Journal
BRITISH JOURNAL OF CANCER
Volume 123, Issue 11, Pages 1705-1712Publisher
SPRINGERNATURE
DOI: 10.1038/s41416-020-01060-8
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Funding
- Edinburgh CRUK Cancer Research Centre
- CRUK programme [C348/A18927]
- NES SCREDS clinical lectureship
- ECAT-linked CRUK ECRC Clinical training award [C157/A23218]
- CRUK Career Development Fellowship [C31250/A22804]
- CSO Senior Clinical Fellowship
- MRC Human Genetics Unit Centre Grant [U127527202, U127527198]
- MRC [MR/M004007/1, MC_PC_U127527198, MR/K018647/1, MC_UU_00007/1] Funding Source: UKRI
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Background Low circulating vitamin D levels are associated with poor colorectal cancer (CRC) survival. We assess whether vitamin D supplementation improves CRC survival outcomes. Methods PubMed and Web of Science were searched. Randomised controlled trial (RCTs) of vitamin D supplementation reporting CRC mortality were included. RCTs with high risk of bias were excluded from analysis. Random-effects meta-analysis models calculated estimates of survival benefit with supplementation. The review is registered on PROSPERO, registration number: CRD42020173397. Results Seven RCTs (n = 957 CRC cases) were identified: three trials included patients with CRC at outset, and four population trials reported survival in incident cases. Two RCTs were excluded from meta-analysis (high risk of bias; no hazard ratio (HR)). While trials varied in inclusion criteria, intervention dose and outcomes, meta-analysis found a 30% reduction in adverse CRC outcomes with supplementation (n = 815, HR = 0.70; 95% confidence interval (CI): 0.48-0.93). A beneficial effect was seen in trials of CRC patients (progression-free survival, HR = 0.65; 95% CI: 0.36-0.94), with suggestive effect in incident CRC cases from population trials (CRC-specific survival, HR = 0.76; 95% CI: 0.39-1.13). No heterogeneity or publication bias was noted. Conclusions Meta-analysis demonstrates a clinically meaningful benefit of vitamin D supplementation on CRC survival outcomes. Further well-designed, adequately powered RCTs are needed to fully evaluate benefit of supplementation in augmenting 'real-life' follow-up and adjuvant chemotherapy regimens, as well as determining optimal dosing.
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