Prognostic Role of Serum Vitamin B12 in Solid Tumor Patients

Hye Kyung Oh; Jee Young Lee; Seong Woo Yoon; Wan Kyu Eo; Sung Nim Han

doi:10.15384/kjhp.2017.17.4.282

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Oh, Lee, Yoon, Eo, and Han: Prognostic Role of Serum Vitamin B12 in Solid Tumor Patients

Original Article

Korean Journal of Health Promotion 2017; 17(4): 282-288.

Published online: 28 December 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.4.282

Prognostic Role of Serum Vitamin B₁₂ in Solid Tumor Patients

Hye Kyung Oh¹, Jee Young Lee², Seong Woo Yoon², Wan Kyu Eo³, Sung Nim Han^1,⁴

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 30 August 2017 Accepted 13 October 2017

Korean Society for Health Promotion and Disease Prevention

(open-access, http://creativecommons.org/licenses/by-nc/3.0/):

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.

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

Figures and Tables

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

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 lesion^a 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

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

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

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.

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