Background: Gastrointestinal (GI) malignancies including pancreatic cancers, periampullary carcinoma and cholangiocarcinoma associated with a high rate of mortality. Finding modifiable risk factors is particularly important to reduce their incidence and associated mortality. Vitamin D and its analogues may play an important role in inhibiting tumor cell proliferation, inducing cell differentiation, or increasing apoptosis. Plasma 25 hydroxy vitamin D biological precursor and active form of vitamin D is the best biomarker for assessing the status of this vitamin in the body. The aim of this study was to evaluate the association between serum level of vitamin D and stage and grade of pancreatic cancer, ampullary carcinoma and cholangiocarcinoma. Material and methods: All patients with pancreatic cancer, ampullary carcinoma and cholangiocarcinoma referred to Rasul Akram and Firoozgar hospital from March 2019 to December 2020 were enrolled in this study. Demographic data, past medical history, drug history, clinical examination, pathological stage, grade and etc. were extracted from patient’s records. Endoscopic ultrasonography (EUS) and fine needle biopsy were done for the cases with suspicious diagnosis of malignancy. The Patients with pancreatic cancer who managed only with chemotherapy, the metastatic cases whose therapy is based on only chemotherapy and the patients died after chemotherapy were excluded from the study. The control group was selected from the patients referred to measuring serum level of vitamin D without a history of pancreatic, ampullary and bile duct diseases, and almost similar in age and sex. Serum level of vitamin D was measured (chemiluminescence immunoassay method) in both case and control group and Vitamin D deficiency was defined as under 30ng/ml in serum. After data collecting statistical analysis was performed using SPSS software Version 23. Results: Comparing mean serum levels of vitamin D in case and control groups, a significant difference was observed (P-value=<0.001). Moreover 81.8% of patients with lymph node involvement were deficient in vitamin D. Additionally, all patients with grade 3, 90.5% of patients with lymphovascular invasion and 93.3% of patients with perineural invasion were deficient in vitamin D. Conclusion: Our results showed that there is a significant difference between mean serum levels of vitamin D in case and control groups, as mean serum levels of vitamin D in case group was lower.This study showed that there is a significant association between decreased serum levels of vitamin D and increased risk of pancreatic cancer, ampullary carcinoma and cholangiocarcinoma. Moreover, a significant percentage of patients with perineural invasion, lymph node involvement, and lymphovascular invasion had vitamin D levels less than 30 ng/ml.

Serum level of vitamin D, pancreatic cancer, ampullary carcinoma, cholangiocarcinoma