Journal List > Korean J Health Promot > v.17(4) > 1089928

Korean J Health Promot. 2017 Dec;17(4):282-288. Korean.
Published online December 28, 2017.
Copyright © 2017 Korean Society for Health Promotion and Disease Prevention
Prognostic Role of Serum Vitamin B12 in Solid Tumor Patients
Hye Kyung Oh,1 Jee Young Lee,2 Seong Woo Yoon,2 Wan Kyu Eo,3 and 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, Email:
Received August 30, 2017; Accepted October 13, 2017.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.



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.


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).


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).


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


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.
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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.
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Table 1
Characteristics of patients
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Table 2
Changes in serum vitamin B12 levels according to tumor response
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Table 3
Risk for TTP according to vitamin B12 level
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