Mudra Sarah E, Rayes Danny, Kumar Ashwin K, Li Jason Z, Njus Meredith, McGowan Kevin, Charalampous Charalampos, Kalam Kazi A, Syed Alveena, Majid Muhammad, Schleicher Mary, Agrawal Ankit, Yesilyaprak Abdullah, Klein Allan L
Department of Internal Medicine, MedStar Georgetown University Hospital, MedStar Health, Washington, DC, USA.
Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
CJC Open. 2024 May 15;6(8):967-972. doi: 10.1016/j.cjco.2024.05.003. eCollection 2024 Aug.
Malignant pericardial effusion (Eff) is often asymptomatic and has an unknown prevalence, due to its occult presentation. The condition often is identified postmortem on autopsy, and it is associated with a poor prognosis. Given the late presentation of malignant pericardial Effs, a minimal volume of literature has examined the epidemiology, clinical characteristics, and outcomes of these complex patients. We conducted a systematic review to advance present understanding of this condition.
A search of 4 databases resulted in 41 case reports meeting criteria. Inclusion criteria were being a patient aged > 18 years who presented with pericardial Eff in the setting of malignancy. Intervention was medical and/or surgical therapy, and the outcome was mortality.
For the 41 patients included, the median age was 54 years, and the majority were male patients (58%). Dyspnea was the leading symptom (90%), and cardiac tamponade was present in 78% of cases. Common cancers included lung, gastrointestinal, and renal neoplasms (59%). Pericardiocentesis occurred in 98% of cases, with a median fluid extraction volume of 1000 mL. Death occurred in 44%, primarily due to disease progression and/or metastasis.
This study presents the largest systematic review on malignancy-induced pericardial Effs to date. Notably, solid tumours, and specifically lung adenocarcinomas, are common culprits. Malignant pericardial Effs are often severe, with a majority of patients presenting with cardiac tamponade. Overall, treatment options are limited, and the associated mortality rate is high.
恶性心包积液（Eff）通常无症状，由于其隐匿性表现，其患病率尚不清楚。这种情况常在尸检时被发现，且预后较差。鉴于恶性心包积液出现较晚，仅有少量文献研究了这些复杂患者的流行病学、临床特征及预后。我们进行了一项系统评价以增进对该疾病的当前认识。
对4个数据库进行检索，得到41篇符合标准的病例报告。纳入标准为年龄大于18岁且在恶性肿瘤背景下出现心包积液的患者。干预措施为内科和/或外科治疗，结局为死亡率。
纳入的41例患者中，中位年龄为54岁，大多数为男性患者（58%）。呼吸困难是主要症状（90%），78%的病例存在心脏压塞。常见癌症包括肺癌、胃肠道癌和肾癌（59%）。98%的病例进行了心包穿刺术，中位抽液量为1000 mL。44%的患者死亡，主要原因是疾病进展和/或转移。
本研究是迄今为止关于恶性肿瘤所致心包积液的最大规模系统评价。值得注意的是，实体瘤，尤其是肺腺癌，是常见病因。恶性心包积液通常较为严重，大多数患者存在心脏压塞。总体而言，治疗选择有限，相关死亡率较高。
