The prognostic impact of serum bilirubin in stage IV colorectal cancer patients

Abstract

Background: Bilirubin played a great role in antioxidation and anticancer and has been considered as a promising prognostic factor of non-liver disease-related death in various cancers. The aim of this study was to assess the prognostic value of pre-treatment serum bilirubin in stage IV CRC patients. Methods: Serum bilirubin including TBIL, DBIL, and IBI which were tested at pre-treatment were investigated in 154 stage IV CRC patients in Zhongda Hospital, Nanjing, China, from July 2005 to July 2011. X-tile program was used to determine the optimal cut-off values of these three biomarkers. Kaplan-Meier analysis, univariate, and multivariate cox regression as well as time-dependent ROC curve analysis were performed to evaluate the relations between serum bilirubin and survival outcomes. Results: We got the results that the optimal cut-off points of serum TBIL, DBIL, and IBI levels were 12.9, 6.1, and 4.8 μmol/L, respectively. Univariate analysis showed that elevated TBIL, DBIL, and CEA were significantly associated with poor 5-year OS in stage IV CRC patients. Multivariate cox analysis indicated that the high DBIL (HR=1.603, 95%CI=1.053-2.442, P