Arendt Johan Frederik Håkonsen, Farkas Dóra Körmendiné, Pedersen Lars, Nexo Ebba, Sørensen Henrik Toft
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark; Department of Clinical Biochemistry, Aarhus University Hospital, Norrebrogade 44 Building 9, DK-8000 Aarhus C, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200 Aarhus N, Denmark.
Cancer Epidemiol. 2016 Feb;40:158-65. doi: 10.1016/j.canep.2015.12.007. Epub 2015 Dec 24.
Elevated plasma vitamin B12 levels (cobalamin, Cbl) are associated with increased short-term cancer risk among patients referred for this laboratory measurement. We aimed to assess prognosis in cancer patients with elevated plasma Cbl.
We conducted a population-based cohort study using data from Danish medical registries during 1998-2014. The study included 25,017 patients with a cancer diagnosis and Cbl levels of 200-600 pmol/L (reference/normal range), 601-800 pmol/L and >800 pmol/L measured up to one year prior to diagnosis, and a comparison cohort of 61,988 cancer patients without a plasma Cbl measurement. Patients treated with Cbl were excluded. Survival probability was assessed using Kaplan-Meier curves. Mortality risk ratios (MRR) were computed using Cox proportional hazard regression, adjusted for age, sex, calendar year, cancer stage and comorbidity, scored using the Charlson comorbidity index.
Survival probabilities were lower among patients with elevated Cbl levels than among patients with normal levels and among members of the comparison cohort [(1-year survival,%) Cbl: 200-600 pmol/L: 69.3%; 601-800 pmol/L: 49.6%; >800 pmol/L: 35.8%; comparison cohort: 72.6%]. Thirty-day mortality was elevated for patients with Cbl levels of 601-800 pmol/L or >800 pmol/L, compared to patients with levels of 200-600 pmol/L [(MRR (95% confidence interval): 601-800 pmol/L vs. 200-600 pmol/L: 1.9 (1.6-2.2); >800 pmol/L vs. 200-600 pmol/L: 2.7 (2.4-3.1)]. This association remained robust for 31-90-day and 91-365-day mortality, showing similar dose-response patterns.
Cancer patients with elevated Cbl levels had higher mortality than those with normal Cbl levels. These findings may have clinical significance for assessing the prognosis of cancer patients.
在因该项实验室检测而就诊的患者中，血浆维生素B12水平（钴胺素，Cbl）升高与短期癌症风险增加相关。我们旨在评估血浆Cbl水平升高的癌症患者的预后情况。
我们利用丹麦医疗登记处1998年至2014年的数据进行了一项基于人群的队列研究。该研究纳入了25,017例癌症诊断患者，其Cbl水平在诊断前一年测量，分别为200 - 600 pmol/L（参考/正常范围）、601 - 800 pmol/L和>800 pmol/L，以及一个由61,988例未进行血浆Cbl测量的癌症患者组成的对照队列。接受Cbl治疗的患者被排除。使用Kaplan-Meier曲线评估生存概率。使用Cox比例风险回归计算死亡风险比（MRR），并根据年龄、性别、日历年份、癌症分期和合并症进行调整，合并症使用Charlson合并症指数评分。
Cbl水平升高的患者的生存概率低于Cbl水平正常的患者以及对照队列中的成员[（1年生存率，%）Cbl：200 - 600 pmol/L：69.3%；601 - 800 pmol/L：
49.6%；>800 pmol/L：35.8%；对照队列：72.6%]。与Cbl水平为200 - 600 pmol/L的患者相比，Cbl水平为601 - 800 pmol/L或>800 pmol/L的患者30天死亡率升高[（MRR（95%置信区间）：601 - 800 pmol/L与200 - 600 pmol/L相比：1.9（1.6 - 2.2）；>800 pmol/L与200 - 600 pmol/L相比：2.7（2.4 - 3.1）]。这种关联在31 - 90天和91 - 365天死亡率方面仍然显著，呈现出相似的剂量反应模式。
Cbl水平升高的癌症患者的死亡率高于Cbl水平正常的患者。这些发现可能对评估癌症患者的预后具有临床意义。
