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Preoperative Hyponatremia And Hypocalcemia Predict Poor Prognosis In Elderly Gastric Cancer Patients

Authors Xu J, Chen X, Wang X, Zhu C, Hu Y, Yang X, Xu C, Shen X

Received 9 April 2019

Accepted for publication 29 August 2019

Published 27 September 2019 Volume 2019:11 Pages 8765—8780

DOI https://doi.org/10.2147/CMAR.S211603

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Xueqiong Zhu


Jingxuan Xu,* Xiaodong Chen,* Xiang Wang, Ce Zhu, Yuanbo Hu, Xinxin Yang, Chongyong Xu, Xian Shen

Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Chongyong Xu; Xian Shen
Department of Gastrointestinal Surgery, The Second Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, People’s Republic of China
Tel +86 0577 8800 2709
Email stony693100@163.com; shenxian5166@gmail.com

Background: Hyponatremia and hypocalcemia are common in patients with cancer, but their prognostic impact in patients who underwent gastric cancer (GC) surgery has not been investigated. Therefore, this study aimed to determine the postoperative prognostic impact of hyponatremia and hypocalcemia in patients undergoing curative gastrectomy by age group.
Materials and methods: GC patients preoperatively diagnosed with hyponatremia or hypocalcemia who underwent elective radical gastrectomy were retrospectively evaluated. The patients were divided into the elderly group (≥60 years) and the young group (<60 years), and then further based on their sodium and calcium levels. The effect of preoperative hyponatremia or hypocalcemia on postoperative complications (PCs) by age was determined using univariate and multivariate analyses. Overall survival (OS) was compared between the two groups using log rank test and Cox proportional hazards regression.
Results: Of the 842 patients evaluated, 36 (4.3%) were categorized into the younger hyponatremia group; 64 (7.6%), the elderly hyponatremia group; 48 (5.7%), the young hypocalcemia group; and 128 (15.2%), the elderly hypocalcemia group. Hyponatremia (P=0.001) and hypocalcemia (P=0.038) were independent risk factors for PCs in the elderly group. Further, hypocalcemia (hazard ratio (HR), 0.676; P=0.037) was independently associated with shorter OS.
Conclusion: Preoperative hyponatremia and hypocalcemia predict poor outcomes in the elderly, but not in young GC patients. Further, hyponatremia and hypocalcemia in elderly GC patients should be corrected in the earliest time possible to obtain better clinical outcomes.

Keywords: gastric cancer, hyponatremia, hypocalcemia, elderly patients, postoperative complications, overall survival

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