Tumor Biology

, Volume 36, Issue 2, pp 823–828 | Cite as

The changing of serum vitamin B12 and homocysteine levels after gastrectomy in patients with gastric cancer: do they associate with clinicopathological factors?

  • Ahmet Bilici
  • Alper Sonkaya
  • Serif Ercan
  • Bala Basak Oven Ustaalioglu
  • Mesut Seker
  • Mehmet Aliustaoglu
  • Asuman Orcun
  • Mahmut Gumus
Research Article


After total (TG) or distal subtotal gastrectomy (DG), patients are at high risk of vitamin B12 (vit-B12) deficiency, which results in elevation of homocysteine levels. The changing of serum vit-B12 and homocysteine levels in patients with gastric cancer is not well known. Seventy-two patients with gastric cancer who had undergone currative gastrectomy and 50 healthy controls were included. Serum vit-B12 and homocysteine levels were analyzed in gastric cancer patients. In addition, these parameters were compared with those of healthy control subjects. While serum vit-B12 levels in gastrectomized patients were significantly lower than that of healthy controls (221.8 ± 125.6 pg/mL vs. 309.9 ± 174.3 pg/mL, p = 0.002), homocysteine levels were significantly higher in patients with gastric cancer (14.2 ± 6.7 μmol/L vs. 12.5 ± 6.1 μmol/L, p = 0.016). Mean serum folate level was found to be high in healthy controls (7.3 ng/mL) compared to patients (9.2 ng/mL, p = 0.027). Out of 72 patients, 40 patients (55.6 %) with gastric cancer developed vit-B12 deficiency after gastrectomy. Vit-B12 deficiency was found to be related with gastrectomy type (p = 0.02) and homocysteine levels (p = 0.014). In patients who underwent TG, the incidence of vit-B12 deficiency was significantly higher compared with those with DG (67.5 vs. 32.5 %). In addition, serum vit-B12 level in patients with DG was significantly higher than that of patients with TG (248.3 ± 122.0 pg/mL vs. 200.8 ± 126.7 pg/mL, p = 0.041), whereas homocysteine levels were significantly lower in DG group compared with TG group (12.1 ± 6.1 μmol/L vs. 15.8 ± 6.9 μmol/L, p = 0.014). A logistic regression analysis showed that the extent of gastrectomy was found to be an independent factor for predicting the occurrence of vit-B12 deficiency (p < 0.001, odds ratio 1.38). Our results showed that cumulative vit-B12 deficiency rate was significantly higher after TG compared with that after DG, while homocysteine levels were significantly higher in TG group compared with DG group. The extent of gastrectomy was found to be an independent factor for predicting the occurrence of vit-B12 deficiency. Vit-B12 deficiency and hyperhomocysteinemia are imperious clinical situation for patients with gastric cancer after surgery. Hence, both preoperative and regular postoperative monitoring of vit-B12 and homocysteine levels for all gastrectomized patients with gastric cancer are important and necessary for early detection and prevention of vit-B12 deficiency and hyperhomocysteinemia as a risk factor for cardiovascular diseases.


Vitamin B12 Homocysteine Gastrectomy Gastric cancer 



This study was presented in ECCO 17–38th ESMO, 2013, the European Multidisciplinary Cancer Congress, in a poster session. A. Bilici, A. Sonkaya, S. Ercan, B.B.O. Ustaalioglu, M. Seker, M. Aliustaoglu, A. Orcun, M. Gumus—the changing of serum vitamin B12 and homocysteine levels after gastrectomy in patients with gastric cancer: do they associate with clinicopathological factors? Eur J Cancer, 49, (Suppl 2), S640.

Conflicts of interest



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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2014

Authors and Affiliations

  • Ahmet Bilici
    • 1
  • Alper Sonkaya
    • 2
  • Serif Ercan
    • 3
  • Bala Basak Oven Ustaalioglu
    • 4
  • Mesut Seker
    • 1
  • Mehmet Aliustaoglu
    • 2
  • Asuman Orcun
    • 3
  • Mahmut Gumus
    • 5
  1. 1.Department of Medical Oncology, Medical FacultyIstanbul Medipol UniversityIstanbulTurkey
  2. 2.Department of Medical OncologyDr. Lutfi Kirdar Education and Research HospitalIstanbulTurkey
  3. 3.Department of BiochemistryDr. Lutfi Kirdar Education and Research HospitalIstanbulTurkey
  4. 4.Department of Medical OncologyHaydarpasa Numune Education and Research HospitalIstanbulTurkey
  5. 5.Department of Medical Oncology, Medical FacultyBezmialem Vakif UniversityIstanbulTurkey

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