低钠血症对卡瑞利珠单抗治疗恶性肿瘤患者生存期的影响

Effect of hyponatremia on survival of cancer patients treated with camrelizumab

目的探讨低钠血症对接受卡瑞利珠单抗治疗恶性肿瘤患者生存期的影响。方法回顾性收集2019年5月至2020年5月在复旦大学附属中山医院首次进行卡瑞利珠单抗治疗的100例患者的临床和随访资料,根据患者接受免疫治疗前基线血钠水平分为低钠血症组、正常血钠组。采用χ^(2)检验比较两组分类变量;采用Kaplan-Meier法进行生存分析并行log-rank检验;采用Cox模型分析低钠血症对预后的影响程度。结果两组患者性别、年龄、体质量指数、美国东部肿瘤协作组体能状况(ECOG PS)评分、营养风险筛查2002(NRS2002)评分、原发肿瘤部位、TNM分期、转移部位数及联合用药情况差异均无统计学意义。低钠血症组和正常血钠组中位总生存期分别为3.9个月(95%CI 2.864~5.136)、14.967个月(95%CI6.840~23.093),中位无进展生存期分别为2.933个月(95%CI2.420~3.447)和7.0个月(95%CI4.103~9.897),差异均有统计学意义(P<0.05);校正原发肿瘤因素后,两组总生存期和无进展生存期差异均有统计学意义(P<0.05)。多因素Cox分析结果显示低钠血症患者死亡及疾病进展风险均增加(P<0.05);校正年龄、性别、原发肿瘤部位、TNM分期后,血钠水平仍是患者总生存期和无进展生存期的独立影响因素(P<0.05)。结论基线低钠血症可能影响接受卡瑞利珠单抗治疗的恶性肿瘤患者的预后,有必要开展大样本前瞻性研究验证。

Objective To investigate the effect of hyponatremia on the survival of cancer patients treated with camrelizumab.Methods The clinical and follow-up data of 100 patients treated with camrelizumab for the first time in Zhongshan Hospital,Fudan University from May 2019 to May 2020 were collected retrospectively,and the patients were divided into hyponatremia group and normal blood sodium group according to the blood sodium level at baseline before immunotherapy.Chi-square test was used to compare categorical variables between the two groups.Kaplan-Meier method with log-rank test was used to analyze survival of patients.Cox regression analysis was conducted to evaluate the impact of hyponatremia on prognosis.Results There were no statistically significant differences in gender,age,body mass index,Eastern Cooperative Oncology Group performance status(ECOG PS)score,nutritional risk screening 2002(NRS2002)score,tumor site,TNM stage,metastasis site number,and concurrent medication between the two groups.The median overall survival in the hyponatremia group and the normal sodium group was 3.9 months(95%CI 2.864-5.136)and 14.967 months(95%CI 6.840-23.093),respectively(P<0.05);the median progression-free survival in the hyponatremia group and the normal sodium group was 2.933 months(95%CI 2.420-3.447)and 7.0 months(95%CI 4.103-9.897),respectively(P<0.05).After adjusting for primary tumor,statistically differences were also observed in both overall survival and progression-free survival between the two groups(P<0.05).The multivariate Cox analysis showed that both the death and disease progression risks of patients with hyponatremia increased(P<0.05).After adjusting for age,gender,primary tumor site,and TNM staging,the blood sodium level remained independent influences on both overall survival and progression-free survival of patients(P<0.05).Conclusion Baseline hyponatremia may be associated with the prognosis of patients with malignant tumors treated with camrelizumab,and further validation is warranted through large-scale prospective studies.