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

【摘要】目 的 探讨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。方 法 回顾性收集2019年5月至 2020年5月于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，根据患者使用免疫治疗前基线血钠水平分为低钠血症组、正常血钠组。χ2检验比较分类变量，采用Kaplan-Meier法进行生存分析并行Log - rank检验；Cox模型分析低钠血症对预后的影响程度。 结 果 两组性别、年龄、体质指数、TMN分期、ECOG PS评分、NRS2002评分、原发肿瘤、转移部位及联合用药情况均未达到统计学差异（P>0.05）；低钠血症组和正常血钠组中位总生存期为3.9个月（95%CI 2.864~5.136月）和14.967个月（95%CI 6.840~23.093个月）；中位无进展生存期分别2.933个月（95%CI 2.420~3.447个月）和7.0个月（95%CI 4.103~9.897个月）；调整原发肿瘤Log - rank检验低钠血症组和正常血钠组总生存期（P=0.026）和无进展生存期（P=0.015），差异均存在统计学意义；单因素分析血钠水平与总生存时间（HR=1.863，95% CI为1.065~3.259，P=0.029 ）和无进展生存时间（HR=2.120，95% CI 为1.200~3.744，P=0.010）均存在相关 ；纳入血钠水平、年龄、性别、原发肿瘤、TNM分期、NRS2002及ECOG PS评分的COX多因素分析结果：基线血钠水平对患者的无进展生存时间存在独立影响，低钠血症组疾病进展风险增加84.6%（HR= 1.846, 95% CI为1.020~3.339，P=0.043）；同时纳入其他不同数量的多因素模型分析，血钠水平是总生存期和无进展生存期的独立影响因素（均P<0.05）。结 论 基线低钠血症可能与卡瑞利珠单抗治疗的恶性肿瘤患者的预后相关，有必要开展大样本前瞻性研究进一步验证。

Effect of hyponatremia on survival of cancer patients treated with camrelizumab

[Abstract] Objective To investigate the effect of hyponatremia on the survival of cancer patients treated with carizumab. Methods The clinical and follow-up data of 100 patients treated with carilizumab for the first time in Zhongshan Hospital of 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, and survival analysis was performed using the Kaplan-Meier method with Log-rank test. Cox regression analysis was conducted to evaluate the impact of hyponatremia on prognosis. Results There were no statistically significant differences observed between the two groups in terms of gender, age, TNM stage, ECOG PS score, NRS2002 score, tumor type, sites of metastasis, and concurrent medication use (P > 0.05). The median overall survival in the hyponatremia group and the normal sodium group was 3.9 months (95% CI 2.864-5.136 months) and 14.967 months (95% CI 6.840-23.093 months), respectively. The median progression-free survival was 2.933 months (95% CI 2.420-3.447 months) in the hyponatremia group and 7.0 months (95% CI 4.103-9.897 months) in the normal sodium group. After adjusting for primary tumor, the Log-rank test showed statistically significant differences in both overall survival (P=0.026) and progression-free survival (P=0.015) between the hyponatremia group and the normal sodium group.Univariate analysis revealed an association between blood sodium levels and both overall survival (HR=1.863, 95% CI 1.065~3.259, P=0.029) and progression-free survival (HR=2.120, 95% CI 1.200~3.744, P=0.010). Multivariate Cox analysis, including blood sodium levels, age, gender, primary tumor, TNM stage, NRS2002, and ECOG PS score, showed that baseline blood sodium levels independently affected progression-free survival, with an 84.6% increased risk in the hyponatremia group (HR=1.846, 95% CI 1.020-3.339, P=0.043). Additionally, in various multivariate models, blood sodium levels remained independent factors for both overall survival and progression-free survival (all P<0.05). Conclusion Baseline hyponatremia may be associated with the prognosis of patients with malignant tumors treated with Carilizumab, and further validation is warranted through large-scale prospective studies.