Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis

Abstract

AimThis study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer.Materials and MethodsWe analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death.ResultsThe study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer.ConclusionAmong cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.

Management of Pericardial Effusion in Patients with Solid Tumor

“…[11][12][13] Definitions of recurrence vary between studies, with some reporting any re-accumulation of fluid as recurrence, regardless of whether reintervention is required. 11,13 In our cohort, rates of 30-day and 90-day reintervention (by repeat surgical drainage or repeat IR percutaneous drainage) among patients treated with IR percutaneous drainage were lower than those in published studies, 10,14 and rates of reintervention were not significantly different between surgical drainage and IR percutaneous drainage. It is plausible that the relatively short OS of our cohort of cancer patients and the deteriorating clinical condition of these patients with advanced cancer led to a reluctance among clinicians to perform reintervention unless patients are symptomatic, which may have resulted in an underestimation of the risk of re-accumulation of fluid.…”

“…The median duration of follow-up was 45 months (IQR, 21–67) for all patients. Among patients treated with surgical drainage, those with PHI had worse OS than those without PHI (median [95% confidence interval], 10 0.89 mo [0.33–2.1] vs 6.5 mo [5.0–8.9], P <0.001) (Fig. 2).…”