respectively. Grade 2-4 neutropenia was recorded after 22% of cycles. In univariate logistic regression analysis (LRA) of 25 candidate predictors, platelets, neutrophils, and presence of lung metastasis were found to be significantly associated with the risk of g2-4 neutropenia (p-values from 0.07 to 0.02) and were assessed in a multivariable model. A multivariable LRA confirmed the three variables to be significantly associated with g2-4 neutropenia and were all included in a final predictive model (R2 index 23%, C-statistics 75%; P ¼ .007). The model was internally validated with 100 boot-strap resamples (corrected R2 21%). The three variables were used to build up the nomogram with the following scoring system: absence of lung metastasis ¼ 23 points; any 50000 decrease in platelets ¼ 2.5 points starting from 0 points for ! 750000 platelets; any 2000 decrease in neutrophils ¼ 2 points starting from 0 points for ! 20000 neutrophils. A score ! 126 was associated with a g2-4 neutropenia risk ! 25%. The 25% risk cut-off had the best discriminatory power according to a Receiver Operating Characteristic (ROC) analysis (sensitivity 81%, specificity 68%). A Decision Curve Analysis revealed that for a threshold of risk of 25% or higher, there was an added net benefit of ! 37% patients adequately identified as at risk of grade 2-4 neutropenia by using the nomogram as compared to a 'treat-all' policy. In our cohort, patients with a predicted risk ! 25% had an incidence of grade 2-4 neutropenia of 41% as compared to 7% of patients with a predicted risk 25% (Relative Risk 5.69; P < .003) Conclusion: mPC without lung metastasis and low pre-cycle neutrophil and platelet counts are at increased risk of GnP-induced grade 2-4 neutropenia. Patients with a predicted risk ! 25% according to the proposed nomogram should be considered for prophylactic use of growth factors.
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