151751-Najiba-Chargi

190 CHAPTER 10 Table 4. Univariate and multivariate predictors of cisplatin dose-limiting toxicity Univariate analysis Multivariate analysis Odds Ratio (95% CI) p-value Odds Ratio (95% CI) p-value Gender Male Female Ref. 1.88 (1.18-2.97) 0.007 Age (years) 1.02 (0.99-1.04) 0.23 1.01 (0.98-1.04) 0.53 BMI (kg/m 2 ) 0.97 (0.92-1.02) 0.18 0.99 (0.94-1.05) 0.80 Perfomance ECOG 0 ECOG 1 ECOG ≥2 Unknown Ref. 1.10 (0.65-1.86) 1.27 (0.60-2.70) 0.84 (0.44-1.58) 0.71 0.54 0.58 ACE-27 score None Mild Moderate Severe Ref. 1.17 (0.67-2.02) 1.17 (0.65-2.10) 0.62 (0.27-1.43) 0.58 0.61 0.26 Albumin (g/L) 0.96 (0.90-1.01) 0.14 Total protein (g/L) 0.94 (0.86-1.02) 0.12 Hemoglobin (mmol/L) 0.88 (0.72-1.08) 0.21 Creatinine (mmol/L) 1.00 (0.99-1.01) 0.98 LBM (kg) 0.97 (0.95-0.99) 0.01 Body surface area (m 2 ) 0.58 (0.22-1.55) 0.28 Low SMM No Yes Ref. 1.86 (1.20-2.89) 0.006 1.75 (1.06-2.90) 0.03 DISCUSSION In this large retrospective study, we evaluated the association between low SMM prior to treat- ment with cisplatin-based chemoradiotherapy and the occurrence of cisplatin DLTs. We found that patients with low SMM at diagnosis were at significant risk for experiencing cisplatin DLTs compared to patients without lowSMM. Cisplatin DLTs lead to failure of the intended treatment plan in 44.9% of patients. Our findings are in line with previous studies in patients with LA- HNC. 8,19 Our previous study in a smaller cohort of LA-HNC patients treated with either cisplatin or carboplatin showed a threefold increase in DLT frequency in patients with low SMM. 8 An association between low SMM and DLT has also been found in patients with non-small cell lung cancer, breast cancer, colorectal cancer, esophagogastric cancer and pancreatic cancer. 10,11,20,21 The scale of increased risk for DLTs found in these studies varies, mainly depending on type of cytotoxic agent used and the cut-off points used to define low SMM.