Apodaca-Cruz Angel, Villarreal-Garza Cynthia, Torres-Avila Beatriz, Torres Jorge, Meneses Abelardo, Flores-Estrada Diana, Lara-Medina Fernando, Arrieta Oscar
Department of Internal Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico.
Interact Cardiovasc Thorac Surg. 2010 Aug;11(2):154-61. doi: 10.1510/icvts.2010.232546. Epub 2010 May 26.
We retrospectively reviewed the records of 100 patients with malignant disease and symptomatic pericardial effusion initially treated with pericardiocentesis at the National Cancer Institute of Mexico between 1985 and 2009. We analyzed predictive factors for recurrence of pericardial effusion by bi- and multivariate analyses. The group comprised 74 women and 26 men. Twenty patients had developed malignant pericardial effusion at the time of primary cancer diagnosis. Recurrence rate after pericardiocentesis was 33%. Progression-free survival for pericardial effusion at one year was 59% (range, 47-71%). Median overall survival (OS) after pericardiocentesis was 40.3+/-7.9 weeks (95% Confidence interval, 24.9-55.7). The sole factor that correlated with increased progression-free survival for pericardial effusion was the presence of bloody pericardial effusion. For OS, multivariate analysis yielded that female gender and presence of pericardial effusion at time of primary malignancy diagnosis were associated with higher life expectancy. Initial pericardiocentesis can provide successful management of patients with a control rate of 67%. In spite of the high effectiveness of the primary management of pericardial effusion with pericardiocentesis in oncologic patients, it might be considered for initial treatment, especially those with poor prognosis, leaving pericardial window as a secondary strategy for recurrence.
我们回顾性分析了1985年至2009年间在墨西哥国家癌症研究所最初接受心包穿刺术治疗的100例恶性疾病合并症状性心包积液患者的记录。我们通过双变量和多变量分析来分析心包积液复发的预测因素。该组包括74名女性和26名男性。20例患者在原发性癌症诊断时已出现恶性心包积液。心包穿刺术后的复发率为33%。心包积液一年无进展生存率为59%（范围47%-71%）。心包穿刺术后的中位总生存期（OS）为40.3±7.9周（95%置信区间，24.9-55.7）。与心包积液无进展生存期增加相关的唯一因素是血性心包积液的存在。对于总生存期，多变量分析表明女性性别和原发性恶性肿瘤诊断时存在心包积液与较高的预期寿命相关。初次心包穿刺术对患者的控制率为67%，可实现成功治疗。尽管心包穿刺术对肿瘤患者心包积液的初始治疗效果显著，但对于初始治疗，尤其是预后较差的患者，可考虑将心包开窗术作为复发后的二线策略。
