Furukawa Junya, Miyake Hideaki, Kusuda Yuji, Fujisawa Masato
Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Int J Clin Oncol. 2015 Apr;20(2):351-7. doi: 10.1007/s10147-014-0713-3. Epub 2014 Jun 4.
We aimed to evaluate the prognostic significance of hyponatremia in patients with metastatic clear cell renal cell carcinoma (RCC) treated with a tyrosine kinase inhibitor (TKI).
This study included a total of 209 consecutive Japanese patients undergoing radical nephrectomy who were subsequently treated with either sunitinib or sorafenib as a first-line therapy for metastatic clear cell RCC. In this series, normal natremia and hyponatremia prior to the introduction of TKI was defined as a serum sodium level >136 and ≤136 mEq/L, respectively.
Patients were classified into 165 (78.9 %) with normal natremia and 44 (21.1 %) with hyponatremia. Progression-free survival (PFS) in the hyponatremia group (median 10.0 months) was significantly poorer than that in the normal natremia group (median 28.4 months). Overall survival (OS) in the hyponatremia group (median 20.9 months) was significantly poorer than that in the normal natremia group (median 38.5 months). Multivariate analyses identified hyponatremia, in addition to the existence of sarcomatoid components in radical nephrectomy specimens, high serum C-reactive protein levels, and low serum albumin levels, as poor prognostic factors for both PFS and OS. There were significant differences in both PFS and OS according to the number of these 4 independent risk factors that were positive (negative for any risk factors vs positive for 1 or 2 risk factors vs positive for 3 or 4 risk factors).
Hyponatremia appears to be one of the most powerful prognostic predictors in Japanese patients treated with a TKI as a first-line agent against metastatic clear cell RCC.
我们旨在评估酪氨酸激酶抑制剂（TKI）治疗的转移性透明细胞肾细胞癌（RCC）患者低钠血症的预后意义。
本研究共纳入209例连续接受根治性肾切除术的日本患者，这些患者随后接受舒尼替尼或索拉非尼作为转移性透明细胞RCC的一线治疗。在本系列中，TKI治疗前的正常血钠和低钠血症分别定义为血清钠水平>136和≤136 mEq/L。
患者分为血钠正常组165例（78.9%）和低钠血症组44例（21.1%）。低钠血症组的无进展生存期（PFS）（中位10.0个月）显著低于血钠正常组（中位28.4个月）。低钠血症组的总生存期（OS）（中位20.9个月）显著低于血钠正常组（中位38.5个月）。多变量分析确定，除了根治性肾切除标本中存在肉瘤样成分、高血清C反应蛋白水平和低血清白蛋白水平外，低钠血症也是PFS和OS的不良预后因素。根据这4个独立危险因素为阳性的数量，PFS和OS均存在显著差异（任何危险因素为阴性 vs 阳性1或2个危险因素 vs 阳性3或4个危险因素）。
低钠血症似乎是接受TKI作为一线药物治疗转移性透明细胞RCC的日本患者中最有力的预后预测指标之一。
