Cancer treatment and research communications · 2026
Beyond hyponatremia: serum sodium below 137 mEq/L and postoperative sodium trajectory as prognostic markers in resected non-small cell lung cancer.
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Kaya Seyda Ors, Ceylan Kenan Can, Balsever Serap Yıldız, Bal Yunus Emre, Pek Yunus Emre, İlhan Fehri, Şahin Mustafa
Аннотация
BACKGROUND: Clinical hyponatremia (serum sodium <135 mEq/L) is an established adverse prognostic factor in advanced malignancies, but the prognostic significance of serum sodium within the normal range remains unclear in resected non-small cell lung cancer (NSLC). We evaluated whether preoperative serum sodium below 137 mEq/L predicts survival after curative resection.
METHODS: This retrospective cohort study included 255 patients undergoing curative resection for NSCLC (165 pN0, 90 pN2). Overall survival was the primary endpoint. Preoperative serum sodium was analyzed using Kaplan-Meier analysis and multivariable Cox regression adjusted for age, sex, histology, tumor size, platelet count, and nodal status. One-year postoperative sodium was available in 210 patients for exploratory trajectory analysis.
RESULTS: Preoperative sodium <137 mEq/L was present in 56 patients (22.0%) and was associated with shorter median survival than sodium ≥137 mEq/L (32.7 vs. 68.4 months; p = 0.007). After adjustment, sodium <137 mEq/L remained an independent predictor of poor survival (HR=2.02, 95% CI 1.34-3.04; p < 0.001). Patients with sodium 135-136 mEq/L had survival comparable to clinical hyponatremia (<135 mEq/L; p = 0.587) but significantly worse than sodium ≥137 mEq/L (p = 0.001). Exploratory trajectory analysis showed progressively worse survival from the Normal→Normal to the Low→StillLow group (p < 0.001). Postoperative sodium <137 mEq/L was also associated with worse survival in stage I disease (p = 0.017).
CONCLUSIONS: Preoperative serum sodium below 137 mEq/L is an independent prognostic marker in resected NSCLC. Exploratory postoperative sodium trajectory may provide additional prognostic information and warrants prospective external validation.
METHODS: This retrospective cohort study included 255 patients undergoing curative resection for NSCLC (165 pN0, 90 pN2). Overall survival was the primary endpoint. Preoperative serum sodium was analyzed using Kaplan-Meier analysis and multivariable Cox regression adjusted for age, sex, histology, tumor size, platelet count, and nodal status. One-year postoperative sodium was available in 210 patients for exploratory trajectory analysis.
RESULTS: Preoperative sodium <137 mEq/L was present in 56 patients (22.0%) and was associated with shorter median survival than sodium ≥137 mEq/L (32.7 vs. 68.4 months; p = 0.007). After adjustment, sodium <137 mEq/L remained an independent predictor of poor survival (HR=2.02, 95% CI 1.34-3.04; p < 0.001). Patients with sodium 135-136 mEq/L had survival comparable to clinical hyponatremia (<135 mEq/L; p = 0.587) but significantly worse than sodium ≥137 mEq/L (p = 0.001). Exploratory trajectory analysis showed progressively worse survival from the Normal→Normal to the Low→StillLow group (p < 0.001). Postoperative sodium <137 mEq/L was also associated with worse survival in stage I disease (p = 0.017).
CONCLUSIONS: Preoperative serum sodium below 137 mEq/L is an independent prognostic marker in resected NSCLC. Exploratory postoperative sodium trajectory may provide additional prognostic information and warrants prospective external validation.