Prognostic role of vitamin d status and efficacy of vitamin D supplementation in cancer patients: a systematic review

Abstract

Background: Whether or not hypovitaminosis D can influence the prognosis of cancer patients and whether or not vitamin D (vitD) supplementation improves outcome remain controversial.

Design: Studies evaluating the prognostic role of vitD and vitD receptor (VDR) in cancer patients and trials evaluating the efficacy of vitD administration on patient outcome were identified by a search of MEDLINE, EMBASE, ISI Web of Knowledge, and the Cochrane Library through June 2010.

Results: Twenty-five studies were included. A negative prognostic role for low serum vitD level was observed in five cohort studies including patients with breast cancer (one study), colon cancer (two studies), prostate cancer (one study), and melanoma (one study), but not in two studies on non-small cell lung cancer and one study on breast cancer. Three of four studies showed that VDR(+) tumors carry a better prognosis than VDR(-) tumors, whereas VDR polymorphisms were significantly associated with prognosis in five of 10 studies. A significant interaction between serum vitD level and VDR polymorphism was observed in one study. Three randomized trials involving advanced prostate cancer patients explored the prognostic role of vitD supplementation. A meta-analysis of these trials showed no effect on survival (pooled risk ratio, 1.07; 95% confidence interval, CI, 0.93-1.23), with strong heterogeneity among studies.

Conclusion: Hypovitaminosis D seems to be associated with a worse prognosis in some cancers, but vitD supplementation failed to demonstrate a benefit in prostate cancer patients. The currently available evidence is insufficient to recommend vitD supplementation in cancer patients in clinical practice.

Conflict of interest statement

Disclosures: Consuelo Buttigliero: None; Chiara Monagheddu: None; Paola Petroni: None; Andrea Saini: None; Luigi Dogliotti: None; Giovannino Ciccone: None; Alfredo Berruti: None.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors or independent peer reviewers.

Figures

Figure 1.

Study selection. Abbreviation: MeSH, medical subject heading.

Figure 2.

Meta-analysis of three randomized trials evaluating the effect of vitamin D supplementation on overall survival in advanced prostate cancer patients. Risk ratios estimated with a fixed-effects model. Abbreviations: 25(OH)D, 25-hydroxyvitamin D; CI, confidence interval.