gms | German Medical Science

MAINZ//2011: 56. GMDS-Jahrestagung und 6. DGEpi-Jahrestagung

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie e. V.
Deutsche Gesellschaft für Epidemiologie e. V.

26. - 29.09.2011 in Mainz

25(OH)D, folate, and vitamin B12 biomarkers among international colorectal cancer patients

Meeting Abstract

  • Cornelia Ulrich - Nationales Zentrum für Tumorerkrankungen- Deutsches Krebsforschungszentrum; Fred Hutchinson Cancer Research Center, Heidelberg; Seattle, WA
  • Erin M. Siegel - Moffitt Cancer Center, Tampa, FL
  • Hermann Brenner - Deutsches Krebsforschungszentrum, Heidelberg
  • Jenny Chang-Claude - Deutsches Krebsforschungszentrum, Heidelberg
  • Jana Kotzmann - Nationales Zentrum für Tumorerkrankungen- Deutsches Krebsforschungszentrum, Heidelberg
  • Xiaoling Song - Fred Hutchinson Cancer Research Center, Seattle, WA
  • Robert Owen - Nationales Zentrum für Tumorerkrankungen- Deutsches Krebsforschungszentrum, Heidelberg
  • Michael Hoffmeister - Deutsches Krebsforschungszentrum, Heidelberg
  • Heiko Becher - Universität Heidelberg, Heidelberg
  • David Shibata - Moffitt Cancer Center, Tampa, FL
  • Stephanie Tosic - Nationales Zentrum für Tumorerkrankungen- Deutsches Krebsforschungszentrum, Heidelberg
  • Clare Abbenhardt - Nationales Zentrum für Tumorerkrankungen- Deutsches Krebsforschungszentrum, Heidelberg
  • Karen Makar - Fred Hutchinson Cancer Research Center, Seattle, WA
  • Thomas A. Sellers - Moffitt Cancer Center, Tampa, FL
  • William Grady - Fred Hutchinson Cancer Research Center, Seattle, WA

Mainz//2011. 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi). Mainz, 26.-29.09.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11gmds307

DOI: 10.3205/11gmds307, URN: urn:nbn:de:0183-11gmds3076

Veröffentlicht: 20. September 2011

© 2011 Ulrich et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Vitamin D and folate status are critical for cell signaling and functioning and low levels have been associated with an increased risk for colorectal cancer. Their role in colorectal cancer prognosis is an active area of research: higher vitamin D status is thought to improve outcomes, yet higher folate may increase risk of recurrence. Within an international pilot study we evaluated differences and predictors of vitamin D and one-carbon biomarkers (folate/B12).

Methods: Stage I-IV colorectal cancer cases (ages 18-90) and matched non-cancer controls had been recruited between 2006 and 2010 in Seattle, WA (n=98 cases, 33 controls); Heidelberg, Germany (40/40); and Tampa, FL (18/18). Plasma vitamin D status was measured by LC/MSD and serum folate and B12 by radioassay. To account for skewed distributions, Wilcoxon or Kruskal-Wallis tests were used to test for differences in biomarker concentrations by case status, tumor stage, study site, age, and season. Linear regression analysis with log-transformed outcome parameters was used for multivariate analyses.

Results: As expected, folate levels overall were, on average, lower in Germany than in Tampa or Seattle (13ng/ml (range: 1-52) vs. 22 (4-70) and 23 (7-69) ng/ml), plausibly reflecting an absence of folic-acid fortification and lower supplement use in Germany. In Seattle, colorectal cancer patients using folic-acid containing supplements had on average 1.5-fold higher concentrations of folate than non-users (30ng/ml vs.20ng/ml, p<0.01). For vitamin D, we observed generally consistent levels with wide inter-individual differences across all three sites (Seattle: 24.1ng/ml (4.0-80) Moffitt: 20.8 (4.6-51.6) Heidelberg: 29.6 (11.0-83.0)). In Heidelberg we observed substantial seasonal variation (p=0.002), perhaps due to greater outdoor physical activity in summer months and lower use of sun screen. In multivariate modeling, predictors for biomarkers included season (25(OH)D), study site (25(OH)D; folate, B12); and tumor stage (B12).

Conclusion: Although the sample size in this pilot was small, these findings illustrate the value of an international cohort in studying colorectal cancer prognosis in the context of a broad range of exposures to discern different aspects of risk prediction. For folate, in addition to international differences, our pilot data show that the intra-individual differences at each site are large and that supplement use is a critical determinant of folate levels in colorectal cancer patients. For vitamin D in relation to outcomes, important determinants and confounders may include seasonal variation and sun exposure (e.g., outdoor physical activity and sunscreen use), which need to be well measured and accounted for in prognostic studies.


References

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Ng K, Meyerhardt JA, Wu K, Feskanich D, Hollis BW, Giovannucci EL, Fuchs CS. Circulating 25-hydroxyvitamin d levels and survival in patients with colorectal cancer. J Clin Oncol. 2008;26(18):2984-91.
2.
Ulrich CM, Potter JD. Folate and cancer--timing is everything. Jama. 2007;297(21):2408-2409.