Elevated serum vitamin B(12) levels in association with tumor markers as the prognostic factors predictive for poor survival in patients with hepatocellular carcinoma.

摘要

Elevated blood vitamin B(12) (VitB(12)) level has recently been identified as a prognostic indicator for advanced cancer patients. The predictive value of blood VitB(12) for survival of patients with hepatocellular carcinoma (HCC) remains unclear. Our objective was to examine the determinants of elevated serum VitB(12) levels and their associations with prognosis of patients with HCC. The cohort study included 90 HCC patients who were consecutively admitted to the Chi-Mei Hospital, Taiwan, from April 2005 to December 2006. Nutrition and clinical pathological data were collected. Serum VitB(12) levels were determined by radioimmunoassay. Survival curves were calculated by the Kaplan-Meier method. Multivariate analysis of outcome predictors was assessed by Cox regression. Elevated serum VitB(12) levels of HCC patients were associated with reduced levels of albumin, hemoglobin, red blood cells count, and glutamate-pyruvate transaminase (GPT) (P < 0.05). Serum VitB(12) levels were positively correlated with alpha-fetal protein (AFP) levels (r = 0.623, P = 0.001) and tumor size (r = 0.630, P = 0.001; Table 3). By univariate analysis, survival was significantly worse in patients with elevated serum AFP (> 200 mu g/l) and VitB(12) levels (> 1,500 ng/l; P < 0.05). In multivariate analysis, both elevated AFP (> 200 vs. < 20; HR 4.4; CI = 1.9-10.3, P = 0.001) and VitB(12) levels (> 699 vs. < or = 699; HR = 2.88; CI = 1.26-6.6, P = 0.012) were found to be favorable predictive factors for HCC survival. This study shows that the determinants of elevated serum VitB(12) levels in HCC patients were in association with malnourishment, liver injuries, and tumor progression. Elevated VitB(12) levels in concurrence with AFP levels serve as the prognostic factors predictive for poor survival of HCC patients.