection d’un cancer colorectal.

 
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