Preoperative Albumin-Bilirubin Grade as a Prognostic Predictor in Colorectal Cancer Patients Who Undergo Radical Resection

Ce Zhu; Xiang Wang; Xinxin Yang; Jing Sun; Bujian Pan; Weiteng Zhang; Xiaodong Chen; Xian Shen

doi:10.2147/CMAR.S285212

Preoperative Albumin-Bilirubin Grade as a Prognostic Predictor in Colorectal Cancer Patients Who Undergo Radical Resection

Cancer Manag Res. 2020 Dec 1:12:12363-12374. doi: 10.2147/CMAR.S285212. eCollection 2020.

Authors

Ce Zhu^#¹, Xiang Wang^#¹, Xinxin Yang^#¹, Jing Sun¹, Bujian Pan¹, Weiteng Zhang¹, Xiaodong Chen¹, Xian Shen¹

Affiliation

¹ Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: The relationship between liver function and colorectal cancer without liver metastases has not been explored. Therefore, we investigated whether the preoperative albumin-bilirubin grade could predict the prognosis of patients with colorectal cancer (CRC) undergoing radical resection, and we designed a quantifiable predictive model.

Patients and methods: We retrospectively analyzed data from 284 patients with CRC who underwent radical resection in the Second Affiliated Hospital of the Wenzhou Medical University between January 2011 and January 2016. Patients were divided in two groups according to the calculated cut-off: the high albumin-bilirubin (>-2.48) grade and low albumin-bilirubin (≤-2.48) grade group. Kaplan-Meier curves were constructed to compare the overall survival (OS) between the two groups. Univariate and multivariate analyses were performed to identify the independent risk factors for postoperative complications and OS.

Results: Patients with a high albumin-bilirubin grade (n = 165, 58.1%) had a higher rate of postoperative complications (38.2% versus 17.6%, P < 0.001), especially medical (19.4% versus 6.7%, P = 0.002) and severe complications (1.7% versus 7.3%, P = 0.032). They also had a shorter OS (mean survival time, 47.6 versus 54.3 months, P = 0.005), especially patients with tumor-node-metastasis stage III (42.7 months versus 51.6 months, P = 0.036). Age ≥ 70 years (odds ratio [OR] = 2.22, P = 0.003) and high albumin-bilirubin grade (OR = 2.71, P = 0.001) were independent risk factors for postoperative complications, while age ≥ 70 years (hazard ratio [HR] = 2.65, P < 0.001), high albumin-bilirubin grade (HR = 1.81, P = 0.033), tumor-node-metastasis stage II (HR = 13.83, P = 0.010) and III (HR = 23.66, P = 0.002) were independent risk factors of OS.

Conclusion: Preoperative albumin-bilirubin grade could predict postoperative complications (especially medical and severe complications) and OS in patients with CRC, especially in those with tumor-node-metastasis stage III.

Keywords: albumin-bilirubin; colorectal cancer; liver function; postoperative complications; prognosis.

Grants and funding

This work was supported by General Scientific Research Project of Education Department of Zhejiang Province [grant number Y201941489]; Project of the Regional Diagnosis and Treatment Center of the Health Planning Committee [grant number JBZX-201903] and Special fund for clinical research of Wu Jieping Medical Foundation [grant number 320.6750.19010].