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@ARTICLE{Maalmi:132828,
      author       = {H. Maalmi$^*$ and V. Walter$^*$ and L. Jansen$^*$ and R.
                      Owen$^*$ and A. Ulrich and B. Schöttker$^*$ and J.
                      Chang-Claude$^*$ and M. Hoffmeister$^*$ and H. Brenner$^*$},
      title        = {{D}ose-{R}esponse {R}elationship between {S}erum {R}etinol
                      {L}evels and {S}urvival in {P}atients with {C}olorectal
                      {C}ancer: {R}esults from the {DACHS} {S}tudy.},
      journal      = {Nutrients},
      volume       = {10},
      number       = {4},
      issn         = {2072-6643},
      address      = {Basel},
      publisher    = {MDPI},
      reportid     = {DKFZ-2018-00472},
      pages        = {510},
      year         = {2018},
      abstract     = {Current knowledge on the role of retinol in the prognosis
                      of patients with colorectal cancer (CRC) is very limited. We
                      investigated the association of serum retinol levels with
                      survival outcomes in a large cohort of 2908 CRC patients
                      from Germany. Retinol concentrations were determined in
                      serum collected shortly after diagnosis by mass
                      spectrometry. Associations between serum retinol levels and
                      survival outcomes were assessed using multivariable Cox
                      regression and dose-response analyses. The joint association
                      of serum retinol and serum 25-hydroxyvitamin D₃
                      (25(OH)D₃) with survival outcomes was also examined.
                      During a median follow-up of 4.8 years, 787 deaths occurred,
                      573 of which were due to CRC. Dose-response curves showed an
                      inverse relationship between serum retinol levels and
                      survival endpoints in the range of <2.4 $\&micro;mol/L,$ but
                      no associations at higher levels. Low (<1.2 $\&micro;mol/L)$
                      versus high $(\&ge;2.4$ $\&micro;mol/L)$ serum retinol
                      levels were associated with poorer overall survival (Hazard
                      ratio (HR) = 1.46, $95\%$ confidence interval (CI) =
                      1.19⁻1.78, P-trend = 0.0003) and CRC-specific survival (HR
                      = 1.69, $95\%$ CI = 1.33⁻2.15, P-trend < 0.0001). Joint
                      presence of low serum retinol (<1.2 $\&micro;mol/L)$ and low
                      25(OH)D₃ (<30 nmol/L) was associated with a particularly
                      strong decrease in overall and CRC-specific survival. Low
                      serum retinol levels were identified as a predictor of poor
                      survival in CRC patients, in particular when co-occurring
                      with low serum concentrations of 25(OH)D₃. The clinical
                      implications of these findings require further
                      investigation.},
      cin          = {C020 / C070 / G110 / L101},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331 / I:(DE-He78)C070-20160331 /
                      I:(DE-He78)G110-20160331 / I:(DE-He78)L101-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:29671819},
      doi          = {10.3390/nu10040510},
      url          = {https://inrepo02.dkfz.de/record/132828},
}