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The prognosis of mRCC is poor, with a 5-year survival rate of https://en.wikipedia.org/wiki/Ketanserin mammalian target of rapamycin inhibitors, have revolutionized the treatment of mRCC and have largely displaced immunotherapy as the first-line standard of care.2�C4 Several prognostic factors for patients with mRCC have been identified to improve the selection of patients for the immunotherapy and molecular targeted therapy.5�C7 In previous studies, systematic inflammatory responses, such as neutrophilia, thrombocytosis and elevated CRP, were closely correlated with the prognosis of patients with mRCC. Serum sodium is an easily obtained and routinely measured plasma electrolyte, but hyponatremia is an often underdiagnosed and untreated electrolyte disturbance. In previous reports, hyponatremia has been shown to predict an adverse outcome in liver cirrhosis,8 congestive heart failure9 and community-acquired pneumonia.10 Furthermore, hyponatremia is reported to be associated with poor survival in several carcinomas, such as hepatocellular carcinoma,11 gastric cancer12 and small cell lung cancer.13 In terms of RCC, hyponatremia has been associated with poor survival in localized RCC and mRCC treated with immunotherapy.14�C16 However, there are no reports on the relationship between hyponatremia and the prognosis of mRCC treated with molecular targeted therapy. The aim of the present study was to evaluate the prognostic significance of hyponatremia in mRCC treated with molecular targeted therapy as first-line therapy. Furthermore, we assessed http://www.selleckchem.com/products/liproxstatin-1.html whether consideration of hyponatremia could improve the predictive ability of other prognostic factors including neutrophilia, platelets and CRP level. We retrospectively analyzed a database comprising 87 patients treated from April 2008 to July 2011 with sorafenib or sunitinib as first-line therapy for mRCC at Osaka University Graduate School of Medicine and its affiliated hospitals listed in the acknowledgments. The initially http://www.selleckchem.com/products/midostaurin-pkc412.html diagnosed tumors were staged according to the American Joint Committee on Cancer (2002) cancer staging classification,17 and the patients, characteristics, including laboratory findings, were evaluated at the time of drug administration according to modified MSKCC risk groups.5,18 Clinical features evaluated were age, sex, ECOG PS, hemoglobin, corrected serum calcium, serum LDH, time from diagnosis to treatment, prior nephrectomy, number of organs involved in metastasis, TNM stage, modified MSKCC risk groups, neutrophiles, platelets, eGFR,19 CRP level and the molecular targeted therapy administered. The study was approved by an institutional review board of Osaka University, which provided the necessary institutional data-sharing agreements before initiation of the study. CSS time was calculated from the date of initiation of first-line therapy until death or the date of the patient's last follow-up visit.