International Journal of Clinical Oncology

, Volume 20, Issue 2, pp 351–357 | Cite as

Hyponatremia as a powerful prognostic predictor for Japanese patients with clear cell renal cell carcinoma treated with a tyrosine kinase inhibitor

  • Junya Furukawa
  • Hideaki MiyakeEmail author
  • Yuji Kusuda
  • Masato Fujisawa
Original Article



We aimed to evaluate the prognostic significance of hyponatremia in patients with metastatic clear cell renal cell carcinoma (RCC) treated with a tyrosine kinase inhibitor (TKI).


This study included a total of 209 consecutive Japanese patients undergoing radical nephrectomy who were subsequently treated with either sunitinib or sorafenib as a first-line therapy for metastatic clear cell RCC. In this series, normal natremia and hyponatremia prior to the introduction of TKI was defined as a serum sodium level >136 and ≤136 mEq/L, respectively.


Patients were classified into 165 (78.9 %) with normal natremia and 44 (21.1 %) with hyponatremia. Progression-free survival (PFS) in the hyponatremia group (median 10.0 months) was significantly poorer than that in the normal natremia group (median 28.4 months). Overall survival (OS) in the hyponatremia group (median 20.9 months) was significantly poorer than that in the normal natremia group (median 38.5 months). Multivariate analyses identified hyponatremia, in addition to the existence of sarcomatoid components in radical nephrectomy specimens, high serum C-reactive protein levels, and low serum albumin levels, as poor prognostic factors for both PFS and OS. There were significant differences in both PFS and OS according to the number of these 4 independent risk factors that were positive (negative for any risk factors vs positive for 1 or 2 risk factors vs positive for 3 or 4 risk factors).


Hyponatremia appears to be one of the most powerful prognostic predictors in Japanese patients treated with a TKI as a first-line agent against metastatic clear cell RCC.


Renal cell carcinoma Hyponatremia Sorafenib Sunitinib 


Conflict of interest

No author has any conflict of interest.


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Copyright information

© Japan Society of Clinical Oncology 2014

Authors and Affiliations

  • Junya Furukawa
    • 1
  • Hideaki Miyake
    • 1
    Email author
  • Yuji Kusuda
    • 1
  • Masato Fujisawa
    • 1
  1. 1.Division of UrologyKobe University Graduate School of MedicineKobeJapan

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