Clinical Research Papers:

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

Rossana Berardi _, Matteo Santoni, Thomas Newsom-Davis, Miriam Caramanti, Silvia Rinaldi, Michela Tiberi, Francesca Morgese, Mariangela Torniai, Mirco Pistelli, Azzurra Onofri, Marc Bower and Stefano Cascinu

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Oncotarget. 2017; 8:23871-23879. https://doi.org/10.18632/oncotarget.13372

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Rossana Berardi1, Matteo Santoni1, Thomas Newsom-Davis2, Miriam Caramanti1, Silvia Rinaldi1, Michela Tiberi1, Francesca Morgese1, Mariangela Torniai1, Mirco Pistelli1, Azzurra Onofri1, Marc Bower2 and Stefano Cascinu1,3

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


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 non-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.

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