Hyponatraemia is a predictor of clinical outcome for malignant pleural mesothelioma

Our plain-English summary of Hyponatraemia is a predictor of clinical outcome for malignant pleural mesothelioma, by R. Berardi, M. Caramanti, I. Fiordoliva, et al (Supportive Care in Cancer, 2015).

The study

• Authors: R. Berardi, M. Caramanti, I. Fiordoliva, F. Morgese, A. Savini, S. Rinaldi, M. Torniai, M. Tiberi, C. Ferrini, M. Castagnani, F. Rovinelli, A. Onofri, S. Cascinu
• Journal: Supportive Care in Cancer
• Published: 2015;23(3):621-6
• Cited by: 31 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: Hyponatraemia is one of the most common tumour-related electrolyte disorders. Several clinical, histological and serum factors have been found to influence prognosis, but, to date, there are no studies focusing on the prognostic role of hyponatraemia in mesothelioma. The aim of this study was to assess the prognostic role of hyponatraemia in malignant pleural mesothelioma.

Methods: We analysed 62 consecutive patients with histologically or cytologically proven advanced malignant pleural mesothelioma undergoing chemotherapy at our institution between January 2003 and September 2013.

Results: All patients received a first-line pemetrexed-based chemotherapy. A second-line chemotherapy was administered to 29 patients. The onset of hyponatraemia (serum sodium <135 mEq/L) during the treatment was significantly related to a worsened median overall survival (7.93 vs 13.48 months; p = 0.0069). The occurrence of hyponatraemia during first-line chemotherapy (cutoff 135 and 130 mEq/L) was significantly associated to a shorter median progression-free survival (p = 0.0214). Results were also similar in the subgroup receiving a second-line treatment. At the multivariate analysis, including haemoglobin and sodium level at the beginning of first-line chemotherapy, age, gender, smoking habit, job exposure and performance status, only hyponatraemia was found to be an independent factor (p = 0.029). Hyponatraemia was also found to be a predictive factor for both first-line chemotherapy, being related to poorer response to pemetrexed-based chemotherapy (p = 0.047) and second-line chemotherapy (p = 0.044).

Conclusion: Our results show that hyponatraemia might be considered a negative prognostic parameter in malignant pleural mesothelioma patients. To our knowledge, this is the first study to evaluate the association of hyponatraemia with the outcome of malignant pleural mesothelioma patients.

In plain English

This study from Ancona, Italy, examined whether low blood sodium (hyponatraemia, serum sodium below 135 mEq/L) was linked to outcomes in 62 consecutive patients with advanced malignant pleural mesothelioma between January 2003 and September 2013. All received first-line pemetrexed-based chemotherapy, and 29 also received second-line chemotherapy. Asbestos exposure was recorded in 41 patients (66.1%). Fourteen patients had hyponatraemia during treatment. One already had low sodium before chemotherapy, and the other 13 developed it after one to two cycles. Sodium status was unknown for 10 patients. Median overall survival was 7.93 months with hyponatraemia versus 13.48 months without (p=0.0069). Median progression-free survival (time until the disease worsened or the patient died) after first-line treatment was 6.16 months with normal sodium, 3.87 months with mild hyponatraemia and 2.26 months at 130 mEq/L or below (p=0.0214). A multivariate analysis included haemoglobin, starting sodium, age, sex, smoking, job exposure and performance status. In it, only hyponatraemia was an independent factor (p=0.029). The authors concluded that hyponatraemia could be considered a negative prognostic parameter in these patients. Some patient counts differ between sections.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Single-institution observational study of consecutive patients, analysing survival by sodium level (Kaplan-Meier, log-rank test, Cox multivariate model)
• Who was studied: 62 consecutive patients with histologically or cytologically proven advanced or metastatic malignant pleural mesothelioma treated with chemotherapy at a medical oncology unit in Ancona, Italy, January 2003 to September 2013. 79% were male, and the median age at diagnosis was 68.5 years.
• Exposure: The factor studied was hyponatraemia (serum sodium below 135 mEq/L) arising during chemotherapy. Asbestos exposure was recorded as an underlying risk factor in 41 of 62 patients (66.1%). No fiber types were reported.
• Main results:
  • Hyponatraemia during treatment occurred in 14 patients (22.6%). It was significantly related to worse median overall survival: 7.93 months versus 13.48 months for patients without hyponatraemia (p=0.0069).
  • Of the 14 patients with hyponatraemia, one had low sodium before chemotherapy. The other 13 developed it after 1 to 2 cycles of chemotherapy.
  • Sodium status during first-line therapy was unknown for 10 of the 62 patients (16.1%).
  • Median progression-free survival after first-line chemotherapy was 6.16 months with normal sodium, 3.87 months with sodium at or below 135 mEq/L, and 2.26 months with sodium at or below 130 mEq/L (p=0.0214).
  • In the 29 patients given second-line treatment, median progression-free survival was 3.67 months with normal sodium, 3.21 months with mild hyponatraemia and 1.51 months with severe hyponatraemia (p=0.0386).
  • The multivariate analysis included haemoglobin and sodium level at the start of first-line chemotherapy, age, gender, smoking habit, job exposure and performance status. Only hyponatraemia was an independent factor (p=0.029).
  • Hyponatraemia was related to poorer response to first-line pemetrexed-based chemotherapy (p=0.047) and to second-line chemotherapy (p=0.044).
• The authors' conclusion: The authors concluded that hyponatraemia could be considered a negative prognostic parameter in malignant pleural mesothelioma patients. They stated that further investigations are needed on the effect of treating hyponatraemia.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Mesothelioma, Chemotherapy, Pemetrexed (Alimta), Median Overall Survival, Progression-Free Survival, Multivariate Analysis.

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