Primary cardiac tumors on the verge of oblivion: a European experience over 15 years

Abstract

Background: Primary tumors of the heart represent an exceedingly rare entity in cardiac surgery and literature regarding management and outcome is rare. The aim of this study was to translate 15 years of experience in both multimodal diagnosis and surgical treatment of one of the largest collective of patients in literature into a detailed analysis of patient prognosis, mean survival and best treatment approach.

Methods and results: All patients who underwent open-heart surgery at the Hospital of the Medical University of Vienna for primary cardiac tumor excision between 1999 and 2014 were analyzed retrospectively. Mean follow-up was 76.8 months. Descriptive statistical measurements were applied. 113 patients were identified, 71 (62.8%) female and 42 (37.2%) male patients with a mean age of 57.9 ± 16.8 years. 90.3% (n = 102) masses were benign, 9.7% (n = 11) were malignant. Complete resection was possible for 99% and for 18.2% of benign and malignant masses, respectively. 2.9% of benign tumors and 45.5% of malignant tumors relapsed. The 30-day mortality was 1.8% (n = 2). Mean survival was 187.2 ± 2.7 months and 26.2 ± 9.8 months for benign and malignant pathologies, respectively. Sarcoma patients who underwent adjuvant combination-chemotherapy or adjuvant mono-chemotherapy and radiation had a statistically significant survival advantage of 41.5 months.

Conclusion: Primary cardiac tumors remain challenging in the clinical setting. A multimodality treatment approach especially for sarcoma patients prolongs mean survival and should be regarded as the standard of care.

Figure 1

Kaplan Meier showing mean survival of all patients with benign cardiac masses. Mean survival = 187.2 ± 2.7 months.

Figure 2

(A) Mean survival for dignity matched groups (187.2 ± 2.7 months vs. 26.2 ± 9.8 months for benign versus malignant pathologies, p < 0.01). (B) Mean survival for gender matched groups with benign pathologies (188.0 ± 2.9 months versus 179.9 ± 5.1 months for female versus male gender). (C) Mean survival for gender matched groups with malignant pathologies (16.0 ± 5.1 months versus 22.5 ± 12.5 months for female versus male gender).

Figure 3

Survival in comparison to adjuvant treatment regimen matched population. Patients who were treated with adjuvant combination chemotherapy or doxorubicine and radiation had a statistically significant survival advantage (mean survival 45.7 ± 16.4 months) compared to patients who were treated with either radiation alone (4 months) or mono-chemotherapy (5 months) or who did not receive any adjuvant therapy. P < 0.05 by log rank.