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World J Gastrointest Oncol. Jan 15, 2018; 10(1): 23-30
Published online Jan 15, 2018. doi: 10.4251/wjgo.v10.i1.23
Vitamin D in esophageal cancer: Is there a role for chemoprevention?
Carol Rouphael, Afrin Kamal, Madhusudhan R Sanaka, Prashanthi N Thota
Carol Rouphael, Department of Internal Medicine, Cleveland Clinic, Cleveland, OH 44195, United States
Afrin Kamal, Madhusudhan R Sanaka, Prashanthi N Thota, Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH 44195, United States
Author contributions: All authors contributed to the conception and design, acquisition of data and drafting of manuscript.
Conflict-of-interest statement: Authors deny any conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Prashanthi N Thota, MD, Medical Director, Department of Gastroenterology and Hepatology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, United States. thotap@ccf.org
Telephone: +1-216-4440780 Fax: +1-216-4454222
Received: October 8, 2017
Peer-review started: October 9, 2017
First decision: November 3, 2017
Revised: November 10, 2017
Accepted: December 5, 2017
Article in press: December 5, 2017
Published online: January 15, 2018
Processing time: 95 Days and 11.9 Hours
Abstract

Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Current evidence suggests a protective role of vitamin D in colon cancer. The effect of vitamin D on esophageal cancer remains controversial. Multiple studies investigated the association between vitamin D and esophageal cancer, employing different modes of assessment of vitamin D status such as serum 25-hydroxyvitamin D levels, vitamin D dietary intake or exposure to ultraviolet B (UVB) radiation. Genetic variations of the vitamin D receptor (VDR) gene and VDR expression in esophageal specimens have also been investigated. Ecological studies evaluating exposure to UVB radiation yielded an inverse correlation with esophageal cancer. When vitamin D dietary intake was assessed, direct association with esophageal cancer was observed. However, circulating 25-hydroxyvitamin D concentrations showed inconsistent results. In this review article, we present a detailed summary of the current data on the effects of vitamin D on various histological subtypes of esophageal cancer and their precursor lesions. Well-powered prospective studies with accurate measurement of vitamin D status are needed before chemoprevention with vitamin D is recommended, as current evidence does not support a chemopreventive role of vitamin D against esophageal cancer. Future studies looking at the incidence of esophageal cancer in patients with pre-cancerous lesions (Barrett's esophagus and squamous cell dysplasia) receiving vitamin D supplementation are needed.

Keywords: Vitamin D; Vitamin D receptor; Esophageal adenocarcinoma; Esophageal squamous cell carcinoma; Genetic polymorphism

Core tip: Vitamin D has emerged as a promising anti-cancer agent due to its diverse biological effects on tumor differentiation, apoptosis and suppression of cellular proliferation. Ecological studies evaluating exposure to ultraviolet B radiation yielded an inverse correlation with esophageal cancer. When vitamin D dietary intake was assessed, direct association with esophageal cancer was observed. However, circulating 25-hydroxyvitamin D concentrations showed inconsistent results.