Serum 25-hydroxyvitamin D and overall survival in cholangiocarcinoma, hepatocellular carcinoma, and pancreatic cancer: A Thai cohort study

doi:10.4251/wjgo.124288

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Oncol. Dec 15, 2026; 18(12): 124288
Published online Dec 15, 2026. doi: 10.4251/wjgo.124288

Serum 25-hydroxyvitamin D and overall survival in cholangiocarcinoma, hepatocellular carcinoma, and pancreatic cancer: A Thai cohort study

Chanchai Charonpongsuntorn, Napat Mittparian, Natapon Poonyarangsarit, Nattapat Puengsap, Thearatat Pairatchawan, Naruepanat Maneesian, Panunat Muangnoi, Supagone Wangsubtawee

Chanchai Charonpongsuntorn, Panunat Muangnoi, Supagone Wangsubtawee, Oncology Unit, Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, Thailand

Napat Mittparian, Natapon Poonyarangsarit, Nattapat Puengsap, Thearatat Pairatchawan, Naruepanat Maneesian, Faculty of Medicine, Srinakharinwirot University, Ongkharak, Nakhon Nayok 26120, Thailand

Author contributions: Charonpongsuntorn C conceived and designed the study, supervised the data collection, performed the statistical analyses, and drafted and critically revised the manuscript; Mittparian N, Poonyarangsarit N, Puengsap N, Pairatchawan T, and Maneesian N contributed to the data collection and the development of the clinical database; Muangnoi P and Wangsubtawee S contributed to the study's supervision and data interpretation, and provided critical revision of the successive versions of the manuscript for important intellectual content; all authors read and approved the final manuscript.

AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including those portions for which AI tools were used as assistive technologies. Claude (Anthropic) was used during manuscript revision to assist with language editing and with drafting and structuring portions of the text, and to assist in preparing the response to the reviewers. AI tools were not used to generate original scientific data, to perform the statistical analyses, or to draw scientific conclusions, all of which were undertaken by the authors. All AI-assisted outputs were carefully reviewed, validated and approved by the authors.

Institutional review board statement: This study was reviewed and approved by the Human Research Ethics Committee of Srinakharinwirot University (Approval No. SWUEC-673039).

Informed consent statement: As this was a retrospective study based on existing medical records, the Human Research Ethics Committee of Srinakharinwirot University waived the requirement for written informed consent.

Conflict-of-interest statement: Chanchai Charonpongsuntorn has received research funding from AstraZeneca, BeiGene, Merck Sharp & Dohme, BioNTech, and mAbxience Research S.L.; has served in a consultant or advisory role for Amgen, AstraZeneca, Eisai, Merck Sharp & Dohme, Novartis, and Taiho; and has participated in speakers’ bureaus for Eisai, Janssen, Roche, Sandoz, Pfizer, Novartis, AstraZeneca, and Daiichi-Sankyo. None of these relationships are related to the present study. The remaining authors declare no conflicts of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The de-identified datasets generated and analyzed during the present study are not publicly available because of institutional privacy regulations but are available in anonymized form from the corresponding author (Chanchai Charonpongsuntorn, Chanchaic@g.swu.ac.th) upon reasonable request.

Corresponding author: Chanchai Charonpongsuntorn, MD, Assistant Professor, Oncology Unit, Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, 62 Moo 7, Ongkharak, Nakhon Nayok 26120, Thailand. Chanchaic@g.swu.ac.th

Received: June 15, 2026
Revised: July 28, 2026
Accepted: September 21, 2026
Published online: December 15, 2026
Processing time: 152 Days and 6.5 Hours

Abstract

BACKGROUND

Cholangiocarcinoma, hepatocellular carcinoma (HCC), and pancreatic cancer account for substantial cancer-related mortality in Southeast Asia, with poor outcomes largely driven by late-stage diagnosis and limited therapeutic options. Vitamin D, acting through the vitamin D receptor, has been implicated in the regulation of cancer cell proliferation, apoptosis, angiogenesis, and antitumor immunity. Epidemiological studies suggest that low serum 25-hydroxyvitamin D [25(OH)D] levels are associated with adverse outcomes in gastrointestinal malignancies, and vitamin D deficiency is highly prevalent among Thai patients with cancer. However, data regarding its prognostic significance in hepatobiliary and pancreatic cancers remain limited.

AIM

To evaluate the association between serum 25(OH)D levels and overall survival (OS) in hepatobiliary cancer and pancreatic cancer.

METHODS

This retrospective cohort study included 72 patients diagnosed with cholangiocarcinoma (36.1%), HCC (31.9%), pancreatic cancer (12.5%), or other hepatobiliary cancers (19.4%) between January 2022 and December 2024. Serum 25(OH)D was measured by high-performance liquid chromatography before the initiation of antineoplastic therapy and categorized as deficient (< 20 ng/mL), insufficient (20-30 ng/mL), or sufficient (> 30 ng/mL). OS was assessed using Kaplan-Meier survival analysis and Cox proportional hazards regression models.

RESULTS

The mean age was 57.5 ± 11.3 years, and 68.1% of patients were male. The mean serum 25(OH)D level was 26.1 ng/mL, with 38.9% of patients classified as vitamin D deficient. Median OS was 1.33 years [95% confidence interval (CI): 0.94-1.80]. Serum 25(OH)D levels analyzed as a continuous variable were not significantly associated with mortality [hazard ratio (HR) = 1.01; 95%CI: 0.98-1.03; P = 0.482]. Similarly, patients with serum 25(OH)D ≥ 21 ng/mL did not demonstrate a significant survival advantage compared with those with lower levels (HR = 0.94; 95%CI: 0.46-1.88; P = 0.864). Surgical resection was the only factor significantly associated with improved survival (HR = 0.36; 95%CI: 0.15-0.84; P = 0.019).

CONCLUSION

Vitamin D deficiency was common in hepatobiliary and pancreatic cancers. Serum 25(OH)D was not associated with OS, whereas surgical resection was significantly associated with improved survival.

Keywords: Vitamin D; 25-Hydroxyvitamin D; Cholangiocarcinoma; Hepatocellular carcinoma; Pancreatic cancer; Overall survival; Prognostic biomarker; Southeast Asia

Core Tip: This study evaluated the prognostic significance of serum 25-hydroxyvitamin D in 72 Thai patients with cholangiocarcinoma, hepatocellular carcinoma, pancreatic cancer, and other hepatobiliary malignancies. Vitamin D deficiency was common, affecting 38.9% of patients. Serum 25-hydroxyvitamin D was not associated with survival in any of the categories examined, whereas surgical resection was the only factor significantly associated with favorable outcomes. These findings highlight the limited evidence regarding the prognostic role of vitamin D in hepatobiliary and pancreatic cancers and underscore the need for larger prospective studies incorporating bioavailable vitamin D measurements and vitamin D receptor genotyping.