Can plasma vitamin C predict survival in stage IV colorectal cancer patients? Results of a prospective cohort study

Background and Aims: In light of the inconclusive evidence on the association between vitamin C status and colorectal cancer (CRC) outcome, this study assessed the prognostic value of vitamin C in participants with metastatic CRC (mCRC). Methods: Adults with mCRC and cancer-free controls were recrui...

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Main Author: Temraz, Sally (author)
Other Authors: Jabbour, Jana (author), Nassar, Farah (author), El Helou, Remie (author), Hadla, Ruba (author), Mezher, Maria (author), El Lakkiss, Ahmed (author), Charafeddine, Maya (author), Nasr, Rihab (author), Shamseddine, Ali (author)
Format: article
Published: 2023
Online Access:http://hdl.handle.net/10725/16563
https://doi.org/10.3389/fnut.2023.1110405
http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php
https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1110405/full
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Summary:Background and Aims: In light of the inconclusive evidence on the association between vitamin C status and colorectal cancer (CRC) outcome, this study assessed the prognostic value of vitamin C in participants with metastatic CRC (mCRC). Methods: Adults with mCRC and cancer-free controls were recruited in this prospective cohort study to allow for comparison of vitamin C levels with healthy individuals from the same population. Sociodemographic, lifestyle, medical variables, BRAF and KRAS mutations, as well as Vitamin C plasma level and food intake were evaluated. Predictors of diminished vitamin C level were assessed via multivariate logistic regression. Mortality and progression free survival (PFS) among mCRC participants were analyzed based on plasma vitamin C level. Results: The cancer group (n = 46) was older (mean age: 60 ± 14 vs. 42 ± 9.6, p = 0.047) and included more males (29% vs. 19%, p < 0.001) than the cancer-free group (n = 45). There was a non-significant difference in the vitamin C intake between the two groups; however, the mean plasma vitamin C level was lower in the cancer group (3.5 ± 3.7 vs. 9.2 ± 5.6 mg/l, p < 0.001). After adjusting for age and gender, the cancer group was more likely to be deficient compared to the cancer-free group [Adjusted Odds Ratio (95%CI): 5.4 (2.1–14)]. There was a non-significant trend for higher mortality in the vitamin C deficient cancer group (31% vs. 12%, p = 0.139). PFS did not differ based on vitamin C deficiency and patients with BRAF and KRAS mutations did not have significant differences in vitamin C levels. Conclusion: mCRC patients have lower plasma vitamin C levels than healthy controls. The trend toward higher mortality in the vitamin C deficient cancer group was not statistically significant. Whether this phenomenon affects survival and response to treatment warrants further exploration in phase III clinical trials.