Association of Albumin-Corrected Serum Calcium Levels with Colorectal Cancer Survival Outcomes

Abstract

In epidemiological studies, higher calcium intake has been associated with decreased colorectal cancer (CRC) incidence. However, whether circulating calcium concentrations are associated with CRC prognosis is largely unknown. In this retrospective cohort analysis, we identified 498 patients diagnosed with stage I-IV CRC between the years of 2000 and 2018 in whom calcium and albumin level measurements within 3 months of diagnosis had been taken. We used the Kaplan-Meier method for survival analysis. We used multivariate Cox proportional hazards regression to identify associations between corrected calcium levels and CRC survival outcomes. Corrected calcium levels in the highest tertile were associated with significantly lower progression-free survival rates (hazard ratio (HR) 1.85; 95% confidence interval (CI) 1.28-2.69; p = 0.001) and overall survival (HR 1.86; 95% CI 1.26-2.74, p = 0.002) in patients with stage IV or recurrent CRC, and significantly lower disease-free survival rates (HR 1.44; 95% confidence interval (CI) 1.02-2.03; p = 0.040) and overall survival rates (HR 1.72; 95% CI 1.18-2.50; p = 0.004) in patients with stage I-III disease. In conclusion, higher corrected calcium levels after the diagnosis of CRC were significantly associated with decreased survival rates. Prospective trials are necessary to confirm this association.

Keywords: calcium carbonate; cancer outcomes; cancer survivorship; gastrointestinal malignancies; hypercalcemia.

Figure 1

Study flowchart.

Figure 2

Survival curves of patients with stage IV or recurrent colorectal cancer divided by corrected calcium tertiles (in mg/dL): (a) progression-free survival and (b) overall survival.

Figure 3

Survival curves of patients with stage I–III colorectal cancer divided by corrected calcium levels (in mg/dL): (a) disease-free survival and (b) overall survival.