Nomograms incorporated serum direct bilirubin level for predicting prognosis in stages II and III colorectal cancer after radical resection

Abstract

An elevated serum bilirubin has been reported to be associated with a reduced risk of some cancer; however, the prognostic significance of serum bilirubin in colorectal cancer wasn’t fully understood. The purpose of this study was to evaluate whether serum bilirubin could predict the prognosis of patients in stages II and III colorectal cancer. A retrospective cohort of 986 patients with colorectal cancer who received surgical resection between January 2005 and December 2010 was included in the study. Levels for serum bilirubin were obtained from medical records. Survival analysis was used to evaluate the predictive value of bilirubin. Serum direct bilirubin (DBIL) was validated as a significant prognostic factor by univariate cox regression test for both overall survival (OS) and disease free survival (DFS) (P < 0.05). X-tile program identified 3.6 as optimal cutoff values for DBIL in terms of OS and DFS. Patients were then divided into DBIL high (DBIL ≥ 3.60 μmol/l) and low group (DBIL < 3.60 μmol/l) according to the optimal cutoff. High DBIL had higher percentage of lymph node metastasis and lymphovascular invasion as compared with low DBIL levels (P < 0.05). Multivariate cox regression analyses confirmed that high DBIL level was an independently prognostic factor for both OS (HR: 1.337, 95% CI: 1.022–1.748, P = 0.034) and DFS (HR: 1.312, 95% CI: 1.049–1.643, P = 0.018). In addition, nomograms on OS and DFS were established according to all significant factors, and c-indexes were 0.715 (95% CI: 0.683–0.748) and 0.704 (95% CI: 0.678–0.730), respectively. Nomograms based on OS and DFS can be recommended as practical models to evaluate prognosis for CRC patients.

Serum bilirubin level predicts postoperative overall survival in oral squamous cell carcinoma

“…D, Kaplan-Meier curves of OS in patients with H-DBIL or L-DBIL as well as with or without lymph-node metastasisAmong the different types of bilirubin, we noticed that although TBIL and IBIL were significantly decreased in patients with OSCC, only DBIL predicted overall survival. This is consistent with Zhang's results,14 which demonstrated that pre-treatment serum DBIL, but not TBIL or IBIL, was an independent prognostic factor for both overall survival (OS) and disease-free survival (DFS) in stage II and stage III colorectal cancer (CRC) patients. A high DBIL level correlated with lymph-node metastases and lymphovascular invasion.…”

“…For example, Gao et al used a cutoff value of 2.6 μmol/L to predict prognosis in Chinese rectal cancer patients, and Li et al adopted 3.45 μmol/L for NSCLC . In a study of colorectal cancer, Zhang et al used 3.6 μmol/L to categorize lower or higher DBIL levels . The incidence of lung cancer or colorectal cancer is higher than OSCC, and the living habits of patients with different cancers vary; therefore, the cutoff value may also vary between studies using different samples.…”

“…However, there were some studies with contradictory results. Colorectal cancer patients with higher DBIL had a higher percentage of lymph‐node metastasis and lymphovascular invasion compared to patients with low DBIL levels . The relationship between bilirubin levels and survival in OSCC has not been studied previously.…”

“…Colorectal cancer patients with higher DBIL had a higher percentage of lymph-node metastasis and lymphovascular invasion compared to patients with low DBIL levels. 14…”

A nomogram based on serum bilirubin and albumin levels predicts survival in gastric cancer patients

“…demonstrated that non-small cell lung cell cancer patients with higher pretreatment bilirubin levels had longer OS, DFS, and DMFS than those with lower levels [8]. Zhang and colleagues also found that high DBIL was strongly associated with worse outcomes after surgery in colorectal cancer patients with stage II and stage III disease in a retrospective study [9]; subsequent studies confirmed these results [13, 14]. However, the association between serum bilirubin levels and clinical outcomes in gastric cancer had not been examined.…”