Clinical Characteristics And Prognosis Analysis Of 58 Patients With Small Cell Lung Cancer And Hyponatremia

Background and objectiveAbout 15%of patients with small cell lung cancer(SCLC)are suffering with hyponatremia,which is usually caused by syndrome of normal secretion of antidiuretic hormone(SIADH).This study aims to investigate the clinical features,efficacy and prognosis of patients with small cell lung cancer and hyponatremia,and provide theoretical basis for early diagnosis,efficacy prediction and prognosis of SCLC.Methods:Retrospectively collect 58 patients(14.2%)with hyponatremia,and 92 cases were normal,totally 150 cases which met the inclusion criteria of serum sodium from January 2009 to December 2017,409 patients with SCLC admitted to the First Affiliated Hospital of Dalian Medical University.The patient's gender,age,stage,transfer site,number of metastases,presence or absence of bone metastases,presence or absence of neurological symptoms,hemoglobin levels,neutrophil percentage,serum albumin levels,serum NSE levels,chemotherapy efficacy,adverse chemotherapy effects,and serum sodium levels at the time of onset were collected.Clinical parameters such as serum sodium level during the course of the disease,post-treatment serum sodium recovery,and follow-up of patients'efficacy and survival.The objective response rate(ORR),disease control rate(DCR),overall survival(OS),1 year were compared between the hyponatremia group and the normal sodium group.The difference between the 2-year survival rate and the subgroup analysis of stage,serum sodium recovery after treatment and bone metastases.SPSS17.0 software was used for statistical analysis.The rate was compared using?~2test;single-factor survival analysis was performed using Kaplan-Meier analysis;single factor COX regression with significant difference was used for multi-factor survival analysis.P<0.05 was used as a significant criterion.Results:(1)Serum sodium levels were associated with bone metastases,NSE levels,serum albumin,and hemoglobin(P=0.028,0.013,0.037,and 0.045,respectively),and were associated with gender,age,stage,presence or absence of neurological symptoms,chemotherapy,and adverse outcomes.The response,the number of metastases,brain metastases,liver metastases,adrenal metastases and the proportion of neutrophils have nothing to do.(2)The ORR of hyponatremia group and normal sodium group were 29.31%(17/58)and 48.91%(47/92),respectively,with statistical significance(P=0.026);DCR was65.52%(38/58)and 81.52%(75/92)with statistical difference(P=0.033).(3)The longest survival time of 150 SCLC patients was 68.0 months,the shortest survival time was 1.8 months,and the median survival time(MST)was 13.7months.The MST of hyponatremia group and normal sodium group was 10.7 months and 18.9 months,respectively,with statistical significance(P=0.000).The 1-year and 2-year survival rates of the hyponatremia group were 41.38%and 10.34%,respectively,which were lower than those in the normal sodium group(76.09%and 23.9%,P=0.002and P=0.031).(4)In the subgroup analysis:In the LD group,71 patients had a median survival of 14.3months,including 21 cases of hyponatremia and 50 cases of normal serum sodium,P=0.001.The difference was statistically significant.In the ED group,79 cases had a median survival of 10.2 months,including 37 cases of hyponatremia and 42 cases of normal serum sodium,P=0.000,with statistical significance.(5)The MST of 21 patients whose blood sodium returned to normal after treatment was13.9 months,and the MST of 37 patients with repeated or persistent hyponatremia was10.2 months,with a statistical difference(P=0.033);In the above 21 patients,serum sodium returned to normal after 2-3 cycles of chemotherapy,radiotherapy,and symptomatic treatment,and the median blood sodium recovery time was 48.6 days.The MST of 16 patients with bone metastases was 8.3 months,and the MST of patients without bone metastases was 10.9 months,with statistical significance(P=0.036).(6)Univariate survival analysis showed stage,number of metastases,presence or absence of bone metastases,presence or absence of neurological symptoms,hemoglobin levels,neutrophil percentage,serum albumin levels,serum NSE levels,chemotherapy efficacy,adverse reactions to chemotherapy,and minimal blood in the course of disease.The sodium values and the recovery of serum sodium after treatment were all related to OS,while gender,age,brain,liver and adrenal metastases were not related to OS.(7)COX multivariate analysis showed that the combination of hyponatremia,extensive stage,presence or absence of bone metastases,high serum NSE level,and anemia were independent prognostic factors of SCLC.Conclusions1.Serum sodium levels are associated with bone metastases,NSE levels,serum albumin,and hemoglobin(P=0.028,0.013,0.037,and 0.045,respectively),and were associated with gender,age,stage,presence or absence of neurological symptoms,chemotherapy,and adverse outcomes.The response,the number of metastases,and the proportion of neutrophils are not related to serum sodium levels.2.Hyponatremia can be used as an independent prognostic factor for SCLC.Extensive stages,high levels of blood NSE,and anemia are poor factors that affect prognosis.3.Regardless of LD or ED,the efficacy and prognosis of hyponatremia is worse than that of normal sodium.The ED phase shows more severe hyponatremia than the LD phase and is more difficult to correct.4.The prognosis of blood sodium recovery after treatment is better than repeated or persistent hyponatremia;Patients with bone metastases had a slightly worse prognosis than those without bone metastases.5.Early diagnosis and treatment of hyponatremia of SCLC is essential to improve the efficacy and prognosis of patients.