Published online Nov 15, 2022. doi: 10.4251/wjgo.v14.i11.2224
Peer-review started: July 23, 2022
First decision: August 18, 2022
Revised: August 25, 2022
Accepted: October 2, 2022
Article in press: October 2, 2022
Published online: November 15, 2022
Processing time: 115 Days and 3 Hours
Many biomarkers have predictive value for overall survival (OS) and disease-free survival (DFS) in tumor patients. However, the role of indirect bilirubin (IBIL) in local advanced rectal cancer (LARC) patients treated with neoadjuvant chemoradiotherapy (nCRT) has not been studied.
To explore the predictive value of IBIL before nCRT (pre-IBIL) for the OS and DFS of LARC patients treated with nCRT.
A total of 324 LARC patients undergoing nCRT with total mesorectal excision (TME) were enrolled. Preoperative clinical features and postoperative patho
Among 324 patients, the median pre-IBIL was 6.2 μmol/L (interquartile range: 4.6 μmol/L-8.4 μmol/L). In the Cox multivariate regression analysis, we found that pre-IBIL, smoking history, tumor regression grade (TRG), vascular invasion, and carbohydrate antigen 19-9 before nCRT (pre-CA19-9) were predictors of OS. Additionally, pre-IBIL, body mass index (BMI), nCRT with surgery interval, TRG, and vascular invasion were predictors of DFS. Predictive nomograms were developed to predict 5-year OS and 5-year DFS with area under the ROC curve values of 0.7518 and 0.7355, respectively. Good statistical performance on internal validation was shown by calibration plots and ROC curves.
This study demonstrated that pre-IBIL was an independent prognostic factor for OS and DFS in LARC patients treated with nCRT followed by TME. Nomograms incorporating pre-IBIL, BMI, smoking history, nCRT with surgery interval, TRG, vascular invasion, and pre-CA19-9 could be helpful to predict OS and DFS.
Core Tip: Our study demonstrated that indirect bilirubin measurement before neoadjuvant chemoradiotherapy (nCRT) (pre-IBIL) is an independent and significant risk factor for survival in local advanced rectal cancer patients treated with nCRT followed by total mesorectal excision. In addition, nomograms based on pre-IBIL can predict 5-year overall survival and 5-year disease-free survival with good agreement.