Shu Y, Li KJ, Sulayman S, Zhang ZY, Ababaike S, Wang K, Zeng XY, Chen Y, Zhao ZL. Predictive value of serum calcium ion level in patients with colorectal cancer: A retrospective cohort study. World J Gastrointest Surg 2025; 17(3): 102638 [DOI: 10.4240/wjgs.v17.i3.102638]
Corresponding Author of This Article
Ze-Liang Zhao, MD, PhD, Professor, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, No. 789 Suzhou East Street, Xinshi District, Urumqi 830000, Xinjiang Uygur Autonomous Region, China. zlzhao71@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
Yin Shu, Ke-Jin Li, Subinur Sulayman, Zi-Yi Zhang, Saibihutula Ababaike, Kuan Wang, Xiang-Yue Zeng, Yi Chen, Ze-Liang Zhao, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China
Co-first authors: Yin Shu and Ke-Jin Li.
Author contributions: Shu Y was responsible for the study design, data acquisition, and preliminary analysis, and also took the lead in drafting the initial manuscript; Li KJ made significant contributions to the data analysis and interpretation, and played a key role in revising and improving the manuscript; Shu Y and Li KJ designed the article format, collected the data, and wrote the manuscript; Sulayman S, Zhang ZY, Ababaike S, Wang K, Zeng XY, and Chen Y were responsible for the statistical analyses; Zhao ZL designed the main study and critically revised the manuscript; All authors read and approved the final manuscript. Both authors made equal contributions to the study and as co-first authors of this manuscript.
Institutional review board statement: The Ethics Committee of Affiliated Cancer Hospital of Xinjiang Medical University approved the ethical review after reviewing that the study complied with ethical principles (No. G-2015021).
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
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: Technical appendix, statistical code, and dataset available from the corresponding author at zlzhao71@163.com. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ze-Liang Zhao, MD, PhD, Professor, Department of Gastrointestinal Surgery, The Affiliated Cancer Hospital of Xinjiang Medical University, No. 789 Suzhou East Street, Xinshi District, Urumqi 830000, Xinjiang Uygur Autonomous Region, China. zlzhao71@163.com
Received: October 24, 2024 Revised: December 18, 2024 Accepted: January 20, 2025 Published online: March 27, 2025 Processing time: 123 Days and 8.5 Hours
Abstract
BACKGROUND
Serum calcium ion (Ca2+) is an economical and readily available indicator as a routine screening test for hospitalized patients. There are no studies related to serum Ca2+ level and digestive tract malignancy.
AIM
To evaluate the effectiveness of serum Ca2+ level in predicting the prognosis of patients with colorectal cancer (CRC).
METHODS
We retrospectively collected the data of 280 patients diagnosed with CRC who underwent radical surgery at the Affiliated Cancer Hospital of Xinjiang Medical University. By analyzing the clinicopathological features, differences between serum Ca2+ concentrations on the first day after surgery were determined. We used the receiver operating characteristic curve to assess the predictive ability of serum Ca2+ for survival. Survival analyses were performed using the Kaplan-Meier method, and multivariate Cox proportional risk regression was used to determine association between calibration serum Ca2+ levels and CRC survival outcomes.
RESULTS
By receiver operating characteristic curve analysis, the ideal threshold value for Ca2+ the first postoperative day and delta serum calcium (δCa2+) value were 1.975 and 0.245, respectively. Overall survival (OS) and progression-free survival (PFS) were better in both the high Ca2+ group and high δCa2+ group on the first postoperative day. The variables identified through univariate analysis were incorporated into multivariate analysis and showed that tumor differentiation (P = 0.047), T stage (P = 0.019), N stage (P < 0.001), nerve vascular invasion (P = 0.037), carcinoembryonic antigen (P = 0.039), baseline serum Ca2+ level (P = 0.011), and serum Ca2+ level on the first day (P = 0.006) were independent predictors of prognosis for patients undergoing feasible radical CRC surgery. Using the findings from the multifactorial analysis, we developed a nomogram and the calibration showed a good predictive ability.
CONCLUSION
Low serum Ca2+ level on the first postoperative day is an independent risk factor for OS and PFS in CRC.
Core Tip: Serum calcium ion (Ca2+) is a readily available and cost-effective marker used in routine screenings but has not been studied in relation to digestive tract malignancies until now. This study examined the association of serum Ca2+ concentrations with clinical indicators in patients with colorectal cancer (CRC) undergoing radical surgery. The results show that reduced serum Ca2+ concentrations on the first day after surgery are associated with poorer overall survival and progression-free survival in patients with CRC.
