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Prognostic significance of pretreatment sodium levels in patients of nonsmall cell lung cancer treated with pemetrexed-platinum doublet chemotherapy

1 Department of Clinical Pharmacology, Advanced Centre for Treatment, Education in Cancer, Tata Memorial Centre, Mumbai, Maharashtra, India
2 Department of Biostatistics, Advanced Centre for Treatment, Education in Cancer, Tata Memorial Centre, Mumbai, Maharashtra, India
3 Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Kumar Prabhash,
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

Background: Recent studies have shown pretreatment sodium level to be a predictive and prognostic marker in nonsmall cell lung cancer(NSCLC) patients treated with erlotinib. The objective of this study was to evaluate the prognostic significance of pretreatment sodium levels on progression-free survival(PFS) and overall survival(OS) in patients of NSCLC treated with pemetrexed-platinum doublet chemotherapy. Patients and Methods: Stage IIIb/IV NSCLC patients aged≥18years for whom baseline serum sodium level was available were included in this retrospective study. All patients received standard pemetrexed-cisplatin/carboplatin doublet for six cycles followed by maintenance pemetrexed till progression. Electronic medical record database of our hospital was used to retrieve demographic data, pretreatment sodium levels, and survival data. Normal serum sodium(NSS) was defined as serum sodium≥136 mEq/L, and low serum sodium(LSS) was defined as serum sodium<136 mEq/L. The impact of sodium levels on PFS and OS after adjusting other prognostic factors was estimated using Cox proportional hazard model. Results: Data were available for 257patients(male/female=182/75) with median age of 55(21–78) years. Atotal of 120(46%) patients had LSS whereas 137(54%) had NSS. Patients with NSS had significantly longer median PFS(7months vs. 6months; P<0.05) and OS(16months vs. 11months; P<0.05) compared to LSS group. Multivariate analysis showed LSS as an independent prognostic variable for poor survival(hazard ratio=2.07, 95% confidence interval=1.11–3.84). Conclusion: Pretreatment serum sodium level is an important prognostic marker in Stage IIIb/IV NSCLC patients. The simple possibility of testing coupled with low cost makes it an attractive biomarker.

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