1 Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.
2 Medical Oncology 2, Istituto Oncologico Veneto IRCCS, Padova, Italy.
J Palliat Med. 2019 Jun;22(6):691-695. doi: 10.1089/jpm.2018.0491. Epub 2019 Mar 19.
Neoplastic pericardial effusion (NPE) is a life-threatening condition that can worsen clinical outcome in cancer patients. The optimal management of NPE has yet to be defined because randomized studies are lacking. We report a retrospective monoinstitutional experience describing characteristics, management and prognostic factors in NPE patients. We reviewed clinical, pathological, and echocardiographic features, therapeutic strategies, and outcome in NPE patients referred to our institute from August 2011 to December 2017. Twenty-nine patients with NPE from solid tumors have been identified: 21 lung, 5 breast, and 3 other cancer patients. Median age was 62 years. Most of the patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≥2 (69%) and a symptomatic NPE (69%). In 52% of patients NPE was detected at first diagnosis of metastatic disease, and in 20% of patients pericardium was the only site of metastases. Most of the patients (62%) received systemic therapy, 28% received combined locoregional and systemic therapy, and 10% received locoregional therapy alone. Median overall survival (OS) from NPE diagnosis was 3.9 months. Patients with PS ≥2 had worse OS than patients with better PS <2 (hazard ratio [HR] 3.56, IC 95% 1.19-10.65, 0.02). Older age, extrapericardial disease, and NPE at progression showed a trend of association with worse OS. Patients treated with locoregional therapy alone showed the shortest median OS ( 0.05). NPE is related to dismal prognosis. Poor PS significantly worsens survival and influences therapeutic approaches. Randomized studies are required to investigate prognostic factors and appropriate clinical management for patients with NPE.
肿瘤性心包积液（NPE）是一种危及生命的病症，可使癌症患者的临床预后恶化。由于缺乏随机研究，NPE 的最佳治疗方法尚未确定。我们报告了一项回顾性单机构经验，描述了 NPE 患者的特征、治疗方法和预后因素。我们回顾了 2011 年 8 月至 2017 年 12 月期间我院收治的 NPE 患者的临床、病理和超声心动图特征、治疗策略和结果。确定了 29 例来自实体瘤的 NPE 患者：21 例肺癌、5 例乳腺癌和 3 例其他癌症患者。中位年龄为 62 岁。大多数患者的东部合作肿瘤学组（ECOG）表现状态（PS）≥2（69%）和有症状的 NPE（69%）。在 52%的患者中，NPE 是在转移性疾病的首次诊断时发现的，在 20%的患者中，心包是唯一的转移部位。大多数患者（62%）接受了全身治疗，28%接受了联合局部和全身治疗，10%仅接受了局部治疗。从 NPE 诊断到总生存（OS）的中位时间为 3.9 个月。PS≥2 的患者的 OS 比 PS<2 的患者差（危险比[HR]3.56，95%CI 1.19-10.65，0.02）。年龄较大、心包外疾病和进展时的 NPE 与较差的 OS 呈趋势相关。单独接受局部治疗的患者中位 OS 最短（0.05）。NPE 与预后不良相关。较差的 PS 显著降低了生存率并影响了治疗方法。需要进行随机研究以调查 NPE 患者的预后因素和适当的临床管理。
