The Relationship of Albumin-Bilirubin Grade with Right and Left Colon in Patients with Colon Cancer Treated with Regorafenib

ABS TRACT Objective: The purpose of this study is to evaluate the association between albumin-bilirubin (ALBI) grade and right and left colon in colon cancer (CC) patients with liver metastases who received regorafenib treatment. Material and Methods: This retrospective study included 126 patients treated with regorafenib and was divided into normal-ALBI (ALBI Grade 1) and high-ALBI groups (ALBI Grades 2 and 3). The optimal cut-off values of neutrophil-lymphocyte ratio and prognostic nutritional index (PNI), evaluated by receiver operating characteristic curve analysis, were 4.41 and 40.85, respectively. The associations between parameters with survival were analyzed using Ka- plan-Meier curves and compared by the log-rank test. Cox proportional hazards regression analyzes were used to evaluate the prognostic significance of the parameters for progression-free survival (PFS) and overall survival (OS). Results: The ALBI group for OS (p=0.043) in the right CC (RCC) and the number of metastatic organs for PFS (p=0.048) were found to be independent prognostic variables. The overall response rate (ORR) was significantly higher in the group with low ALBI for RCC. In RCC, adverse events (AE) were higher in the group with high ALBI than in the normal group (p=0.028). The number of metastatic organs in left CC (LCC) (p=0.008, p<0.001, p=0.042) was found to be independent prognostic for both PFS and OS. Both ORR and disease control rate were significantly higher in the LCC group with high PNI. Conclusion: In RCC cases with liver metastases treated with regorafenib, the ALBI group was significantly associated with prognosis, survival, response rates, and AE. ALBI grade should be considered in RCC patients receiving regorafenib therapy.