2108P - Vitamin B12 and its clinical relevance in hospitalized cancer patients

Background

Vitamin B12 impairment is common in cancer patients due to several factors, namely gastrointestinal (GI) surgery, malnutrition, liver metastases, and chemotherapy. Data regarding their prevalence and significance in this setting, as well as the impact on the overall prognosis, are lacking.

Methods

We retrospectively enrolled patients hospitalized for various cancer-related conditions at our Medical Oncology ward (2017-2022). Plasma B12 levels were stratified as Very Low (VL <200 pg/ml), Low (L 200-300 pg/ml), Normal (N 300-813 pg/ml) or High (H >813 pg/ml). We collected demographic and clinical data, including BMI, Cumulative Illness Rating Scale, nutritional status, ECOG PS, primary cancer site, disease stage, liver involvement and function tests, GI surgery. Univariate and multivariate statistical tests identified variables statistically associated to vitamin B12 (p<0.05).

Results

We enrolled 788 patients (F/M: 1.05, median age: 72, IQR: 62-78 y), VL B12 levels were found in 14.09% cases, L in 19.42%, N in 49.37% and H in 17.13%. At univariate analysis, B12 distribution was significantly different between genders, with females being characterized by higher median values compared to males. Vitamin B12 distribution increased significantly as function of ECOG PS levels. Breast cancer patients were characterized by the highest median B12 value while colorectal cancer patients by the lowest. B12 was also significantly higher in advanced compared to early-stage patients as well as in those who had liver failure. The correlation between B12 and age, albumin, prealbumin, total protein and folates was statistically significant but negligible (|r|<0.3). Multivariate analysis showed that the probability of H vs VL B12 levels was increased in patients with hypoproteinemia, hypoprealbuminemia and ECOG PS≥2, and decreased in those with colorectal and gastric cancer

Conclusions

To our knowledge, this is the first study investigating B12 levels in a wide and well clinically-characterized group of cancer patients; our data suggest that increased B12 is associated to an impaired clinical status, while in early stage patients, especially the elderly, B12 deficiency is of concern and may negatively impact the overall outcomes.

Clinical trial identification

#2734CE, released on the 31/01/2023.

Editorial acknowledgement

Legal entity responsible for the study

IRCCS Pavia - Istituti Clinici Scientifici Maugeri.

Funding

Has not received any funding.

Disclosure

A. Malovini: Financial Interests, Personal, Stocks/Shares: Biomeris S.R.L. L.D. Locati: Financial Interests, Institutional, Speaker, Consultant, Advisor: Lilly, Eisai, MSD, Ipsen, Bayer, Roche, Gentili SrL. All other authors have declared no conflicts of interest.