低钠血症与接受依维莫司治疗的转移性肾细胞癌患者预后不良相关：预后影响。
Hyponatremia associates with poor outcome in metastatic renal cell carcinoma patients treated with everolimus: prognostic impact.
机构信息
a Comprehensive Cancer Center Helsinki University Hospital , Helsinki , Finland.
b Department of Oncology , Aarhus University Hospital , Palle , Denmark.
出版信息
Acta Oncol. 2018 Nov;57(11):1580-1585. doi: 10.1080/0284186X.2018.1477256. Epub 2018 Jun 4.
BACKGROUND
The prognostication of metastatic renal cell carcinoma (mRCC) is based on Memorial Sloan Kettering Cancer Center (MSKCC) and International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) risk classifications. Research has shown that hyponatremia is associated with worse prognosis in cancer. We analyzed the association of hyponatremia and outcome in everolimus-treated mRCC patients.
PATIENTS AND METHODS
Baseline and on-treatment (≤12 weeks) sodium in 233 mRCC patients was analyzed using Kaplan-Meier, Cox regression and logistic regression. Baseline sodium was correlated with baseline thrombocyte and neutrophil values.
RESULTS
65 (28%) and 41 (18%) patients had sodium < lower limit of normal (LLN) at baseline and on-treatment, respectively. Baseline sodium < LLN was associated with shorter overall survival (OS) (6.1 vs. 10.3 months; p < .001) and progression-free survival (PFS) (2.8 vs. 3.5 months; p = .04). On-treatment sodium < LLN was associated with shorter OS (5.4 vs. 9.9 months; p < .001) and PFS (2.8 vs. 4.0 months; p < .001). In multivariate analyses adjusted for IMDC factors, baseline and on-treatment sodium < LLN were significantly associated with shorter OS (adjusted HR 1.46 (95% CI 1.04-2.05); p = .02; adjusted HR 1.80 (95% CI 1.23-2.61); p = .002; respectively). On-treatment sodium < LLN was significantly associated with progressive disease (OR 0.23 (95% CI 0.10-0.56); p = .001). A landmark analysis demonstrated that on-treatment hyponatremia was significantly associated with shorter OS and PFS (p = .01 and p = .03, respectively). On-treatment normalization of hyponatremia was associated with improved OS (unadjusted HR 0.61 (95% CI 0.35-0.98); p = .04), as compared to patients with sustained hyponatremia throughout follow-up.
CONCLUSIONS
Hyponatremia associates with poor outcome in mRCC patients treated with everolimus. On-treatment normalization of hyponatremia to normal sodium values associates with favorable outcome.
背景
转移性肾细胞癌（mRCC）的预后基于纪念斯隆凯特琳癌症中心（MSKCC）和国际转移性肾细胞癌数据库联盟（IMDC）风险分类。研究表明，低钠血症与癌症的预后较差有关。我们分析了在依维莫司治疗的 mRCC 患者中低钠血症与结局的关系。
患者和方法
使用 Kaplan-Meier、Cox 回归和 logistic 回归分析了 233 例 mRCC 患者的基线和治疗期间（≤12 周）的钠水平。基线钠与基线血小板和中性粒细胞值相关。
结果
65（28%）例和 41（18%）例患者基线和治疗期间的钠值<正常值下限（LLN）。基线时的低钠血症与总生存（OS）（6.1 个月 vs. 10.3 个月；p<0.001）和无进展生存（PFS）（2.8 个月 vs. 3.5 个月；p=0.04）较短有关。治疗期间的低钠血症与 OS（5.4 个月 vs. 9.9 个月；p<0.001）和 PFS（2.8 个月 vs. 4.0 个月；p<0.001）较短有关。在调整了 IMDC 因素的多变量分析中，基线和治疗期间的低钠血症与较短的 OS（调整后的 HR 1.46（95%CI 1.04-2.05）；p=0.02；调整后的 HR 1.80（95%CI 1.23-2.61）；p=0.002）显著相关。治疗期间的低钠血症与进展性疾病显著相关（OR 0.23（95%CI 0.10-0.56）；p=0.001）。一个里程碑分析表明，治疗期间的低钠血症与较短的 OS 和 PFS 显著相关（p=0.01 和 p=0.03）。与整个随访期间持续低钠血症的患者相比，治疗期间低钠血症正常化与 OS 改善相关（未调整的 HR 0.61（95%CI 0.35-0.98）；p=0.04）。
结论
低钠血症与依维莫司治疗的 mRCC 患者的不良结局相关。治疗期间低钠血症正常化至正常钠值与良好结局相关。
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