Department of Surgery, Methodist Hospital, Houston, Texas, USA.
Ann Thorac Surg. 2011 Mar;91(3):770-6. doi: 10.1016/j.athoracsur.2010.09.079.
In patients with primary cardiac sarcoma, the tumor's location is more important than cell type in determining patient presentation, therapy options, and outcomes. The purpose of the current study was to investigate the outcomes after right-side heart sarcoma resection.
Clinicopathologic data from patients who underwent right-side heart sarcoma resection at our institution and patients identified in a literature search were examined. Morbidity and the 30-day mortality rate and survival were determined. We used univariate and multivariate analyses to identify independent predictors of overall survival.
We identified 57 patients who underwent right-side heart sarcoma resection. Right-side heart failure was the most common complication (4 patients, 19%), and the 30-day mortality was 14% (3 patients). The overall 5-year survival rate was 17%, and the median overall survival duration was 9 months. Multivariate analyses revealed that surgical margin status was the only independent predictor of survival. Patients with negative surgical margins had a longer median overall survival duration (27 months versus 4 months) and a significantly higher overall 5-year survival rate (36% versus 0%; p = 0.0003) than patients with positive surgical margins.
The patients with right-side heart sarcoma resection had worse survival after resection than that reported for our patients who underwent resection for left-side heart sarcoma or pulmonary artery sarcoma. Because positive surgical margin status is an independent predictor of reduced survival, induction chemotherapy should considered to enhance resectability in right-side heart sarcoma patients, thus maximizing the possibility of obtaining negative surgical margins.
在原发性心脏肉瘤患者中，肿瘤位置比细胞类型更能决定患者的表现、治疗选择和预后。本研究的目的是探讨右心肉瘤切除后的结果。
检查了在我院接受右心肉瘤切除术的患者和文献检索中确定的患者的临床病理数据。确定了发病率、30 天死亡率和生存率。我们使用单变量和多变量分析来确定总生存率的独立预测因素。
我们确定了 57 例接受右心肉瘤切除术的患者。右心衰竭是最常见的并发症（4 例，19%），30 天死亡率为 14%（3 例）。总 5 年生存率为 17%，中位总生存时间为 9 个月。多变量分析显示手术切缘状态是唯一的生存预测因素。切缘阴性的患者中位总生存时间更长（27 个月比 4 个月），总 5 年生存率显著更高（36%比 0%；p = 0.0003）。
与我们接受左心肉瘤或肺动脉肉瘤切除术的患者相比，接受右心肉瘤切除术的患者切除后生存率更差。由于阳性手术切缘状态是降低生存率的独立预测因素，因此应考虑诱导化疗以提高右心肉瘤患者的可切除性，从而最大限度地获得阴性手术切缘。
