Tamura A, Matsubara O, Yoshimura N, Kasuga T, Akagawa S, Aoki N
Department of Internal Medicine, Tokyo Medical and Dental University, Japan.
Cancer. 1992 Jul 15;70(2):437-42. doi: 10.1002/1097-0142(19920715)70:2<437::aid-cncr2820700211>3.0.co;2-l.
Although lung cancer frequently spreads to the heart, details of cardiac metastases of lung cancer have not been fully discussed. The authors attempted to elucidate the relationship between the mechanisms of cardiac metastasis and a variety of clinical manifestations caused by cardiac metastasis.
Clinical and autopsy records were reviewed in 74 autopsied cases of lung cancer. In cases with cardiac metastasis, the metastatic pathways to the heart were determined by the macroscopic examinations, and the relationship between the metastatic pathways and the clinical manifestations were studied.
Metastases to the pericardium or heart were seen in 23 cases (31%). A lymphatic metastatic pathway was detected in 18 cases (hilar lymphatic routing in 12 cases, and mediastinal lymphatic routing in 6 cases), and a hematogenous metastatic pathway was detected in 5 cases. Malignant pericardial effusion was documented in 15 of 23 cases. The metastatic pathway in 14 of 15 cases was lymphatic (hilar lymphatic routing in 10 cases, and mediastinal lymphatic routing in 4 cases). Patients showing lymphatic metastasis had higher incidence of malignant pericardial effusion than those with hematogenous metastasis (P less than 0.05). Of 23 cases of cardiac metastasis, myocardial infarction was found in 1 case, resulting from the compression of the coronary arteries by the tumor. Concurrent supraventricular arrhythmias were recorded in eight cases with cardiac metastasis. Patients with cardiac metastasis had higher incidence of arrhythmia than those without cardiac metastasis (P less than 0.05). In cases of cardiac metastasis, patients with arrhythmia were older (P less than 0.01) than those without arrhythmia.
The authors concluded that the hilar lymphatic pathway is essential for early development of malignant pericardial effusion in lung cancer and that aging and cardiac metastasis may be responsible for arrhythmia in patients with lung cancer.
尽管肺癌常转移至心脏，但肺癌心脏转移的细节尚未得到充分讨论。作者试图阐明心脏转移机制与心脏转移所致各种临床表现之间的关系。
回顾了74例肺癌尸检病例的临床和尸检记录。在发生心脏转移的病例中，通过大体检查确定心脏的转移途径，并研究转移途径与临床表现之间的关系。
23例（31%）出现心包或心脏转移。检测到18例有淋巴转移途径（12例为肺门淋巴途径，6例为纵隔淋巴途径），5例有血行转移途径。23例中有15例记录有恶性心包积液。15例中的14例转移途径为淋巴转移（10例为肺门淋巴途径，4例为纵隔淋巴途径）。发生淋巴转移的患者恶性心包积液的发生率高于血行转移患者（P<0.05）。23例心脏转移病例中，1例因肿瘤压迫冠状动脉导致心肌梗死。8例心脏转移患者记录有并发室上性心律失常。有心脏转移的患者心律失常的发生率高于无心脏转移的患者（P<0.05）。在心脏转移病例中，有心律失常的患者比没有心律失常的患者年龄更大（P<0.01）。
作者得出结论，肺门淋巴途径对于肺癌恶性心包积液的早期形成至关重要，并且衰老和心脏转移可能是肺癌患者心律失常产生的原因。
