Urbanski Geoffrey, Hamel Jean-François, Prouveur Benoît, Annweiler Cédric, Ghali Alaa, Cassereau Julien, Lozac'h Pierre, Lavigne Christian, Lacombe Valentin
Department of Internal Medicine, Angers University Hospital, 49933 Angers, France.
Department of Biostatistics and Methodology, Angers University Hospital, 49933 Angers, France.
J Clin Med. 2020 Feb 9;9(2):474. doi: 10.3390/jcm9020474.
The association between elevated plasma vitamin B12 (B12) level and solid cancers has been documented by two national registries. However, their design did not allow for the adjustment for other conditions associated with elevated B12. The objectives of this study were to confirm this association after the adjustment for all causes of elevated B12, and to study the variations according to the increasing B12 level, the type of cancers, and the presence of metastases. We compared 785 patients with B12 ≥ 1000 ng/L with 785 controls matched for sex and age with B12 < 1000 ng/L. Analyses were adjusted for the causes of elevated B12: myeloid blood malignancies, acute or chronic liver diseases, chronic kidney failure, autoimmune or inflammatory diseases, and excessive B12 supplementation. A B12 ≥ 1000 ng/L was associated with the presence of solid cancer without metastases (OR 1.96 [95%CI: 1.18 to 3.25]) and with metastases (OR 4.21 [95%CI: 2.67 to 6.64]) after adjustment for all elevated B12-related causes. The strength of the association rose with the increasing B12 level, in particular in cases of metastases. No association between liver cancers and elevated B12 level was found after adjustment for chronic liver diseases. In conclusion, unexplained elevated B12 levels should be examined as a possible marker of solid cancer.
两项国家登记处记录了血浆维生素B12（B12）水平升高与实体癌之间的关联。然而，它们的设计不允许对与B12升高相关的其他情况进行调整。本研究的目的是在对B12升高的所有原因进行调整后确认这种关联，并研究根据B12水平升高、癌症类型和转移情况的变化。我们将785例B12≥1000 ng/L的患者与785例年龄和性别匹配的B12<1000 ng/L的对照进行了比较。分析针对B12升高的原因进行了调整：骨髓血液恶性肿瘤、急性或慢性肝病、慢性肾衰竭、自身免疫或炎症性疾病以及过量补充B12。在对所有与B12升高相关的原因进行调整后，B12≥1000 ng/L与无转移的实体癌存在相关（OR 1.96 [95%CI：1.18至3.25]）以及与转移相关（OR 4.21 [95%CI：2.67至6.64]）。关联强度随着B12水平升高而增加，尤其是在转移病例中。在对慢性肝病进行调整后，未发现肝癌与B12水平升高之间存在关联。总之，原因不明的B12水平升高应作为实体癌的可能标志物进行检查。
