Ahmed Talha, Mouhayar Elie, Song Juhee, Koutroumpakis Efstratios, Palaskas Nicolas L, Yusuf Syed Wamique, Lopez-Mattei Juan, Hassan Saamir A, Kim Peter, Cilingiroglu Mehmet, Marmagkiolis Konstantinos, Vaporciyan Ara A, Swisher Stephen, Deswal Anita, Iliescu Cezar
Department of Cardiology, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Front Cardiovasc Med. 2022 May 31;9:916325. doi: 10.3389/fcvm.2022.916325. eCollection 2022.
This study investigated the factors predicting survival and the recurrence of pericardial effusion (PE) requiring pericardiocentesis (PCC) in patients with cancer.
We analyzed the data of patients who underwent PCC for large PEs from 2010 to 2020 at The University of Texas MD Anderson Cancer Center. The time to the first recurrent PE requiring PCC was the interval from the index PCC with pericardial drain placement to first recurrent PE requiring drainage (either repeated PCC or a pericardial window). Univariate and multivariate Fine-Gray models accounting for the competing risk of death were used to identify predictors of recurrent PE requiring drainage. Cox regression models were used to identify predictors of death.
The study cohort included 418 patients with index PCC and pericardial drain placement, of whom 65 (16%) had recurrent PEs requiring drainage. The cumulative incidences of recurrent PE requiring drainage at 12 and 60 months were 15.0% and 15.6%, respectively. Younger age, anti-inflammatory medication use, and solid tumors were associated with an increased risk of recurrence of PE requiring drainage, and that echocardiographic evidence of tamponade at presentation and receipt of immunotherapy were associated with a decreased risk of recurrence. Factors predicting poor survival included older age, malignant effusion on cytology, non-use of anti-inflammatory agents, non-lymphoma cancers and primary lung cancer.
Among cancer patients with large PEs requiring drainage, young patients with solid tumors were more likely to experience recurrence, while elderly patients and those with lung cancer, malignant PE cytology, and non-use of anti-inflammatory agents showed worse survival.
本研究调查了癌症患者心包穿刺引流（PCC）后心包积液（PE）复发及生存的预测因素。
我们分析了2010年至2020年在德克萨斯大学MD安德森癌症中心因大量心包积液接受心包穿刺引流的患者数据。首次复发需心包穿刺引流的心包积液时间为从首次心包穿刺引流并留置心包引流管到首次复发需引流（再次心包穿刺引流或心包开窗术）的时间间隔。采用考虑死亡竞争风险的单因素和多因素Fine-Gray模型来确定需引流的心包积液复发的预测因素。采用Cox回归模型确定死亡的预测因素。
研究队列包括418例行首次心包穿刺引流并留置心包引流管的患者，其中65例（16%）出现复发性心包积液需引流。12个月和60个月时需引流的心包积液复发累积发生率分别为15.0%和15.6%。年龄较小、使用抗炎药物和实体瘤与需引流的心包积液复发风险增加相关，而超声心动图提示心包填塞及接受免疫治疗与复发风险降低相关。预测生存不良的因素包括年龄较大、细胞学检查提示恶性积液、未使用抗炎药物、非淋巴瘤癌症和原发性肺癌。
在因大量心包积液需引流的癌症患者中，年轻实体瘤患者更易复发，而老年患者以及患有肺癌、恶性心包积液细胞学检查阳性和未使用抗炎药物的患者生存较差。
