Prognostic factors affecting survival of patients with cancer-related pericardial effusion managed by surgery

Abstract

BackgroundAlthough pericardial effusion (PE) is not uncommon in patients with cancer, it may lead to cardiac tamponade, a life-threatening condition. Prompt life-saving treatment is essential, and also allows the continuation of the cancer treatment. The aim of this study was to determine the prognostic factors for survival in patients with cancer who were treated surgically for PE.MethodsWe retrospectively reviewed the medical records of 55 patients with cancer with PE between January 2003 and October 2012, who were treated with a pericardial window operation. Overall survival (OS) was estimated from the date of surgery, and patients were followed until the time of the final visit or time of death. Clinical outcomes and candidate prognostic factors were analyzed.ResultsThe median age of patients was 57 years (range 29 to 82 years), and 31 patients (56.4%) were male. The most common primary malignancy was lung cancer (65.5%), followed by breast cancer (10.9%). Fifteen patients (27.3%) developed recurrence of PE after surgery. The median OS duration was 4 months (range 0 to 39 months). Multivariate analysis found that evidence of pericardial metastasis on preoperative imaging (P = 0.029) and confirmation of malignant cells in the PE and/or pericardial tissue (P = 0.034) were associated with reduced OS.ConclusionEvidence of pericardial metastasis on preoperative imaging and cytopathologic confirmation that the PE and/or pericardial tissue are positive for malignant cells can be used to predict poor clinical outcomes in patients with cancer-related PE.

Prolonged Drainage and Intrapericardial Bleomycin Administration for Cardiac Tamponade Secondary to Cancer-Related Pericardial Effusion

“…However, the complication rate is in the order of 4.5%. 35 – 37 An equal rate of effusion control was reported also in the studies with percutaneous balloon pericardiotomy, although this technique seems to be subject to a higher rate of complications, namely pleural effusion and pneumothorax. 27 , 38 – 40 …”

Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion

“…Previous reports have stated that the presence of pericardial malignant cytology does not appear to significantly affect outcomes [8]. However, another study reported that pericardial malignant cytology can be used to predict poor clinical outcomes in patients with malignant PE [15]. Lekhakul reported that patients with either lymphoma or chronic leukemia presented better survival than those with carcinoma or sarcoma [14].…”

Advanced lung cancer presenting with malignant pericardial effusion

“…PE resulting from malignancy is uncommon as incidence is approximately 10% in autopsy patients with known malignancies 6 . Primary lung malignancy is the most common associated with PE (approximately 30%), followed by malignancy of breast (approximately 25%), leukemia, and lymphoma (approximately 15%) 6,7 . There have been reports of other malignant organ systems causing PE such as esophageal, gastric, and ovarian.…”