Clinical characteristics of malignant pericardial effusion associated with recurrence and survival

Abstract

Purpose: We evaluated clinical outcomes after drainage for malignant pericardial effusion with imminent or overt tamponade.

Materials and methods: Between August 2001 and June 2007, 100 patients underwent pericardiocentesis for malignant pericardial effusion. Adequate follow-up information on the recurrence of pericardial effusion and survival status was available for 98 patients.

Results: Recurrence of effusion occurred in 30 patients (31%), all of whom were diagnosed with adenocarcinoma. Multivariate analysis indicated that adenocarcinoma of the lung (hazard ratio [HR], 6.6; 95% confidence interval [CI], 1.9 to 22.3; p=0.003) and progressive disease despite chemotherapy (HR, 4.3; 95% CI, 1.6 to 12.0; p=0.005) were independent predictors of recurrence. Survival rates three months after pericardiocentesis differed significantly with the type of primary cancer; the rates were 73%, 18%, 90% and 30% in patients with adenocarcinoma of the lung, squamous cell carcinoma of the lung, breast cancer and other cancers, respectively.

Conclusion: Recurrence and survival of patients with malignant pericardial effusion are dependent on the type of primary cancer and response to chemotherapy. Patients with adenocarcinoma of the lung may be good candidates for surgical drainage to avoid repeated pericardiocentesis, but pericardiocentesis is considered effective as palliative management in patients with other cancers.

Keywords: Neoplasms; Pericardial effusion; Pericardiocentesis; Prognosis.

Fig. 1

Recurrences of malignant pericardial effusion. (A) Overall recurrence rates after first pericardiocentesis. (B) Recurrence rates in patients with different types of primary cancer. (C) Association between recurrence rate and response to chemotherapy. No recurrence of pericardial effusion was observed in patients with breast cancer and squamous cell carcinoma of the lung. Therefore, two lines were overlaid in (B).

Fig. 2

Survival outcomes. (A) Overall survival rate after first pericardiocentesis. (B, C) Survival rates according to the type of primary cancer (B) and response to chemotherapy (C).