title: Significance and prognostic value of increased serum direct bilirubin level for lymph node metastasis in Chinese rectal cancer patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Higher serum direct bilirubin concentration was associated with the increased risk of LNM and poor prognosis in our rectal cancers.
authors.affiliation: Chun Gao, Long Fang, Jing-Tao Li, Hong-Chuan Zhao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing 100029, China.
authors.forename: Chun
authors.initials: C
authors.lastname: Gao
authors.affiliation: Chun Gao, Long Fang, Jing-Tao Li, Hong-Chuan Zhao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing 100029, China.
authors.forename: Long
authors.initials: L
authors.lastname: Fang
authors.affiliation: Chun Gao, Long Fang, Jing-Tao Li, Hong-Chuan Zhao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing 100029, China.
authors.forename: Jing-Tao
authors.initials: JT
authors.lastname: Li
authors.affiliation: Chun Gao, Long Fang, Jing-Tao Li, Hong-Chuan Zhao, Department of Gastroenterology, China-Japan Friendship Hospital, Ministry of Health, Beijing 100029, China.
authors.forename: Hong-Chuan
authors.initials: HC
authors.lastname: Zhao
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000556:secondary*; D000368:Aged; D001663:Bilirubin / Q000097:blood*; D014408:Biomarkers, Tumor / Q000097:blood*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012004:Rectal Neoplasms / Q000097:blood* / Q000473:pathology*; D012307:Risk Factors; D013997:Time Factors; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; D001663:Bilirubin
keywords: Direct bilirubin; Lymph node metastasis; Prognosis; Rectal cancer; Risk