https://orcid.org/0000-0002-5021-7588
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Abstract
Background: Low serum sodium affects cancer prognosis, but its impact on immunotherapy is unclear. Objective: Assessing the association of pre- and post-ICI treatment sodium levels with survival. Methods: We retrospectively analyzed patients receiving ICI in January 2012–December 2023, collecting serum sodium levels at treatment initiation and 4 weeks post-ICI, with overall survival (OS) as the primary outcome. Results: Low sodium was observed in 125 and 119 patients pre-and post-treatment respectively. Pre-ICI and post-ICI low sodium correlated with decreased OS [10.6 vs. 22.9 months (p = 0.001) and 11.6 vs. 27.2 months (p = 0.009)]. Multivariate analysis identified pre-ICI low sodium [HR: 1.685; 95% CI: 1.050–2.705; p = 0.031] as an independent risk factor for worse OS. Conclusion: Low baseline serum sodium was an independent risk factor for poor OS in patients treated with ICIs.
Plain language summary
This study explored how sodium levels impact cancer patients’ outcomes during treatment with immune checkpoint inhibitors (ICIs). We examined sodium levels before and after ICI treatment in patients with cancer. Low sodium levels both before and after treatment were associated with poorer outcomes. Specifically, patients with low sodium levels before treatment had shorter survival times compared to those with normal levels. Similarly, patients with low sodium levels after treatment had shorter survival times compared to those with normal levels. These findings suggest that low baseline sodium levels could indicate poorer outcomes in patients receiving ICIs.
TWEETABLE ABSTRACT
Our study unveils a striking finding: low pre-treatment serum sodium levels emerge as an independent predictor of worse overall survival in cancer patients undergoing immune checkpoint inhibitor (ICI) therapy. These insights could revolutionize patient selection strategies for ICI therapy. #immunotherapy #cancerresearch
Background
Immune checkpoint inhibitors (ICI) offer promising outcomes in cancer therapy, albeit with variable efficacy.
Hyponatremia, linked to increased mortality in diverse conditions, presents complexities in ICI treatment.
This study aimed to evaluate the impact of serum sodium levels on survival in ICI-treated cancer patients.
Methods
Retrospective analysis of 200 patients revealed low pre-ICI sodium levels associated with poorer overall survival (OS).
Outcomes
Post-ICI hyponatremia also correlated with inferior OS outcomes, indicating its prognostic relevance.
Multivariate analysis identified low pre-ICI sodium as an independent predictor of worse OS.
Discussion
Despite study limitations, such as its retrospective nature, findings underscore the need for further investigation into hyponatremia’s role in ICI therapy.
Conclusion
Results suggest that hyponatremia is associated with worse survival in patients receiving ICI treatment, warranting clinical attention.
Prospective studies are warranted to elucidate underlying mechanisms and refine patient selection criteria for ICI therapy.
Author contributions
All authors contributed to the study conception and design. Data collection and analysis were performed by BB Karaoğlan, E Yekedüz, EE Mocan and SC Yazgan. The first draft of the manuscript was written by BB Karaoğlan and E Yekedüz. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Financial disclosure
The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
Competing interests disclosure
The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, stock ownership or options and expert testimony.
Writing disclosure
No writing assistance was utilized in the production of this manuscript.
Ethical conduct of research
The authors state that they have obtained Ankara University clinical research ethics committee approval and have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations.