151751-Najiba-Chargi

186 CHAPTER 10 Known risk factors for HNC are smoking and alcohol use, which is also seen in this study. Ma - jority of patients smoked (n=282, 82.2%) and used alcohol (n=283, 82.5%). In the selection of patients fit for cisplatin treatment, the medical oncologist takes into consideration patients’ comorbidities. This is represented by the minority of patients (n=34, 9.9%) who had severe comorbidities, as evaluated by the ACE-27 comorbidity score, in this study. Most patients (n=144, 42%) were symptomatic but completely ambulatory as indicated by the ECOG perfor - mance status of 1. Cisplatin-based chemoradiotherapy is most frequently given in a primary treatment setting in patients with LA-HNC. As previously mentioned, adjuvant chemoradiotherapy is only advised when the tumor is irradically resected or in the presence of extracapsular lymph-nodal extension. In this study, majority of patients were treated in a primary setting (n=274, 79.9%) and had a tumor, node, metastasis (TNM) stage IV tumor according to the 7 th edition TNM cancer staging criteria (n=284, 82.8%). Prior to initiation of chemoradiotherapy the mean biochemical values of the patients were as follows: mean hemoglobin of 8.5 mmol/L (SD 1.1), mean serum creatinine of 69.9 mmol/L (SD 15.6), mean serum albumin of 40.0 g/L (SD 4.9) and mean total protein of 71.2 g/L (SD 7.9). ANTHROPOMETRIC MEASUREMENTS Table 2 shows the anthropometric measurements of the included patients. Of the 343 includ - ed patients, 199 patients (58.0%) had low SMM at diagnosis. The median LSMI was 41.6 cm 2 / m 2 (IQR 35.4-45.5). The median LBM was 44.8 kg (IQR 37.1-50.6). Majority of patients (n=191, 55.7%) had ad normal weight as indicated by the body mass index (BMI) of 18.5-24.9 kg/m 2 . The median body surface area at diagnosis was 1.9 m 2 (IQR 1.7-2.0). LOW SKELETAL MUSCLE MAS Table 1 shows the differences in demographic, clinical and biochemical characteristics be - tween patients with and without low SMM (LSMI ≤ 43.2 cm 2 /m 2 ) at diagnosis. Demographical and clinical characteristics which were significantly more likely to be present in patients with low SMM were being of female gender (n=103, 95.4%; p <0.01), older age at diagnosis (59.4 years; p<0.01), smoking (n=173, 61.3%; p=0.01), an ECOG performance status of ≥ 2 (n=24, 63.2%; p=0.02) and being treated in an adjuvant chemoradiotherapy setting (n=48, 69.6%, p=0.04). In comparison to patients without low SMM, patients with low SMMwere more likely to have lower mean albumin levels (38.4 g/L versus 39.9g/L; p<0.05), lower mean hemoglobin levels (8.2 mmol/L versus 8.9 mmol/L; p<0.01) and lower mean serum creatine levels (65.1 mmol/L versus 76.8mmol/L; p<0.01). Interestingly, patients with lowSMMat diagnosis received significantly higher cumulative doses of cisplatin per kilogram of LBM compared to patients without low SMM (9.0mg/kg LBM versus 7.4 mg/kg LBM, p<0.0001). Table 2 shows the differences in anthropometric measurements between patients with low SMM at diagnosis and patients without low SMM. All underweight patients (BMI < 18.5 kg/ m 2 ) (n=30, 8.7%) had low SMM. Patients without low SMM were more likely to be overweight (65.5%; p<0.01) and obese (73.7%; p<0.01).