Recurrence of pericardial effusion after different procedure modalities in patients with non-small-cell lung cancer

Abstract

Background Lung cancer with related pericardial effusion is not rare. Intervention is a crucial step for symptomatic effusion. It is unknown, however, whether the different invasive interventions for pericardial effusion result in different survival outcomes. This study analyzed the clinical characteristics and prognostic factors for patients with non-small-cell lung cancer (NSCLC) who have undergone different procedures. Methods From January 2006 to June 2018, we collected data from patients with NSCLC who have received invasive intervention for pericardial effusions. The patients were divided into three categories: simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy. Kaplan–Meier curve and log-rank test were used to analyze the pericardial effusion recurrence-free survival (RFS) and overall survival (OS). Results A total of 244 patients were enrolled. Adenocarcinoma (83.6%) was the major NSCLC subtype. Invasive intervention, including simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy, had been carried out on 52, 170, and 22 patients, respectively. The 1-year RFS rates in simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy were 19.2%, 31.2%, and 31.8%, respectively ( P = 0.128), and the median RFS was 1.67, 5.03, and 8.32 months, respectively ( P = 0.008). There was no significant difference in OS, however, with the median OS at 1.67, 6.43, and 8.32 months, respectively ( P = 0.064). According to the multivariable analysis, the gravity in pericardial fluid analysis, receiving systemic therapy after pericardial effusion, and the time period from stage IV lung cancer to the presence of pericardial effusion were independent prognostic factors for pericardial effusion RFS and OS. Conclusions Patients who have undergone simple pericardiocentesis alone for the management of NSCLC-related pericardial effusion have lower 1-year RFS rates than those who have undergone balloon pericardiotomy and surgical pericardiectomy. Therefore, balloon pericardiotomy and surgical pericardiectomy should be carried out for patients with NSCLC-related pericardial effusion if tolerable.

Malignant Pericardial Effusion Presenting as a Sequela of Lung Adenocarcinoma

“…Malignant pericardial effusions are seen in about 10% of patients diagnosed with cancer [ 5 ]. Primary malignant pericardial effusions due to myxomas, lipomas, fibrosarcoma, lymphangiomas, hemangiomas, and neurofibromas are less common than secondary malignant pericardial effusions due to metastatic disease.…”

Management of Pericardial Effusion in Patients with Solid Tumor

“…Patients treated with IR percutaneous drainage had higher rates of residual effusion and recurrence of effusion, whereas patients treated with surgical drainage had a higher rate of hemodynamic instability following intervention. In a study by Chang et al comprising 274 patients with non-small-cell lung cancer, patients treated with IR percutaneous drainage (n=52) had worse recurrence-free survival and OS, compared with patients treated with balloon pericardiotomy (n=170) and surgical drainage (n=22) 12 . Neither of these investigations specifically examined the association of PHI with survival among patients with cancer.…”

“…Previous investigators have advocated the use of surgical drainage on the basis of the observation that IR percutaneous drainage is associated with higher rates of recurrence of effusion 11–13 . 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 a study by Chang et al comprising 274 patients with non-small-cell lung cancer, patients treated with IR percutaneous drainage (n = 52) had worse recurrence-free survival and OS, compared with patients treated with balloon pericardiotomy (n = 170) and surgical drainage (n = 22). 12 Neither of these investigations specifically examined the association of PHI with survival among patients with cancer.…”

“…Previous investigators have advocated the use of surgical drainage on the basis of the observation that IR percutaneous drainage is associated with higher rates of recurrence of effusion. [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.…”