Wang Tiance, Lv Zijian, Fan Runjia, Han Weidong, Mei Qian
Department of Bio-Therapeutic, the First Medical Center, Chinese PLA General Hospital, Beijing, China.
Changping Laboratory, Beijing, China.
Hum Vaccin Immunother. 2025 Dec;21(1):2535168. doi: 10.1080/21645515.2025.2535168. Epub 2025 Jul 18.
Hyponatremia, a common electrolyte imbalance in cancer patients, has frequently been disregarded in terms of its prognostic implications for immunotherapy. This study examined the prognostic implications of pre-treatment hyponatremia in patients with biliary tract cancers (BTC) undergoing immunotherapy. We retrospectively included 112 BTC patients who received immune checkpoint inhibitors (ICIs) treatment from August 2016 to December 2024, with an average follow-up period of 11.25 months. In accordance with the diagnosis of hyponatremia before the first ICIs treatment, patients were divided into two distinct groups. There were no significant differences in age (OR = 0.6, 95% CI, 0.2-1.8) or gender distribution (OR = 0.8, 95% CI, 0.3-2.4). Kaplan-Meier curves and the Mantel-Haenszel log-rank test were utilized to compare progression-free survival (PFS) and overall survival (OS) among groups. Cox and logistic regressions were employed to analyze the relationship between serum sodium levels and prognosis in 112 BTC patients, considering baseline characteristics. Patients with hyponatremia demonstrated reduced PFS (6 vs. 9 months, < .001) and OS (7.5 vs. 11.3 months, < .001*). Serum sodium was identified as an independent prognostic indicator for both PFS (HR = 4.5, 95% CI, 1.5-14.0) and OS (HR = 3.1, 95% CI, 1.2-8.3). Subgroup analysis indicated that BTC patients with hyponatremia experienced no advantage from immunotherapy regarding PFS and OS. Hyponatremia indicates unfavorable prognostic outcomes in BTC patients undergoing ICI treatment and may function as a significant prognostic biomarker.
低钠血症是癌症患者常见的电解质失衡，但其对免疫治疗的预后影响常常被忽视。本研究探讨了接受免疫治疗的胆道癌（BTC）患者治疗前低钠血症的预后意义。我们回顾性纳入了2016年8月至2024年12月期间接受免疫检查点抑制剂（ICI）治疗的112例BTC患者，平均随访时间为11.25个月。根据首次ICI治疗前低钠血症的诊断，将患者分为两个不同的组。年龄（OR = 0.6，95%CI，0.2 - 1.8）或性别分布（OR = 0.8，95%CI，0.3 - 2.4）无显著差异。采用Kaplan-Meier曲线和Mantel-Haenszel对数秩检验比较各组的无进展生存期（PFS）和总生存期（OS）。考虑基线特征，采用Cox和逻辑回归分析112例BTC患者血清钠水平与预后的关系。低钠血症患者的PFS（6个月对9个月，< 0.001）和OS（7.5个月对11.3个月，< 0.001*）降低。血清钠被确定为PFS（HR = 4.5，95%CI，1.5 - 14.0）和OS（HR = 3.1，95%CI，1.2 - 8.3）的独立预后指标。亚组分析表明，低钠血症的BTC患者在PFS和OS方面未从免疫治疗中获益。低钠血症表明接受ICI治疗的BTC患者预后不良，可能是一个重要的预后生物标志物。
