Toward Optimized Platinum Therapy: A Risk Prediction Model for Toxicity Based on Platinum Accumulation and Its Impact...

Platinum-based chemotherapeutic agents are fundamental in the treatment of various malignancies, yet their long-term efficacy is often compromised by cumulative toxicity. This study investigates the association between platinum accumulation and length of hospital stay (LOS), and develops a predictive tool to optimize individualized platinum therapy.

A total of 300 cancer patients receiving platinum-based chemotherapy were enrolled. Serum platinum concentration was measured on day 21 ± 3 after drug administration. The LOS and adverse events were recorded. Mediation analysis explored underlying mechanisms, and a classification and regression tree (CART) model was constructed for risk prediction.

Elevated serum platinum concentration significantly prolonged LOS, primarily mediated through reduced red blood cell count (mediation effect accounted for 32.3%). The CART model identified serum platinum concentration > 534.40 μg/L as a key threshold and major predictor of adverse reactions, alongside age > 60.5 years, serum creatinine > 94.50 μmol/L, and use of cisplatin or carboplatin. The model demonstrated an AUC of 0.782 and accuracy of 75.7%.

A serum platinum concentration > 534.40 μg/L serves as a clinically meaningful cutoff for identifying patients at high risk of platinum‑related toxicity. The proposed decision‑tree model offers a clinically actionable framework for the early recognition of these high‑risk individuals, facilitating timely dose management and treatment optimization in clinical practice.