Outcomes of Octogenarians with Primary Malignant Cardiac Tumors: National Cancer Database Analysis

Rahouma, Mohamed; Baudo, Massimo; Dabsha, Anas; Dimagli, Arnaldo; Mohamed, Abdelrahman; Mick, Stephanie; Girardi, Leonard N.; Gaudino, Mario; Lorusso, Roberto

doi:10.3390/jcm11164899

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…Patients with an age > 57 experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This survival difference is in line with a previous report that analyzed age-related differences in primary malignant cardiac tumors [6]. Early (p < 0.001) and late (log-rank p < 0.001) survival outcomes were negatively impacted by increasing age.…”

Section: Discussionsupporting

confidence: 92%

“…A recent meta-analysis reported an improvement in mortality at 1 year, but no significant differences at 2, 3, 4, or 5 years between surgery only and multimodality groups [8]. Chemotherapy was identified as a protective factor for long-term mortality, while radiotherapy was not [6]. The current analysis on primary cardiac angiosarcomas suggests that chemotherapy (p = 0.425) and radiotherapy (p = 0.739) are not significantly associated with late survival with Cox regression.…”

Section: Discussionmentioning

confidence: 97%

“…Among primary malignant cardiac tumors, 95% are sarcomas of varying histologic types [4]. Primary cardiac sarcomas, which derive from endothelial cells, are generally located in the right atrium [5] and have an unfavorable prognosis [1] due to their aggressive biological behavior, which particularly impacts elderly patients [6]. Nevertheless, with the development of diagnostic and combination therapeutic approaches including surgery, chemotherapy, and radiotherapy, the survival of these patients has been improved [7].…”

Section: Introductionmentioning

confidence: 99%

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Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Rahouma,

Baudo,

Khairallah

et al. 2023

JCM

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Angiosarcoma is a rare type of soft-tissue sarcoma arising from endothelial cells. It is considered ‘high-grade’ by definition, reflecting its aggressive behavior. We sought to investigate the role of surgery in cardiac angiosarcoma, identify late mortality predictors, and identify interactions with other modalities in its treatment using a national dataset. The 2004–2017 National Cancer Database was reviewed for patients with primary cardiac angiosarcoma. Late mortality predictors were evaluated with Kaplan–Meier curves and Cox regression analysis. Surgery in primary cardiac angiosarcoma was performed in 130 patients (median age 50.5 years; female sex 36.9%). The median follow up was 72.02 months, with a median overall survival (OS) of 14.32 months. In patients treated with surgery in combination with other modalities compared with those treated with surgery alone, median OSs were 17.28 and 2.88 months, respectively (log-rank = 0.018). Older patients (age > 57 years) experienced lower OS compared to those with an age < 57 (log-rank = 0.012). This may be partially explained by the difference in treatment strategies among age groups: those with increasing age, less surgery (p = 0.037), and less chemotherapy (p < 0.001) were chosen. With multivariable Cox regression analysis, age and race other than white or black were identified to be significant independent predictors of late mortality. Cardiac angiosarcoma has poor overall survival, and our findings should further encourage the use of surgery in combination with other therapeutic modalities in treating such an aggressive disease whenever possible.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Rahouma,

Baudo,

Khairallah

et al. 2023

JCM

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“…In PMCT, age has proven to negatively impact survival outcomes of a prior analysis of the National Cancer Database ( 36 ).With increasing age, patients presented a more significant comorbidity burden compared to younger ones and were treated more conservatively. This was confirmed also in the current analysis were patients that did not receive any treatment were significantly older than the other treatment subgroups (p<0.001).…”

Section: Discussionmentioning

confidence: 99%

Geographic variation in malignant cardiac tumors and their outcomes: SEER database analysis

et al. 2023

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IntroductionPrimary malignant cardiac tumors (PMCTs) are rare. Geographical distribution has been demonstrated to affect cancer outcomes, making the reduction of geographical inequalities a major priority for cancer control agencies. Geographic survival disparities have not been reported previously for PMCT and the aim of this study is to compare the prevalence and the long-term survival rate with respect to the geographic location of PMCTs using the Surveillance, Epidemiology, and End Results (SEER) research plus data 17 registries between 2000 and 2019.MethodsThe SEER database was queried to identify geographic variation among PMCTs. We classified the included states into 4 geographical regions (Midwest, Northeast, South and West regions) based on the U.S. Census Bureau-designated regions and divisions. Different demographic and clinical variables were analyzed and compared between the four groups. Kaplan Meier curves and Cox regression were used for survival assessment.ResultsA total of 563 patients were included in our analysis. The median age was 53 years (inter-quartile range (IQR): 38 - 68 years) and included 26, 90, 101, and 346 patients from the Midwest, Northeast, South, and West regions respectively. Sarcoma represented 65.6% of the cases, followed by hematological tumors (26.2%), while mesothelioma accounted for 2.1%. Treatment analysis showed no significant differences between different regions. Median overall survival was 11, 21, 13, and 11 months for Midwest, Northeast, South and West regions respectively and 5-year overall survival was 22.2%, 25.4%, 14.9%, and 17.6% respectively. On multivariate Cox regression, significant independent predictors of late overall mortality among the entire cohort included age (Hazard Ratio [HR] 1.028), year of diagnosis (HR 0.967), sarcoma (HR 3.36), surgery (HR 0.63) and chemotherapy (HR 0.56).ConclusionPrimary malignant cardiac tumors are rare and associated with poor prognosis. Sarcoma is the most common pathological type. Younger age, recent era diagnosis, surgical resection, and chemotherapy were the independent predictors of better survival. While univariate analysis revealed that patients in the South areas had a worse survival trend compared to other areas, geographic disparity in survival was nullified in multivariate analysis.

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“…Even though many patients refuse surgery or other treatment due to their poor general condition or the presence of significant comorbidities, the available retrospective data suggest that multimodality treatment (including surgery, chemotherapy, and radiation) planned by a multidisciplinary team and patient-tailored may improve the relapse-free survival (RFS) and, in some cases, the overall survival (OS) ( 6 ). However, due to the lower incidence and the difficulty of early diagnosis of PMCTs, the data are limited and are mostly based on single center studies, multicenter studies with small sample sizes, case reports, and autopsy studies ( 7 - 11 ). Nevertheless, almost nothing is known on the mortality and survival rates of PMCTs currently, particularly in different age and treatment groups.…”

Section: Introductionmentioning

confidence: 99%

Age and treatment disparities in survival of primary malignant cardiac tumors: an analysis of over 40 years and 500 patients

Wang,

Kang,

Zhang

et al. 2023

J Thorac Dis

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Background Primary malignant cardiac tumors (PMCTs) are rare and tend to have a poor prognosis, due to their aggressive biological behavior and the inadequate expertise with the disease. This article compares the survival of patients with PMCT subtypes in the United States across age and treatment groups. Methods Data of 529 patients diagnosed with PMCTs were analyzed. Chi-squared test was used to assess signiﬁcance of the differences between proportions in demographic and tumor characteristics by age and treatment. Cox regression analysis was used to estimate survival from the Surveillance, Epidemiology, and End Results (SEER) follow-up data. Results Survival rates for PMCTs differed significantly between age groups, with patients younger than 20 years surviving significantly longer than those older than 80 years. The median survival times of all patients with PMCTs were 22.5, 11, 5, and 1 month for ages less than 20, 20–50, 51–80, and greater than 80 years, respectively (global log-rank P=0.0026). In the treatment cohort, for all tumors [hazard ratio (HR) 1.52, P<0.001], sarcomas (HR 1.83, P=0.002), and other tumors (HR 2.24, P=0.017), survival was lower in patients who did not receive treatment than in those who received only surgery. Survival after diagnosis of sarcoma was lower in patients who received radiotherapy only than in those who received surgery only (HR 1.49, P=0.046). However, there was no significant association between treatment and survival for lymphoma and mesothelioma. Conclusions This study confirms that PMCTs have limited treatment options and poor patient survival, especially for elderly patients and patients who receive no treatment. And patients with PMCTs of any age, whether treated or not, have poor survival rates. Techniques for early diagnosis and treatment may be necessary. Surgical treatment should have a higher priority for future treatment of patients with sarcomas.

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Outcomes of Octogenarians with Primary Malignant Cardiac Tumors: National Cancer Database Analysis

Cited by 4 publications

References 38 publications

Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Surgically Resected Cardiac Angiosarcoma: Survival Analysis from the National Cancer Database

Geographic variation in malignant cardiac tumors and their outcomes: SEER database analysis

Age and treatment disparities in survival of primary malignant cardiac tumors: an analysis of over 40 years and 500 patients

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