Darocha Szymon, Wilk Michał, Walaszkowska-Czyż Anna, Kępski Jarosław, Mańczak Rafał, Kurzyna Marcin, Torbicki Adam, Szmit Sebastian
Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland.
Department of Clinical Oncology, European Health Centre, Otwock, Poland.
In Vivo. 2018 Mar-Apr;32(2):373-379. doi: 10.21873/invivo.11248.
Pericardial effusion is associated with high mortality in oncology. The etiology of infectious pericarditis and iatrogenic effects of previous radio-/chemotherapy may be always suspected, especially when a subsequent episode is observed.
The study included 17 hemodynamically-unstable patients with cancer due to recurrent pericardial bloody effusion after previous pericardiocentesis and analyzed survival determinants after intrapericardial chemotherapy with cisplatin.
The mortality rate was not significantly associated with the level of N-terminal pro-B type natriuretic peptide, low hemoglobin (<12 g/dl), elevated white blood cell account (>10/μl), large volume (>1500 ml) and long duration (>8 days) of pericardial drainage, cardiac arrhythmias, positive culture test results nor fever occurring during cisplatin administration. Subsequent systemic anticancer therapy was the strongest factor determining a longer survival (hazard ratio(HR)=0.31, 95% confidence interval(CI)=0.11-0.9; p=0.03).
Efficacy of rescue intrapericardial chemotherapy with cisplatin is independent of parameters of hemodynamic instability and levels of inflammatory markers in recurrent pericardial effusion.
心包积液在肿瘤学中与高死亡率相关。感染性心包炎的病因以及既往放疗/化疗的医源性影响总是值得怀疑，尤其是当观察到后续发作时。
该研究纳入了17例因先前心包穿刺术后复发性心包血性积液而导致血流动力学不稳定的癌症患者，并分析了顺铂心包内化疗后的生存决定因素。
死亡率与N末端B型利钠肽前体水平、低血红蛋白（<12 g/dl）、白细胞计数升高（>10/μl）、心包引流量大（>1500 ml）和持续时间长（>8天）、心律失常、培养试验结果阳性或顺铂给药期间出现发热均无显著相关性。后续的全身抗癌治疗是决定更长生存期的最强因素（风险比[HR]=0.31，95%置信区间[CI]=0.11 - 0.9；p = 0.03）。
顺铂心包内挽救性化疗的疗效与复发性心包积液中血流动力学不稳定参数及炎症标志物水平无关。
