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Prognostic Role of Serum Vitamin B12 in Solid Tumor Patients

Article information

Korean J Health Promot. 2017;17(4):282-288
Publication date (electronic) : 2017 December 28
doi : https://doi.org/10.15384/kjhp.2017.17.4.282
Hye Kyung Oh1, Jee Young Lee2, Seong Woo Yoon2, Wan Kyu Eo3, Sung Nim Han1,4
1Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Korea.
2Department of Internal Korean Medicine, Korean Medicine Cancer Center, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
3Department of Hematology/Medical Oncology, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
4Research Institute of Human Ecology, College of Human Ecology, Seoul National University, Seoul, Korea.
Corresponding author: Sung Nim Han, PhD. Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Korea. Tel: +82-2-880-6836, Fax: +82-2-884-0305, snhan@snu.ac.kr
Received 2017 August 30; Accepted 2017 October 13.

Abstract

Background

Serum vitamin B12 has been suggested as one of the cancer diagnostic markers and predictors for survival in cancer patients. In this study, we investigated the relationship between vitamin B12 and tumor progression.

Methods

Solid tumor patients who had serum vitamin B12 levels and radiologic test follow-up were included in the study. A total of 55 patients were included. Receiver operating characteristic analysis was performed to determine the cut-off value of vitamin B12 for tumor progression. Kaplan-Meier method and Cox proportional hazard model for time to progression (TTP) were performed. Subgroup analysis was performed on patients with or without liver lesion (hepatocellular carcinoma and liver metastasis).

Results

The cut-off value of vitamin B12 for tumor progression prediction was 691.4 pg/mL, the sensitivity was 57.1% and the specificity was 59.3%. Patients with vitamin B12≥691.4 pg/mL had shorter median TTP (2.1 months vs. 3.4 months, P=0.011). In subgroup analysis of patients without liver lesion, median TTP was significantly shorter in patients with vitamin B12≥691.4 pg/mL (1.6 months vs. 6.3 months, P=0.021), while there was no significant difference in TTP among the patients with liver lesion. Higher vitamin B12 level (≥691.4 pg/mL) was an independent prognostic factor for tumor progression (adjusted hazard ratio 2.4, 95% confidence interval 1.2–4.8, P=0.019).

Conclusions

Serum vitamin B12 level can be used as a predictor of tumor progression in patients with solid tumors especially in patients without liver lesion. Additional large scale prospective studies are required to confirm this.

Keywords: Vitamin B12; Biomarkers; Neoplasms; Disease progression

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Copyright © 2017 Korean Society for Health Promotion and Disease Prevention
Korean Society for Health Promotion and Disease Prevention

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Figure 1

Figure 1

Progression receiver operating characteristic curve for vitamin B12. 691.4 pg/mL was the cut-off value for serum vitamin B12 level related with tumor progression.

Figure 2

Figure 2

Kaplan-Meier curve for time to progression (TTP). (A) All patients. Median TTP in patients with vitamin B12<691.4 pg/mL and in patients with vitamin B12≥691.4 pg/mL was 3.4 months (95% confidence interval [CI] 1.8–5.0) and 2.1 months (1.9–2.3), respectively (P=0.011). (B) Non-liver lesiona group. Median TTP in patients with vitamin B12<691.4 pg/mL and in patients with vitamin B12≥691.4 pg/mL was 6.3 months (2.9–9.7) and 1.6 months (0.0–3.5), respectively (P=0.021). (C) Liver lesion group. Median TTP in patients with vitamin B12<691.4 pg/mL and in patients with vitamin B12≥691.4 pg/mL was 1.8 months (1.0–2.6) and 2.1 months (2.0–2.3), respectively (P=0.816). P values by log-rank test.

aLiver lesion included hepatocellular carcinoma and liver metastasis.

Table 1

Characteristics of patients

Table 1

Abbreviations: NED, no evidence of disease; ECOG PS, Eastern Cooperative Oncology Group performance status.

Values are presented as number (%) or mean±standard error.

aLiver lesion included hepatocellular carcinoma and liver metastasis.

Table 2

Changes in serum vitamin B12 levels according to tumor response

Table 2

Abbreviations: PD, progressive disease; SD, stable disease; PR, partial response; NED, no evidence of disease; T1, first measurement; T2, second measurement.

Values are presented as mean±standard error.

P values by Wilcoxon's singed rank test.

Table 3

Risk for TTP according to vitamin B12 level

Table 3

Abbreviations: TTP, time to progression; HR, hazard ratio; CI, confidence interval.

P values by Cox proportional hazard model.

aLiver lesion included hepatocellular carcinoma and liver metastasis.

bAdjusted for age, sex, Eastern Cooperative Oncology Group Performance Status, and concurrent chemotherapy.