Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients

• Published in: World journal of gastroenterology : WJG 2016-02, Vol.22 (8), p.2576-2584
• Main Authors: Gao, Chun, Fang, Long, Li, Jing-Tao, Zhao, Hong-Chuan
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - blood; Adenocarcinoma - secondary; Aged; Bilirubin - blood; bilirubin; Risk; Prognosis; Biomarkers, Tumor - blood; cancer; Lymph; Case Control Study; Case-Control Studies; Chi-Square Distribution; China; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Lymphatic Metastasis; Male; metastasis; Direct; Middle Aged; Multivariate Analysis; node; Odds Ratio; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Rectal; Rectal Neoplasms - blood; Rectal Neoplasms - pathology; Risk Factors; Time Factors; Up-Regulation
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v22.i8.2576

AIM: To determine the significance of increased serum direct bilirubin level for lymph node metastasis(LNM) in Chinese rectal cancer patients, after those with known hepatobiliary and pancreatic diseases were excluded.METHODS: A cohort of 469 patients, who were treated at the China-Japan Friendship Hospital, Ministry of Health(Beijing, China), in the period from January 2003 to June 2011, and with a pathological diagnosis of rectal adenocarcinoma, were recruited. They included 231 patients with LNM(49.3%) and 238 patients without LNM. Follow-up for these patients was taken through to December 31, 2012.RESULTS: The baseline serum direct bilirubin concentration was(median/inter-quartile range) 2.30/1.60-3.42 μmol/L. Univariate analysis showed that compared with patients without LNM, the patients with LNM had an increased level of direct bilirubin(2.50/1.70-3.42 vs 2.10/1.40-3.42, P = 0.025). Multivariate analysis showed that direct bilirubin wasindependently associated with LNM(OR = 1.602; 95%CI: 1.098-2.338, P = 0.015). Moreover, we found that:(1) serum direct bilirubin differs between male and female patients; a higher concentration was associated with poor tumor classification;(2) as the baseline serum direct bilirubin concentration increased, the percentage of patients with LNM increased; and(3) serum direct bilirubin was associated with the prognosis of rectal cancer patients and higher values indicated poor prognosis.CONCLUSION: Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.