Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, BioMedical Park Hospital, Hsin-Chu, Taiwan.
Department of Integrated Diagnostics & Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.
ESMO Open. 2022 Feb;7(1):100354. doi: 10.1016/j.esmoop.2021.100354. Epub 2021 Dec 23.
Lung cancer with related pericardial effusion is not rare. Intervention is a crucial step for symptomatic effusion. It is unknown, however, whether the different invasive interventions for pericardial effusion result in different survival outcomes. This study analyzed the clinical characteristics and prognostic factors for patients with non-small-cell lung cancer (NSCLC) who have undergone different procedures.
From January 2006 to June 2018, we collected data from patients with NSCLC who have received invasive intervention for pericardial effusions. The patients were divided into three categories: simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy. Kaplan-Meier curve and log-rank test were used to analyze the pericardial effusion recurrence-free survival (RFS) and overall survival (OS).
A total of 244 patients were enrolled. Adenocarcinoma (83.6%) was the major NSCLC subtype. Invasive intervention, including simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy, had been carried out on 52, 170, and 22 patients, respectively. The 1-year RFS rates in simple pericardiocentesis, balloon pericardiotomy, and surgical pericardiectomy were 19.2%, 31.2%, and 31.8%, respectively (P = 0.128), and the median RFS was 1.67, 5.03, and 8.32 months, respectively (P = 0.008). There was no significant difference in OS, however, with the median OS at 1.67, 6.43, and 8.32 months, respectively (P = 0.064). According to the multivariable analysis, the gravity in pericardial fluid analysis, receiving systemic therapy after pericardial effusion, and the time period from stage IV lung cancer to the presence of pericardial effusion were independent prognostic factors for pericardial effusion RFS and OS.
Patients who have undergone simple pericardiocentesis alone for the management of NSCLC-related pericardial effusion have lower 1-year RFS rates than those who have undergone balloon pericardiotomy and surgical pericardiectomy. Therefore, balloon pericardiotomy and surgical pericardiectomy should be carried out for patients with NSCLC-related pericardial effusion if tolerable.
肺癌合并心包积液并不罕见。对于有症状的心包积液，介入治疗是关键步骤。然而，尚不清楚不同的心包积液介入治疗是否会导致不同的生存结果。本研究分析了接受不同介入程序的非小细胞肺癌（NSCLC）患者的临床特征和预后因素。
本研究从 2006 年 1 月至 2018 年 6 月收集了接受心包积液介入治疗的 NSCLC 患者的数据。患者被分为三组：单纯心包穿刺、球囊心包切开术和心包切除术。采用 Kaplan-Meier 曲线和对数秩检验分析心包积液无复发生存（RFS）和总生存（OS）。
共纳入 244 例患者。腺癌（83.6%）是主要的 NSCLC 亚型。包括单纯心包穿刺、球囊心包切开术和心包切除术在内的介入治疗分别在 52、170 和 22 例患者中进行。单纯心包穿刺、球囊心包切开术和心包切除术的 1 年 RFS 率分别为 19.2%、31.2%和 31.8%（P=0.128），中位 RFS 分别为 1.67、5.03 和 8.32 个月（P=0.008）。然而，OS 无显著差异，中位 OS 分别为 1.67、6.43 和 8.32 个月（P=0.064）。根据多变量分析，心包液分析的严重程度、心包积液后接受全身治疗以及从 IV 期肺癌到心包积液出现的时间是心包积液 RFS 和 OS 的独立预后因素。
单独接受单纯心包穿刺治疗 NSCLC 相关心包积液的患者 1 年 RFS 率低于接受球囊心包切开术和心包切除术的患者。因此，如果耐受，对于 NSCLC 相关心包积液患者应进行球囊心包切开术和心包切除术。
