In a new study published in Alimentary Pharmacology and Therapeutics, researchers have found that very low levels of vitamin D may relate to a poor prognosis in hepatocellular cancer. They also found that vitamin D status may relate to severity of chronic liver disease that is common in hepatocellular cancer.
A small number of studies have evaluated the relationship between vitamin D and hepatocellular cancer (HCC). This research has looked at whether low vitamin D levels increase the risk of developing HCC. Last month, we covered a study on this relationship in our blog.
That being said, there haven’t been any studies that have looked at how vitamin D may relate to the prognosis of HCC.
Recently, researchers out of Germany conducted a prospective study to determine if vitamin D relates to the prognosis and stage of HCC and if vitamin D levels relate to severity of liver disease.
They recruited 200 patients with HCC from the Department of Internal Medicine at the Frankfurt University Hospital. The researchers assessed the patients’ vitamin D levels as well as determined the state of HCC using the Cancer of the Liver Italian Program (CLIP) and the Barcelona Clinic Liver Cancer stages (BCLC).
CLIP is an assessment tool designed to estimate survival from HCC based on a numerical score. A lower score indicates a greater likelihood of survival. BCLC is a system designed to evaluate a specific treatment strategy based on the stage of disease.
Since chronic liver disease is common among those with HCC, the researchers also collected data to determine if vitamin D relates to the severity of chronic liver disease. To do so, the patients were assessed using the model for end-stage liver disease (MELD) score and the Child-Pugh score.
The MELD score is a tool used to evaluate the severity of chronic liver disease. A higher score indicates a higher risk for mortality. The Child-Pugh score is a tool used to assess the prognosis of chronic liver disease. It is based on a point system that places a patient in one of three classes. Class A indicates a high chance of survival, class B indicates a moderate to high chance of survival, and class C indicates a low chance of survival.
Does vitamin D status relate to severity of chronic liver disease? Here’s what the researchers found:
- The average vitamin D level was 17 ng/ml and 72.5% of the patients had levels lower than 20 ng/ml.
- Patients with a Child-Pugh score in class A had significantly higher vitamin D levels compared to patients in Class C.
- Vitamin D levels were significantly negatively associated with MELD score. This means that those with lower vitamin D levels had a higher MELD score and an increased risk of mortality.
Here’s what the researchers found regarding vitamin D status and HCC prognosis:
- Patients with earlier stage HCC, according to BCLC, had significantly higher vitamin D levels compared to those with late stage HCC.
- Patients with higher vitamin D levels had lower CLIP scores compared to those with lower levels.
- Patients with severely low vitamin D levels (less than or equal to 10 ng/ml) had a significantly higher mortality risk from HCC compared to patients with higher levels.
The researchers concluded,
“In this study, we were able to show that the serum [vitamin D] did not only correlate with the severity of liver insufficiency but also with stages of HCC. Furthermore, very low [vitamin D] levels were associated with a higher mortality in patients with HCC.”
There weren’t any limitations noted in the study. However, the observational design limits our ability to know for sure if low vitamin D levels cause a poor prognosis and increase mortality risk in those with HCC.
Future trials are needed in which vitamin D supplements are administered to determine if there are improvements in prognosis and survival rate in patients with HCC.
Finkelmeier, F. et al. Severe 25-hydroxyvitamin D deficiency identifies a poor prognosis in patients with hepatocellular carcinoma – a prospective cohort study. Alimentary Pharmacology and Therapeutics, 2014.