Department of Anesthesiology and Intensive Care Medicine, University Hospital of Cologne, Cologne, Germany.
Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
J Card Surg. 2021 Jul;36(7):2476-2485. doi: 10.1111/jocs.15538. Epub 2021 Apr 2.
Primary cardiac sarcomas (PCSs) are an extremely rare and aggressive type of malignancies that have been described only by a limited number of observational studies. This study aimed to evaluate the currently existing evidence comparing surgical to multimodality treatment of PCS.
We systematically reviewed Embase, MEDLINE, Cochrane Database, and Google Scholar, from inception to December 2020, for original articles about surgical and multimodality treatment of PCS. The outcomes included were mortality at various time points, resection margin status, and mean estimated survival. The pooled treatment effects were calculated using a random-effects model.
Ten studies including a total of 1570 patients met our inclusion criteria. Surgery was associated with significantly lower mortality when compared to conservative treatment at 1, 2, and 3 years, whereas no significant difference was found at 5 years. Furthermore, multimodality treatment showed significantly lower mortality at 1 year when compared to surgery alone, but not at 2 and 5 years. We found no difference in mortality between angiosarcomas and other PCS subtypes.
Overall, surgery was found to provide a significant mortality advantage to PCS patients up to 3 years following treatment. Multimodality treatment might be of additional benefit, although only within the first year. Prospective randomized studies are needed to further explore these differences in the treatment of PCS.
原发性心脏肉瘤（PCSs）是一种极其罕见且侵袭性的恶性肿瘤，仅通过少数观察性研究进行了描述。本研究旨在评估目前比较 PCSs 手术与多模式治疗的现有证据。
我们系统地检索了 Embase、MEDLINE、Cochrane 数据库和 Google Scholar，从建库至 2020 年 12 月，以获取关于 PCS 手术和多模式治疗的原始文章。评估的结局包括各时间点的死亡率、切缘状态和平均估计生存率。使用随机效应模型计算汇总治疗效果。
共有 10 项研究纳入了 1570 例患者，符合我们的纳入标准。与保守治疗相比，手术在 1、2 和 3 年时的死亡率明显更低，而在 5 年时无显著差异。此外，与单独手术相比，多模式治疗在 1 年时的死亡率显著降低，但在 2 年和 5 年时无差异。我们发现血管肉瘤和其他 PCS 亚型的死亡率无差异。
总体而言，手术可使 PCS 患者在治疗后 3 年内的死亡率显著降低。多模式治疗可能具有额外的益处，但仅限于治疗后的最初 1 年。需要前瞻性随机研究来进一步探讨 PCS 治疗中这些差异。
