Incidental detection of raised serum levels of vitamin B12 and its association with neoplasms

Detección incidental de niveles de vitamina B12 elevados y su relación con neoplasias

J. Pardo Llediasa,

Corresponding author

[e-mail]

Corresponding author.

, M. Martín Millána, J.A. Mazariegos Canoa, C. Aimar Marcob, N. Arias Martínezc, B. San Pedro Careagaa, E. Urizar Ursuaa, M.C. Insua Garcíaa, B.A. Lavin Gómezd, J.L. Hernández Hernándeza

a Servicio de Medicina Interna, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, Spain

b Servicio de Pediatría, Hospital Universitario Araba, Gasteiz, Spain

c Universidad de Cantabria, Santander, Cantabria, Spain

d Servicio de Análisis Clínico, Hospital Unversitario Marqués de Valdecilla, Santander, Cantabria, Spain

Abstract

Background and objectives

Elevated serum levels of vitamin B12 have been associated with oncohematological diseases. However, the relevance of its incidental detection in subjects without a previous diagnosis of cancer is unknown. The aim of this study was to evaluate the relationship between incidental hypercobalaminemia (vitamin B12 > 1000 pg/mL) and the diagnosis of a tumor process in patients without a diagnosis and to establish the risk factors.

Material and methods

Retrospective observational study of a cohort of patients with hypercobalaminemia. The incidence of neoplasms was compared with a cohort of patients with vitamin B12 levels <1000 pg/mL.

Results

Vitamin B12 determinations of 4800 subjects were selected. Of them, 345 (7.1%) had levels >1000 pg/mL. 68 (28.4%) were excluded due to exogenous administration, 12 (5%) due to insufficient data and 15 (3%) due to having an active neoplasia, selecting 250 patients, with a median follow-up of 22 (IQR 12–39) months. Structural liver disease was detected in 59 (23.6%). 18.2% (44 patients) had solid organ cancer and 17 (7.1%) had malignant hemopathy. The average time from the detection of hypercobalaminemia to the diagnosis of cancer was about 10 months. The median until the diagnosis of neoplasia was higher in the high vitamin B12 group (13 vs. 51 months p < 0.001). Hypercobalaminemia (HR 11.8; 95% CI 2.8–49.6; p = 0.001) and smoking (HR 4.0; 95% CI, 2.15–7.59; p < 0.001) were independent predictors of neoplasia in the multivariate analysis.

Conclusions

Incidental detection of serum vitamin B12 levels >1000 pg/mL is high in the population. The diagnosis of solid organ and hematological neoplasia is frequent during the following year of follow-up, with hypercobalaminemia and smoking being predictors of a higher risk of cancer.

Keywords:

Vitamin B12

Neoplasm

Hematologic malignancy

Resumen

Antecedentes y objetivo

Los niveles elevados de vitamina B12 se han asociado a enfermedades oncohematológicas. Sin embargo, se desconoce la relevancia de su detección incidental en sujetos sin un diagnóstico previo de cáncer. Evaluar la relación de la hipercobalaminemia y el diagnóstico de un proceso tumoral y establecer los factores de riesgo.

Material y métodos

Estudio observacional retrospectivo de una cohorte de pacientes con hipercobalaminemia. Se comparó la incidencia de neoplasias con una cohorte de pacientes con vitamina B12 < 1000 pg/mL.

Resultados

Se seleccionaron 4800 sujetos con determinaciones de vitamina B12: 345 (7,1%) presentaban niveles >1000 pg/mL. Se excluyeron 68 (28,4%) administración exógena, 12 (5%) datos insuficientes y 15 (3%) una neoplasia activa, seleccionando 250 pacientes; mediana de seguimiento 22 (RIQ 12–39 ) meses. Se detectó: hepatopatía 59 (23,6%), 18,2% (44) presentaron cáncer de órgano sólido y 17 (7,1%) hemopatía maligna. El tiempo medio desde la detección de hipercobalaminemia al diagnóstico fue 10 meses. La mediana hasta el diagnóstico fue mayor en el grupo de vitamina B12 elevada (13 vs. 51 meses p < 0,001). La hipercobalaminemia (HR 11,8; IC95 2,8–49,6; p = 0,001) y tabaquismo (HR 4,0; IC95%, 2,15–7,59; p < 0,001) resultaron predictores independientes.

Conclusiones

La detección incidental de niveles séricos de vitamina B12 >1000 pg/mL es elevada. El diagnóstico de neoplasia órgano sólido y hematológica es frecuente durante el año siguiente de seguimiento, siendo la hipercobalaminemia y el tabaquismo factores predictores de un mayor riesgo de cáncer.

Palabras clave:

Vitamina B12

Neoplasias

Neoplasias hematológicas