文章：

化疗与免疫检查点抑制剂治疗下呼吸及胸内肿瘤患者低钠血症的时间趋势分析

Temporal Trends of Hyponatremia in Patients with Respiratory and Intrathoracic Cancers Treated with Chemotherapy and Immune Checkpoint Inhibitors

原文发布日期：26 April 2025

DOI: 10.3390/cancers17091459

类型: Article

开放获取: 是

英文摘要：

Background: Immune checkpoint inhibitors (ICIs) offer a novel approach to cancer treatment by enhancing immune responses against malignant cells. However, ICIs are associated with immune-related adverse events (irAEs), including hyponatremia, a potentially severe electrolyte disturbance. The risk of hyponatremia increases further when ICIs are combined with cisplatin, a nephrotoxic chemotherapy agent widely used in treating respiratory and intrathoracic cancers. This study investigated the incidence, severity, and temporal dynamics of hyponatremia in patients treated with ICIs alone or in combination with cisplatin. Methods: A retrospective cohort study was conducted using data from the TriNetX global health research network. Patients with respiratory or intrathoracic malignancies (n= 14,026) were divided into two groups: ICI-only (n= 7013) and ICI with cisplatin combination (n= 7013), matched using propensity scores. Hyponatremia was categorized into mild (130–134 mmol/L), moderate (125–129 mmol/L), and severe (<125 mmol/L). Temporal trends and cumulative incidence over 90 days were analyzed using Poisson regression. Results: The combination group exhibited a higher cumulative incidence of hyponatremia across all severity levels, with early-phase risk peaking within 20 days of treatment. Rate ratios for mild, moderate, and severe hyponatremia were significantly elevated in the combination group (p< 0.01). Conclusions: Hyponatremia is a significant complication in patients receiving ICIs, particularly when combined with cisplatin. Early monitoring and tailored management are essential to mitigate risks and optimize treatment outcomes.

摘要翻译： 

背景：免疫检查点抑制剂通过增强对恶性细胞的免疫应答，为癌症治疗提供了新策略。然而，该疗法可能引发免疫相关不良事件，其中低钠血症作为一种潜在严重的电解质紊乱值得关注。当免疫检查点抑制剂与顺铂（一种广泛应用于呼吸系统及胸腔内恶性肿瘤治疗的肾毒性化疗药物）联合使用时，低钠血症风险进一步增加。本研究旨在探讨单用免疫检查点抑制剂或联合顺铂治疗患者发生低钠血症的发病率、严重程度及时间动态特征。 方法：基于TriNetX全球健康研究网络数据开展回顾性队列研究。将14,026例呼吸系统或胸腔内恶性肿瘤患者通过倾向评分匹配分为两组：单用免疫检查点抑制剂组（7,013例）和免疫检查点抑制剂联合顺铂组（7,013例）。低钠血症按严重程度分为轻度（130–134 mmol/L）、中度（125–129 mmol/L）和重度（<125 mmol/L）。采用泊松回归分析90天内的时间趋势及累积发病率。 结果：联合治疗组在所有严重程度级别的低钠血症累积发病率均更高，治疗早期风险在20天内达到峰值。联合治疗组轻度、中度和重度低钠血症的发生率比显著升高（p<0.01）。 结论：低钠血症是接受免疫检查点抑制剂治疗患者的重要并发症，在联合顺铂治疗时尤为显著。早期监测和个体化管理对降低风险、优化治疗结局至关重要。

原文链接：

Temporal Trends of Hyponatremia in Patients with Respiratory and Intrathoracic Cancers Treated with Chemotherapy and Immune Checkpoint Inhibitors