Cullinane Carey A, Paz I Benjamin, Smith David, Carter Nora, Grannis Frederic W
Division of General Oncologic Surgery, City of Hope National Medical Center, Los Angeles, CA, USA.
Chest. 2004 Apr;125(4):1328-34. doi: 10.1378/chest.125.4.1328.
Pericardial effusion in the patient with cancer presents a unique management problem. Although multiple methods of operative and nonoperative drainage of pericardial effusions have been described, surgical pericardial window remains the standard approach to long-term drainage. Selecting the patient who may benefit from an operative approach presents a difficult challenge. In the present study, we retrospectively analyzed the clinical outcome of 63 consecutive patients with malignancy who underwent surgical pericardial window for symptomatic pericardial effusion between January 1, 1990, and July 1, 2001, at City of Hope National Medical Center in order to try to determine whether the type of cancer, the presence of malignant cells in pericardial fluid, or tissue specimens or the method of surgery influenced the incidence of recurrent pericardial effusion or duration of survival.
The cohort was comprised of 15 patients with non-small cell lung cancer (NSCLC), 22 patients with breast cancer, 17 patients with hematologic malignancy, and 9 patients with other solid tumors. Pertinent clinical, laboratory, hospital stay, and outcome data including long-term follow-up were recorded. Patients were followed up until the time of last clinical follow-up or death. Univariate survival analyses were performed to determine significant clinical factors contributing to outcome.
Median follow-up was 6.6 months for the group and 8.3 months for those alive at last follow-up. Median survival rates for patients with lung, breast, hematologic, and other solid-tumor malignancies were 3.2 months, 8.8 months, 17 months, and 16.4 months, respectively. Preoperative factors that negatively correlated with survival included a diagnosis of NSCLC (p = 0.0014), the presence of a pleural effusion (p = 0.003), or positive pathologic (p = 0.02) or cytologic findings (p = 0.02).
A surgical approach to pericardial drainage is effective (< 5% failure rate) and provides an opportunity for continued therapy with the potential for relief of dyspnea and improvement in quality of life and survival in selected patients.
癌症患者的心包积液带来了独特的管理难题。尽管已经描述了多种心包积液的手术和非手术引流方法，但手术心包开窗术仍是长期引流的标准方法。选择可能从手术方法中获益的患者是一项艰巨的挑战。在本研究中，我们回顾性分析了1990年1月1日至2001年7月1日期间在希望之城国家医疗中心连续接受手术心包开窗术治疗症状性心包积液的63例恶性肿瘤患者的临床结局，以试图确定癌症类型、心包液或组织标本中恶性细胞的存在与否或手术方法是否会影响心包积液复发率或生存期。
该队列包括15例非小细胞肺癌（NSCLC）患者、22例乳腺癌患者、17例血液系统恶性肿瘤患者和9例其他实体瘤患者。记录了相关的临床、实验室、住院时间和结局数据，包括长期随访。对患者进行随访直至最后一次临床随访或死亡。进行单因素生存分析以确定影响结局的重要临床因素。
该组的中位随访时间为6.6个月，最后一次随访时仍存活患者的中位随访时间为8.3个月。肺癌、乳腺癌、血液系统和其他实体瘤恶性肿瘤患者的中位生存率分别为3.2个月、8.8个月、17个月和16.4个月。与生存呈负相关的术前因素包括NSCLC诊断（p = 0.0014）、胸腔积液的存在（p = 0.003）或病理（p = 0.02）或细胞学检查结果阳性（p = 0.02）。
心包引流的手术方法是有效的（失败率<5%），并为继续治疗提供了机会，有可能缓解呼吸困难，改善选定患者的生活质量和生存期。
