Wang Qifeng, Peng Lin, Han Yongtao, Li Tao, Dai Wei, Wang Yi, Wu Lei, Wei Yang, Xie Tianpeng, Fang Qiang, Li Qiang, Lang Jinyi, Cao Bangrong
Department of Radiation Oncology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Front Oncol. 2021 Jan 21;10:555714. doi: 10.3389/fonc.2020.555714. eCollection 2020.
Low serum sodium has been associated with unfavorable outcome in several cancers. The prognostic value of serum sodium in esophageal carcinoma (EC) remains unclear. This study aimed to investigate preoperative serum sodium in association with outcome and survival benefit of adjuvant therapy for patients with EC.
Preoperative serum sodium and clinicopathological indexes were retrospectively analyzed in 2155 patients who underwent esophagectomy at Sichuan cancer hospital. Overall survival (OS) and disease-free survival (DFS) were analyzed by using Kaplan-Meier method and Cox regression. Benefit of adjuvant therapy was estimated by using Propensity Score Matching.
The incidence of hyponatremia and hypernatremia were 2% (43/2155) and 3.5% (76/2155) in treatment-naive patients. Both sodium disorders indicated unfavorable OS (hyponatremia, adjusted HR[95% CI] = 1.78[1.2-2.62]; hypernatremia, adjusted HR = 1.52[1.1-2.11]) and DFS (hyponatremia, adjusted HR[95% CI] = 1.52[1.03-2.23]; hypernatremia, adjusted HR = 1.45[1.06-1.99]). Decreased sodium concentrations within the normal range were associated with poor OS and DFS. Postoperative adjuvant therapy was associated with improved three-year OS (56.6 vs. 40%; adjusted HR = 0.55 [95% CI, 0.41-0.73]) and DFS (51.9 vs. 36.2%; adjusted HR = 0.63 [95% CI, 0.48-0.83]) versus surgery alone in patients with low serum sodium (Na < 139.6 mmol/liter), but not in other sodium subgroups. Meanwhile, serum sodium was inversely correlated with cell counts of leukocytes, neutrophils, monocytes and C-reactive protein levels.
These results suggested that low preoperative serum sodium is associated with poor outcome in EC patients, and may predict survival benefit of adjuvant therapy.
低血清钠与多种癌症的不良预后相关。血清钠在食管癌（EC）中的预后价值仍不清楚。本研究旨在调查术前血清钠与EC患者辅助治疗的结局及生存获益的关系。
回顾性分析在四川省肿瘤医院接受食管切除术的2155例患者的术前血清钠及临床病理指标。采用Kaplan-Meier法和Cox回归分析总生存期（OS）和无病生存期（DFS）。采用倾向评分匹配法评估辅助治疗的获益情况。
初治患者中低钠血症和高钠血症的发生率分别为2%（43/2155）和3.5%（76/2155）。两种钠紊乱均提示不良的OS（低钠血症，校正HR[95%CI]=1.78[1.2 - 2.62]；高钠血症，校正HR = 1.52[1.1 - 2.11]）和DFS（低钠血症，校正HR[95%CI]=1.52[1.03 - 2.23]；高钠血症，校正HR = 1.45[1.06 - 1.99]）。正常范围内血清钠浓度降低与不良的OS和DFS相关。术后辅助治疗与血清钠低（Na < 139.6 mmol/升）的患者相比单纯手术患者的三年OS（56.6%对40%；校正HR = 0.55[95%CI，0.41 - 0.73]）和DFS（51.9%对36.2%；校正HR = 0.63[95%CI，0.48 - 0.83]）改善相关，但在其他钠亚组中无此情况。同时血清钠与白细胞、中性粒细胞、单核细胞计数及C反应蛋白水平呈负相关。
这些结果提示术前血清钠低与EC患者的不良结局相关，且可能预测辅助治疗的生存获益。
