Department of Health Sciences, Section of Clinical Pharmacology and Oncology, University of Firenze, Firenze, Italy.
Medical Oncology Unit, Ospedale San Paolo, Savona, Italy.
Front Immunol. 2024 Jul 5;15:1361010. doi: 10.3389/fimmu.2024.1361010. eCollection 2024.
Immune-checkpoint inhibitors (ICIs) have significantly improved metastatic renal cell carcinoma (mRCC) prognosis, although their efficacy in patients with bone metastases (BMs) remains poorly understood. We investigated the prognostic role of natremia in pretreated RCC patients with BMs receiving immunotherapy.
This retrospective multicenter study included RCC patients with BMs receiving nivolumab as second-line therapy or beyond. Inclusion criteria involved baseline sodium levels (pre-ICI) and sodium levels after 4 weeks of nivolumab initiation (post-ICI). The population was divided into two groups based on the median value, and response rates, progression-free survival (PFS), and overall survival (OS) were assessed.
Among 120 eligible patients, those with pre-treatment sodium levels ≥140 mEq/L showed longer OS (18.7 12.0 months, p=0.04). Pre-treatment sodium levels ≥140 mEq/L were associated with better OS compared to levels <140 mE/L (18.7 12.0, p=0.04). Post-treatment sodium levels ≥140 mEq/L were associated with improved PFS (9.6 . 3.2 months) and OS (25.1 8.8 months) (p=0.05 and p<0.01, respectively). Patients with consistent sodium levels ≥140 mEq/L at both time points exhibited the best outcomes compared to those with lower values (PFS 11.5 3.3 months and OS 42.2 9.0 months, respectively, p<0.01). Disease control rate was significantly higher in the latter group (p<0.01). Multivariate analysis confirmed the prognostic significance of sodium levels.
Elevated sodium levels (≥140 mEq/L) pre- and post-ICI treatment correlate with better survival outcomes in mRCC patients with BMs. This finding suggests sodium level assessment as a potential prognostic factor in these patients and warrants further investigation, particularly in combination immunotherapy settings.
免疫检查点抑制剂（ICIs）显著改善了转移性肾细胞癌（mRCC）的预后，尽管它们在骨转移（BMs）患者中的疗效仍知之甚少。我们研究了 pretreated RCC 患者在接受免疫治疗时的钠水平对预后的影响。
这是一项回顾性多中心研究，纳入了接受纳武单抗二线或以上治疗的伴有 BMs 的 RCC 患者。纳入标准包括基线钠水平（ICI 前）和纳武单抗治疗 4 周后的钠水平（ICI 后）。根据中位数将人群分为两组，并评估反应率、无进展生存期（PFS）和总生存期（OS）。
在 120 名符合条件的患者中，治疗前钠水平≥140 mEq/L 的患者 OS 更长（18.7 12.0 个月，p=0.04）。治疗前钠水平≥140 mEq/L 与<140 mEq/L 相比，OS 更好（18.7 12.0，p=0.04）。治疗后钠水平≥140 mEq/L 与改善的 PFS（9.6. 3.2 个月）和 OS（25.1 8.8 个月）相关（p=0.05 和 p<0.01）。与较低水平的患者相比，两个时间点均保持钠水平≥140 mEq/L 的患者结局最佳（PFS 分别为 11.5 3.3 个月和 OS 分别为 42.2 9.0 个月，p<0.01）。后者疾病控制率显著更高（p<0.01）。多变量分析证实了钠水平的预后意义。
ICI 治疗前和后升高的钠水平（≥140 mEq/L）与伴有 BMs 的 mRCC 患者的生存结局改善相关。这一发现提示钠水平评估可能成为这些患者的潜在预后因素，值得进一步研究，特别是在联合免疫治疗环境中。
