The occurrence of hyponatremia in SCLC and the influence on prognosis: A retrospective study of 453 patients treated in a single institution in a 10-year period
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Background
In Denmark, approximately 400–500 people are diagnosed with small-cell lung cancer every year. Hyponatremia is very often seen in SCLC, and is proposed caused by the paraneoplastic syndrome SIADH. The prognostic significance of low plasma sodium (P-Na) has been found in some, but not in the majority of the published studies. This study was performed to investigate the prognostic value of hyponatremia in SCLC
Methods
Data was obtained from the patient files from all 455 patients diagnosed with SCLC and treated with chemotherapy at Odense University Hospital from January 1st 1995 to August 31st 2005. In 453 cases, data on the P-Na values at treatment start was available. A total of 402 patients were treated with carboplatin (AUC5) day 1 and etoposide 120 mg/m2 i.v. or 240 mg/m2 orally day 1–3 every 3–4 weeks to a maximum of six cycles. The remaining patients, except for one, were treated with etoposide as
Results
The basic characteristics of the evaluable patients are shown in Table 1. The median value of P-Na was 136 mEq/L. P-Na was <125 mEq/L in 47 patients (11%), between 126 and 135 mEq/L in 151 (33%), and 255 patients (56%) showed normal values of P-Na. A total of 44% of the patients presented with P-Na below the lower limit of normal (LLN, Fig. 1). Statistical significant lower values of P-Na were found in patients with extensive disease (ED) compared with limited disease (LD), although the difference
Discussion
Hyponatremia is a common phenomenon in SCLC. The value of 135 mEq/L is the LLN of P-Na, and values below that are by many defined as hyponatremia while other reserve this term for values below 130 mEq/L. In our study 44% had subnormal values at presentation, and 16% had hyponatremia defined as a value less than 130 mEq/L, and 10% had severe hyponatremia defined as a value of 125 mEq/L or below. Symptoms of moderate hyponatremia include tiredness, disorientation, headache, muscle cramps, and nausea,
Conflict of interest
None
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