Clinical Research Papers:

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

Qunfeng Zhang _, Xiaowei Ma, Qunhuan Xu, Juanxiu Qin, Yanhua Wang, Qian Liu, Hua Wang and Min Li

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Oncotarget. 2017; 8:71138-71146. https://doi.org/10.18632/oncotarget.11424

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Qunfeng Zhang1, Xiaowei Ma2, Qunhuan Xu1, Juanxiu Qin2, Yanhua Wang1, Qian Liu2, Hua Wang2 and Min Li2

1Department of Laboratory Medicine, The Fifth People’s Hospital of Shanghai, Fudan University, Shanghai, China

2Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China

Correspondence to:

Qunfeng Zhang, email: [email protected]

Hua Wang, email: [email protected]

Min Li, email: [email protected]

Keywords: colorectal cancer, direct bilirubin, surgery, survival analysis

Received: June 03, 2016     Accepted: July 19, 2016     Published: August 19, 2016


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.

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