Hyponatremia as a prognostic and predictive factor in metastatic renal cell carcinoma

• Published in: British journal of cancer Vol. 102; no. 5; pp. 867 - 872
• Main Authors: Jeppesen, A N, Jensen, H K, Donskov, F, Marcussen, N, von der Maase, H
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 02-03-2010; Nature Publishing Group
• Subjects: 631/45/321/1157; 692/53/2423; 692/699/67/589/1588/1351; 692/700/1750; Adolescent; Adult; Aged; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer Research; Carcinoma, Papillary - blood; Carcinoma, Papillary - drug therapy; Carcinoma, Papillary - pathology; Carcinoma, Renal Cell - blood; Carcinoma, Renal Cell - drug therapy; Carcinoma, Renal Cell - pathology; Cohort Studies; Cytokines; Dehydrogenases; Disease; Drug Resistance; Electrolytes; Epidemiology; Female; Follow-Up Studies; Hospitals; Humans; Hyponatremia; Hyponatremia - diagnosis; Kidney cancer; Kidney Neoplasms - blood; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidneys; Male; Medical prognosis; Medical research; Medical sciences; Metastasis; Middle Aged; Molecular Diagnostics; Molecular Medicine; Multivariate analysis; Nephrology. Urinary tract diseases; Neutrophils; Oncology; Patients; Prognosis; Retrospective Studies; Sodium; Sodium - blood; Survival analysis; Survival Rate; Tumors; Tumors of the urinary system; Young Adult; Denmark; Aarhus Denmark; mortality; predictive; sodium; renal cell carcinoma; metastatic; Kidney disease; Hydroelectrolytic balance disorder; mortality: predictive; Urinary system disease; Carcinoma; Hyponatremia; Prognosis; Mortality; Malignant tumor; Metastasis; Inorganic element; Metabolic disorder; Cancerology; Sodium; Kidney cancer; Grawitz tumor; Advanced stage; Predictive factor; Cancer
• ISSN: 0007-0920; 1532-1827
• DOI: 10.1038/sj.bjc.6605563

Background:
Low serum sodium has recently been associated with poor survival in
localised
renal cell carcinoma (RCC). We now show the prognostic effect of serum sodium in patients with
metastatic
RCC (mRCC).
Methods:
Cohort A comprised 120 consecutive patients with mRCC receiving subcutaneous, low-dose interleukin-2 and interferon-
α
. Hyponatremia was assessed in univariate and multivariate analyses. An independent cohort of another 120 patients with mRCC was used for validation (cohort B).
Results:
In cohort A, estimated 5-year survival was 15% and median survival was 15.1 months. Serum sodium ranged between 126 and 144 m
M
. Twenty-four patients (20%) had serum sodium levels below normal range (<136 m
M
). In multivariate analysis, significant independent risk factors for short survival were low serum sodium (
P
=0.014), high neutrophils (
P
=0.018), lactate dehydrogenase >1.5 upper normal level (
P
=0.002), and number of metastatic sites (+3) (
P
=0.003). In cohort B, serum sodium ranged between 128 and 146 m
M
. Seventeen patients (14%) had sodium levels below normal range. In multivariate analysis, serum sodium was validated as an independent prognostic factor (
P
=0.001). A significant association between lack of response and hyponatremia was observed in both cohorts (
P
=0.003 and
P
=0.02, respectively).
Conclusion:
Low serum sodium is a new, validated, independent prognostic, and predictive factor in patients with mRCC.