Objective:

To investigate the association between nerve conduction study (NCS) abnormality patterns and clinical severity grading in patients with chemotherapy-induced peripheral neuropathy (CIPN).

Key Findings:

• Sural SNAP amplitude showed a strong inverse association with end-of-treatment NCI-CTCAE severity (r = −0.724, P < 0.001).
• Absolute end-of-treatment sural SNAP amplitude identified Grade ≥2 CIPN with an AUC of 0.856.
• A relative decline from baseline of ≥35% in SNAP amplitude yielded an AUC of 0.872.
• Patients requiring neurotoxicity-related dose modification had larger early sural SNAP reductions from baseline to mid-treatment compared to those without treatment change (34.8% ± 13.2% vs. 17.6% ± 11.4%, P < 0.001).
• Four electrophysiological phenotypes were identified, associated with different clinical severity and recovery trajectories.

Interpretation:

The findings support the use of serial large-fiber NCS, particularly sural SNAP amplitude and its percentage change from baseline, as objective correlates of CIPN severity and treatment tolerance.

Limitations:

• The study was retrospective and did not use NCS results to direct treatment in real time.
• The cohort represents a clinically referred population rather than an unselected chemotherapy population.

Conclusion:

The study highlights the potential of NCS as a tool for assessing CIPN severity and guiding treatment decisions.