Hyponatremia as a prognostic factor in non-small cell lung cancer: a systematic review and meta-analysis

Sandfeld-Paulsen, Birgitte; Aggerholm‐Pedersen, Ninna; Winther‐Larsen, Anne

doi:10.21037/tlcr-20-877

Cited by 11 publications

(12 citation statements)

References 41 publications

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“…Indeed, it is a common electrolyte disorder in hospitalized patients ( 24 , 25 ) and a negative prognostic factor in several diseases such as liver cirrhosis, congestive heart failure, infections, and several malignancies ( 4 – 7 , 9 , 12 , 26 ). Previous evidence points to a correlation between hyponatremia and poor prognosis in different tumors, including hepatocellular carcinoma, gastric cancer, and localized or metastatic RCC ( 10 , 11 , 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Serum sodium levels have been shown to be a prognostic marker in several diseases, including congestive heart failure, liver cirrhosis, systemic infections, and malignancies ( 4 – 9 ). Hyponatremia, commonly defined as a serum sodium level lower than 135 mEq/L, is an independent prognostic factor for solid malignancies such as hepatocellular carcinoma ( 10 ), advanced small cell lung cancer ( 11 , 12 ), advanced gastric cancer ( 13 ), and localized RCC ( 14 ). In mRCC patients treated with vascular endothelium growth factor (VEGF)- and mammalian target of rapamycin (mTOR)-targeted agents, hyponatremia has been correlated with a worse prognosis ( 15 ).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic value of normal sodium levels in patients with metastatic renal cell carcinoma receiving tyrosine kinase inhibitors

Roviello

Catalano²,

Giorgi³

et al. 2022

Front. Oncol.

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BackgroundAlthough serum sodium concentration, particularly hyponatremia, has been shown to be a prognostic marker of survival in metastatic renal cell carcinoma (mRCC), the impact of normal sodium levels has not been investigated. Herein, we investigate the influence of normonatremia in mRCC patients treated with tyrosine kinase inhibitors (TKIs).Materials and methodsFor this retrospective study, the clinical and biochemical data of patients treated with first-line TKIs for mRCC were available from seven Italian cancer centers. We collected natremia levels at baseline and first evaluation after treatment excluding patients with sodium levels outside the normal range (<135 or >145 mEq/L). The remaining patients were subdivided into two groups according to the median sodium value: natremia patients with <140 mEq/L (n = 132) and baseline natremia patients with ≥140 mEq/L (n = 185). Subsequently, we analyzed the impact of sodium levels on response rate (RR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). PFS and OS were estimated through the Kaplan–Meier method, and differences between groups were examined by the log-rank test. Univariate and multivariate Cox regression analyses were applied to evaluate the prognostic factors for PFS and OS.ResultsOf the 368 patients, 317 were included in the analysis, 73.1% were men, and the median age was 67 years (range 36–89). When comparing patients with baseline natremia ≥140 mEq/L (n = 185) to patients with natremia <140 mEq/L (n = 132), the PFS was 15 vs. 10 months (p < 0.01) and the OS was 63 vs. 36 months, respectively (p = 0.02). On the first evaluation, patients with serum sodium ≥140 mEq/L had longer PFS (15 vs. 10 months, p < 0.01) and OS (70 vs. 32 months, p < 0.01) than patients with levels <140 mEq/L. Moreover, clinical outcomes showed a significant improvement in patients with natremia ≥140 mEq/L compared with patients with levels <140 mEq/L both at baseline and first evaluation: PFS was 19 vs. 11 months (p < 0.01) and OS was 70 vs. 36 months (p < 0.01), respectively.ConclusionsTo the best of our knowledge, this is the first study to investigate the impact of normonatremia in mRCC. We found that serum sodium levels <140 mEq/L at baseline and first assessment are independently associated with worse PFS and OS in mRCC patients treated with TKIs in the first-line setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prognostic value of normal sodium levels in patients with metastatic renal cell carcinoma receiving tyrosine kinase inhibitors

Roviello

Catalano²,

Giorgi³

et al. 2022

Front. Oncol.

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“…Regardless of the differences, their conclusion was similar to ours. They found that hyponatremia is a frequent electrolyte abnormality among patients with NSCLC, and it increases mortality, more pronounced if it remains uncorrected ( 65 ).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Prognostic Significance of Hyponatremia in Patients With Lung Cancer: Systematic Review and Meta-Analysis

et al. 2021

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Background: The prevalence of hyponatremia is highly variable among patients with lung cancer. However, its prevalence and prognostic significance in subgroups of patients with lung cancer have not yet been evaluated in a meta-analysis.Methods: We have registered our meta-analysis and review protocol to the PROSPERO International Prospective Register of Systematic Reviews, with the following registration number: CRD42020167013. A systematic search was done in the following sources: MEDLINE, Embase, CENTRAL, Web of Science, ClinicalTrials.gov, a WHO Global Health Library.Results: We identified a total of 8,962 potentially eligible studies, and we included 31 articles in our evaluation. The prevalence of hyponatremia in patients with lung cancer varied between 3 and 94.8% with an average of 25% without any significant differences between the following subgroups: histotype, gender, age, Eastern Cooperative Oncology Group (ECOG) state, and the extent of disease. The overall survival (OS) was significantly lower in hyponatremic compared to normonatremic patients at 10 months [RR.59 (95% CI.47–0.74), p < 0.001] and at 20 months [RR.44 (95% CI.33–0.59), p < 0.001], with worse survival rates in non-small cell lung cancer (NSCLC) [RR.27 (95% CI.12–0.44), p < 0.001] than in small cell lung cancer (SCLC) [RR.42 (95% CI.27–0.57), p < 0.001]. If hyponatremia was corrected, OS at 10 months was significantly higher than in the uncorrected hyponatremia group [RR 1.83 (95% CI 1.37–2.44), p < 0.001], but, at 20 months, no statistically significant difference could be found between these subgroups [RR 2.65 (95% CI.94–7.50), p = 0.067].Conclusions: Patients with lung cancer diagnosed with hyponatremia, especially patients with NSCLC, seem to have significantly lower survival rates than normonatremic patients. If hyponatremia remains uncorrected, the mortality rates might be even higher.

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“…In lung malignancy, hyponatremia is often recognized as a paraneoplastic SIADH in small cell lung cancer (SCLC). However, a growing body of research is shedding light on the occurrence and prognostic value of hyponatremia in non-small cell lung cancer (NSCLC) as well [7]. Ultimately, there is no definitive say whether this patient's lung malignancy was a contributor to his hyponatremia, but proper workup of the hyponatremia allowed for it to be discovered.…”

Section: Differential Diagnosismentioning

confidence: 99%

Multifactorial Hyponatremia: Don’t Miss Ruling Out Malignancy

Keirns¹,

Krautbauer²,

Zamora³

et al. 2023

Cureus

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A 62-year-old male with a history of chronic obstructive pulmonary disease (COPD), schizoaffective disorder treated with Zoloft, type 2 diabetes mellitus, and tobacco use presented with an acute on chronic hyponatremia of 120 mEq/L. He presented with only a mild headache and endorsed recently increasing his free water intake due to a cough. Labs and physical exam findings suggested a true, euvolemic hyponatremia. Polydipsia and Zoloft-induced syndrome of inappropriate antidiuretic hormone (SIADH) were determined to be likely contributors to his hyponatremia. However, given his tobacco use, further workup was done to rule out malignancy causing hyponatremia. Chest CT did ultimately suggest malignancy and further workup was recommended. With the hyponatremia treated, the patient was discharged with recommended outpatient workup. This case serves as a reminder to consider that hyponatremia may be multifactorial and even if there is a likely cause identified, malignancy should be ruled out in patients with risk factors.

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Hyponatremia as a prognostic factor in non-small cell lung cancer: a systematic review and meta-analysis

Cited by 11 publications

References 41 publications

Prognostic value of normal sodium levels in patients with metastatic renal cell carcinoma receiving tyrosine kinase inhibitors

Prognostic value of normal sodium levels in patients with metastatic renal cell carcinoma receiving tyrosine kinase inhibitors

Prevalence and Prognostic Significance of Hyponatremia in Patients With Lung Cancer: Systematic Review and Meta-Analysis

Multifactorial Hyponatremia: Don’t Miss Ruling Out Malignancy

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