Abstract 471P
Background
Many clinical studies have shown that bilirubin level may predict prognosis of colorectal cancer (CRC). Neutrophils-to-lymphocytes (NLR) is a well-known prognostic factor for CRC with high predictive performance. The aim of our study was to combine the two to find a highly specific prognostic factor for resectable CRC.
Methods
Our study included 702 patients histopathologically confirmed CRC. Routine preoperative serum examinations were performed within one week before surgery. The DIR was defined as the level of direct bilirubin divided by indirect bilirubin. Patients were divided into a high-level group or a low-level group according to the cut-off values. Patients with a low DIR and low NLR level were scored as 0, those with a high DIR or a high NLR level were scored as 1, and those with a high DIR and high NLR level were scored as 2. The entire population was randomly assigned to a training (491) or testing (211) group. Chi-square tests, Kaplan-Meier survival analyses, and cox regression analyses were used to evaluate prognosis. The accuracy of the model was evaluated by Harrell’s concordance index (C-index).
Results
The median follow-up time was 35 months. Besides, the combination of DIR and NLR (DIR-NLR) was an independent prognostic factor in dieases-free survival (DFS) for patients with resectable CRC (HR: 1.323; 95% CI, 1.072-1.633). More interestingly, the prognostic model based on age, sex, TNM stage, differenation, circumferential margin, vascular cancer embolus status, nerve infiltration status, DIR-NLR, CEA and CA199 was found to present exceptional performance in overall survival (OS) prediction [C-index: 0.782 (95% CI, 0.73-0.83)]. The area under the curve (AUC) values were illustrated the predictive power of the nomogram, which were 0.81 in training cohort and 0.89 in testing cohort for 1-year OS, 0.80 in training cohort and 0.81 in testing cohort for 3-year OS, respectively. Besides, the prognostic model also was found to present exceptional performance in DFS prediction [C-index: 0.769 (95% CI, 0.73-0.80)].
Conclusions
We successfully established a novel biomarker based on bilirubin and NLR to guide clinical decision-making for CRC.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
This work was supported by the National Natural Sciences Foundation of China (Grants No. 81772499), the National Key R&D Program of China (Grant No. 2017YFC0908204), the Health commission of Hubei Province scientific research project (Grant No. WJ2017Z020, Grant No. WJ2019H121, Grant No. WJ2017M142, Grant No. WJ2021Z001), the Natural Science Foundation of Hubei Province (Grant No. 2019ACA135), Applied Basic Research Program of Wuhan Science and Technology Bureau (Grant No. 2020020601012250).
Disclosure
All authors have declared no conflicts of interest.