Buck M, Ingle J N, Giuliani E R, Gordon J R, Therneau T M
Cancer. 1987 Jul 15;60(2):263-9. doi: 10.1002/1097-0142(19870715)60:2<263::aid-cncr2820600225>3.0.co;2-n.
Ninety patients with a history of breast cancer and pericardial effusion detected on echocardiography were identified and divided on a clinical basis into three groups. Group 1 consisted of 20 patients who had progressive metastatic breast cancer and echocardiography performed on a routine basis as a part of a clinical trial involving 38 patients. All 20 had small unexpected effusions, and only one patient developed symptomatic malignant pericardial disease late in her clinical course. Group 2 consisted of 32 patients who were without evidence of metastatic disease at the time of positive echocardiography and the etiology was considered benign in all patients. Six patients required pericardiectomy, five for severe radiation induced pericarditis and one for amyloid. No patient developed proven or suspected malignant pericardial disease. Group 3 comprised 38 patients who had known metastatic disease outside the pericardium at the time of positive echocardiography. Nineteen patients in Group 3 had histologically proven malignant involvement during life or at autopsy, and five more had suspected malignant pericardial disease. Ten patients initially were treated with pericardiectomy and 28 patients were managed with systemic therapy alone (24 patients) or with pericardiocentesis (four patients). Among the 12 patients with malignant effusion treated without surgery, proven local progression of pericardial disease occurred in six, with sudden death in two of those patients. No patient treated initially with surgery suffered progression of her pericardial disease. It was concluded that: small, clinically unsuspected pericardial effusions appear to be relatively common in women with metastatic breast cancer; no patient with clinical pericardial disease confirmed on echocardiography and no evidence of metastatic breast cancer developed malignant pericardial involvement; 50% of patients with known metastatic disease and a clinically apparent pericardial effusion had malignant pericardial disease; and nonsurgical therapy in patients with histologically proven or clinically suspected malignant pericardial effusion was associated with a high incidence of progressive pericardial disease.
90例有乳腺癌病史且经超声心动图检查发现有心包积液的患者被纳入研究，并根据临床情况分为三组。第一组有20例患者，患有进展期转移性乳腺癌，作为一项涉及38例患者的临床试验的一部分，定期进行超声心动图检查。所有20例患者均有意外的少量积液，只有1例患者在临床病程后期出现有症状的恶性心包疾病。第二组有32例患者，在超声心动图检查阳性时无转移疾病证据，所有患者的病因均被认为是良性的。6例患者需要进行心包切除术，5例是因为严重的放射性心包炎，1例是因为淀粉样变性。没有患者发生经证实或疑似的恶性心包疾病。第三组包括38例患者，在超声心动图检查阳性时已知有心包外转移疾病。第三组中有19例患者在生前或尸检时经组织学证实有恶性累及，另外5例有疑似恶性心包疾病。10例患者最初接受了心包切除术，28例患者仅接受全身治疗（24例患者）或心包穿刺术（4例患者）。在12例未接受手术治疗的恶性积液患者中，6例出现心包疾病的经证实的局部进展，其中2例患者猝死。最初接受手术治疗的患者均未出现心包疾病进展。研究得出结论：在转移性乳腺癌女性中，临床上未被怀疑的少量心包积液似乎相对常见；超声心动图检查确诊为临床心包疾病且无转移性乳腺癌证据的患者均未发生恶性心包累及；已知有转移疾病且临床上有心包积液的患者中有50%患有恶性心包疾病；组织学证实或临床怀疑为恶性心包积液的患者接受非手术治疗与心包疾病进展的高发生率相关。
