Hyponatremia normalization as an independent prognostic factor in patients with advanced non-small cell lung cancer treated with first-line therapy

// Rossana Berardi 1 , Matteo Santoni 1 , Thomas Newsom-Davis 2 , Miriam Caramanti 1 , Silvia Rinaldi 1 , Michela Tiberi 1 , Francesca Morgese 1 , Mariangela Torniai 1 , Mirco Pistelli 1 , Azzurra Onofri 1 , Marc Bower 2 and Stefano Cascinu 1,3 1 Clinica di Oncologia Medica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I–GM Lancisi–G Salesi, Ancona, Italy 2 Chelsea & Westminster Hospital, London, United Kingdom 3 Oncologia Medica, Università degli studi di Modena e Reggio Emilia, Modena, Italy Correspondence to: Rossana Berardi, email: // Keywords : hyponatremia; lung cancer; platinum-base chemotherapy; prognosis; targeted therapy Received : August 11, 2016 Accepted : October 13, 2016 Published : November 15, 2016 Abstract The aim of the study was to assess, for the first time, the prognostic role of hyponatremia and sodium normalization in patients receiving first-line chemo- or targeted therapy for advanced n on-small cell lung cancer . Four hundred thirty-three patients with advanced non small cell lung cancer were treated with first line chemo- or targeted therapy between 2006 and 2015 at our institutions. Patients were stratified in two groups, with or without hyponatremia (group A and B, respectively). Progression free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier method. A Cox regression model was carried out for univariate and multivariate analyses. Sixty-nine patients (16%) presented with hyponatremia at the start of first-line therapy. The median OS was 8.78 months in Group A and 15.5 months in Group B ( p < 0.001), while the median PFS was 4.1 months and 6.3 months respectively ( p = 0.24). In Group A, median OS was significantly higher in patients who normalized their sodium levels (11.6 vs. 4.7 months, p = 0.0435). Similarly, the median PFS was significantly higher in patients who normalized their sodium levels (6.7 vs. 3.3 months, p = 0.011). At multivariate analysis, sodium normalization was an independent prognostic factor for both OS and PFS. Sodium normalization during first-line therapy is an independent prognostic factor for OS and PFS in patients with advanced lung cancer treated with first-line therapies. Frequent clinical monitoring and prompt treatment of hyponatremia should be emphasized to optimize the outcome of these patients.