Colorectal Cancer Coverage from Every Angle

Risk of Recurrence and Circulating Folates in Patients With Colorectal Cancer

By: Joshua Swore
Posted: Monday, August 31, 2020

High concentrations of circulating folic acid may increase the risk of colorectal cancer, according to an article published in JNCI Cancer Spectrum. According to Ellen Kampman, PhD, of Wageningen University & Research, the Netherlands, and colleagues, “folic acid may facilitate [the] growth of potentially remaining tumor cells in the body, similar as what is hypothesized concerning premalignant lesions during colorectal cancer development.”

The researchers included patients from six different cohorts as a part of the FOCUS consortium. A total of 2,024 patients with stage I to III colorectal cancer were enrolled in the study. Clinical, demographic, and lifestyle characteristics were balanced across the cohorts. Patients’ plasma was collected upon colorectal cancer diagnosis, and folate concentrations were measured.

The authors recorded a median concentration of circulating folate at 15 nmol/L (9.8–24.5 nmol/L). Detectable levels of folic acid were found in 301 patients; of p-aminobenzoylglutamate (pABG), in 1,946 patients; and p-acetamidobenzoylglutamate (apABG), in 1,801 patients, with median concentrations of 1.0 nmol/L, 2.5 nmol/L, and 0.7 nmol/L, respectively.

The authors found the risk of recurrence was associated with higher folic acid concentrations (95% confidence interval = 1.31, P = .03). Subgroup analysis also revealed that patients who received neoadjuvant treatment had an increased risk of recurrence with increased concentrations of folic acid. However, there was no significant trend found between patients who did not receive treatment and the risk of recurrence. Associations among folate, pABG, apABG, and hazard ratios were not statistically significant nor was the risk of death.

Disclosure: For full disclosures of the study authors, visit

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