Prognostic and predictive value of B12/CRP index (BCI) level in patients with a diagnosis of solid cancer

OBJECTIVE: The correct estimation of the survival time in cancer patients is important in the follow-up and treatment decisions of the patients.For this reason, many prognostic tools have been developed to provide better estimation of survival.Considering that it may contribute to previous prognostic scoring to predict survival times, in this study, the effect of B12 / CRP index (BCI) level calculated by serum vitamin B12 level and CRP value on survivaltime in solid organ cancers was examined as a predictive and prognostic biomarker in advanced stage (Stage 4) / early stage (Stage 1, 2, and 3) differentiation. METHODS: 344 patients diagnosed with solid cancer between 2016-2019 in Dokuz Eylul University Faculty of Medicine, Department of Internal Diseases, Department of Medical Oncology were included in the study. Demographic characteristics of the patients, diagnosis, location of metastasis, presence of liver lesions (presence of liver metastasis, hepatocellular cancer), ECOG performance score (As <2 and ≥2), B12, c-reactive protein (CRP), hemoglobin, lactate dehydrogenase (LDH), albumin level, neutrophil lymphocyte ratio (NLR), thrombocyte lymphocyte ratio (PLR), mean thrombocyte volume (MPV), eosinophil level and overall survival (OS) time were recorded retrospectively. RESULTS: Median follow-up period was 46,8 (4-63) months, 47.7% were female and 52.5% were male. The mean age was 60.9 ± 11.9 years. 49.4% of the patients were advanced stage at the time of diagnosis and 51.7% had metastasis. Mortality developed in 191 patients at the end of the follow-up period. Median OS was 15 (0-52) months. As for the ECOG performance status, 86.6% of them had a score less than two. The patients were divided into three groups according to their BCI levels. BCI level was ≤10,000 in 32.6% of the patients, BCI level was between 10.001-40.000 in 29.7% and BCI level was found to be >40.000 in 37.8%. It was found that 51.8% of the patient group with a BCI level of >40,000 consisted of advanced stage patients, and advanced stage patients had higher BCI levels than early stage patients (p<0.001). Mortality risk in early-stage patients with a BCI level of 13262.2 and above is 13262. It was calculated to be higher than patients with less than 2 (OR= 3.1; 95% CI; (1.6-6.1)) (p = 0.001). The cut-off value for BCI could not be determined to predict mortality risk in advanced stage patients. The mortality risk was higher in patients with a BCI value of 27023.3 and above in the whole population (OR= 3.8; 95% CI; (2.4-6.0) (p<0.001)). CONCLUSION: The B12 / CRP Index (BCI) is a simple, time-consuming and inexpensive marker, and it is thought that it can be used in daily practice in terms of its discrimination between high and low risk patient groups and predictive of survival difference in both groups. Prospective large-scale studies with larger numbers of patients are needed to determine its predictivity in advanced stage patients. In line with these studies, it is predicted that fixed international cut-off values for which mortality risk is determined can be determined. KEY WORDS: Vitamin B12, CRP, Solid Cancer, Survival, Prognostic Factor