Association Between Body Mass Index and Hematotoxicity in Gynecological Cancer Patients Receiving Paclitaxel-Carboplatin Therapy: A Retrospective Study.

INTRODUCTION: In gynecological cancer treatment, carboplatin dosage is generally calculated based on renal function to ensure appropriate drug exposure. In clinical practice, serum creatinine levels are sometimes adjusted when extremely low values are observed to avoid overdosing. Body mass index (BMI) has been suspected to influence the development of chemotherapy-induced hematotoxicity, but this relationship remains uncertain. This study aimed to investigate the effect of BMI on hematotoxicity in gynecological cancer patients receiving paclitaxel-carboplatin combination therapy (TC therapy). METHODS: Using electronic medical records, patients with gynecological cancer who received TC therapy for the first time between January 2014 and December 2021 were included in this retrospective study. BMI, Cockcroft-Gault formula (C-G formula) factors such as age, body weight, serum creatinine (sCr), and laboratory values related to hematotoxicity (leukopenia, anemia, neutropenia, and thrombocytopenia) prior to and after TC therapy. Nadir values obtained before the start of the second course of TC therapy were extracted from the electronic medical records. Among the extracted patient information, the presence or absence of grade ≥ 3 hematotoxicity was used as the outcome variable, and the grade of each blood cell prior to TC therapy, age, glomerular filtration rate (GFR) calculated using the C-G formula, and BMI were used as explanatory variables in multiple logistic regression analysis. RESULTS: Among the 273 eligible patients, no significant correlation was found between grade ≥ 3 hematotoxicity and BMI (leukopenia: odds ratio (OR) = 1.08, 95% confidence interval (CI) = 0.98-1.19, p = 0.12; anemia: OR = 1.06, 95% CI = 0.85-1.30, p = 0.57; neutropenia: OR = 1.05, 95% CI = 0.97-1.15, p = 0.20; thrombocytopenia: OR = 1.34, 95% CI = 0.93-1.89, p = 0.10). Younger age was associated with an increased risk of grade ≥ 3 leukopenia (OR = 0.96, 95% CI = 0.92-1.00, P = 0.035), and lower GFR was associated with increased risks of grade ≥ 3 leukopenia (OR = 0.97, 95% CI = 0.95-1.00, P = 0.049) and anemia (OR = 0.95, 95% CI = 0.89-0.99, P < 0.01). CONCLUSIONS: BMI was not associated with grade ≥ 3 hematotoxicity across all hematologic endpoints. Although serum creatinine correction to 0.7 mg/dL may reduce BMI-related variability in renal function estimation, this interpretation remains speculative because our study did not include a non-corrected comparison group.