Case Control Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 28, 2016; 22(8): 2576-2584
Published online Feb 28, 2016. doi: 10.3748/wjg.v22.i8.2576
Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients
Chun Gao, Long Fang, Jing-Tao Li, Hong-Chuan Zhao
Chun Gao, Long Fang, Jing-Tao Li, Hong-Chuan Zhao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing 100029, China
Author contributions: Gao C conceived the study, participated in the study design, acquisition of data, statistical analysis and manuscript writing. Fang L and Li JT participated in the acquisition of data and statistical analysis. Zhao HC participated in the study design and critical revision of manuscript for important intellectual content. All authors have read and approved the final manuscript.
Supported by the National Specific Research Project for Health and Welfare of China, No. 200902002-1; the Research Fund of Beijing Municipal Science and Technology Commission, No. Z111107067311021; and Beijing NOVA Programme, No. Z131107000413067.
Institutional review board statement: The study was reviewed and approved by The Human Research Ethics Committee of China-Japan Friendship hospital.
Informed consent statement: Informed written consent was obtained from all patients.
Conflict-of-interest statement: The authors have declared that no competing interests exist.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author at gaochun@bjmu.edu.cn. Participants gave informed consent for data sharing.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hong-Chuan Zhao, MD, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, No. 2 Yinghua East Road, Beijing 100029, China. hongchuanzhao@hotmail.com
Telephone: +86-10-84205313 Fax: +86-10-64481924
Received: August 10, 2015
Peer-review started: August 11, 2015
First decision: September 29, 2015
Revised: October 25, 2015
Accepted: December 8, 2015
Article in press: December 8, 2015
Published online: February 28, 2016
Processing time: 198 Days and 21.1 Hours
Abstract

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 was independently 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.

Keywords: Rectal cancer; Lymph node metastasis; Direct bilirubin; Risk; Prognosis

Core tip: Serum bilirubin has been associated with colorectal cancer; however, no information is available for the association between bilirubin and lymph node metastasis (LNM). This study was designed to determine the significance and prognostic value of increased serum direct bilirubin for Chinese rectal cancer patients with LNM, after exclusion of known hepatobiliary and pancreatic diseases. For the first time, this study found that higher serum direct bilirubin concentration was associated with an increased risk of LNM and poor prognosis in rectal cancer patients.