American Association for Cancer Research
ccr-23-0447_supplementary_figure_s2_suppfs2.pdf (104.11 kB)

Supplementary Figure S2 from Plasma 25-Hydroxyvitamin D Levels and Survival in Stage III Colon Cancer: Findings from CALGB/SWOG 80702 (Alliance)

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posted on 2023-06-08, 13:20 authored by Qiao-Li Wang, Chao Ma, Chen Yuan, Qian Shi, Brian M. Wolpin, Yin Zhang, Charles S. Fuchs, Jeffrey Meyer, Tyler Zemla, En Cheng, Priya Kumthekar, Katherine A. Guthrie, Felix Couture, Philip Kuebler, Pankaj Kumar, Benjamin Tan, Smitha Krishnamurthi, Richard M. Goldberg, Alan Venook, Charles Blanke, Anthony F. Shields, Eileen M. O'Reilly, Jeffrey A. Meyerhardt, Kimmie Ng

Figure S2. Dose-response relationship and test of linearity for the hazard ratio (HR) of disease-free survival (A), overall survival (B), and time to recurrence (C) by continuous predicted vitamin D scores, with reference of plasma 25-hydroxyvitamin D set at 12 ng/ml



To assess whether higher plasma 25-hydroxyvitamin D [25(OH)D] is associated with improved outcomes in colon cancer and whether circulating inflammatory cytokines mediate such association. Plasma samples were collected from 1,437 patients with stage III colon cancer enrolled in a phase III randomized clinical trial (CALGB/SWOG 80702) from 2010 to 2015, who were followed until 2020. Cox regressions were used to examine associations between plasma 25(OH)D and disease-free survival (DFS), overall survival (OS), and time to recurrence (TTR). Mediation analysis was performed for circulating inflammatory biomarkers of C-reactive protein (CRP), IL6, and soluble TNF receptor 2 (sTNF-R2). Vitamin D deficiency [25(OH)D <12 ng/mL] was present in 13% of total patients at baseline and in 32% of Black patients. Compared with deficiency, nondeficient vitamin D status (≥12 ng/mL) was significantly associated with improved DFS, OS, and TTR (all Plog-rank<0.05), with multivariable-adjusted HRs of 0.68 (95% confidence interval, 0.51–0.92) for DFS, 0.57 (0.40–0.80) for OS, and 0.71 (0.52–0.98) for TTR. A U-shaped dose–response pattern was observed for DFS and OS (both Pnonlinearity<0.05). The proportion of the association with survival that was mediated by sTNF-R2 was 10.6% (Pmediation = 0.04) for DFS and 11.8% (Pmediation = 0.05) for OS, whereas CRP and IL6 were not shown to be mediators. Plasma 25(OH)D was not associated with the occurrence of ≥ grade 2 adverse events. Nondeficient vitamin D is associated with improved outcomes in patients with stage III colon cancer, largely independent of circulation inflammations. A randomized trial is warranted to elucidate whether adjuvant vitamin D supplementation improves patient outcomes.

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