Clinical Outcome of Patients Undergoing Pericardiocentesis of Pericardial Effusion Associated with Advanced Lung Cancer

Abstract

Background: Symptomatic pericardial effusion in cancer patients poses a complex challenge to clinicians. To evaluate the clinical outcome and to determine the prognostic role of pericardial fluid cytology, we evaluated lung cancer patients with pericardial effusion. Methods: Patients with lung cancer and pericardial effusion who underwent pericardiocentesis between July 2000 and December 2003 at National Taiwan University Hospital were identified. We retrospectively analyzed the clinical outcome, echocardiography, characteristics of the pericardial effusion, and the survival difference between the pericardial effusion cytology-negative patients and the cytology-positive patients. Results: Fifty-four patients who received therapeutic pericardiocentesis were included. Forty- seven patients (87%) received a single pericardiocentesis, and 7 needed repeated pericardiocenteses. Double-balloon pericardiotomy was performed in 47 patients (87%). Seven patients received a simple pericardiocentesis. The pericardial fluid cytology examination was positive for malignant cells in 40 patients (74%) and negative in 14 patients (26%). The patients in the cytology-positive group had more concurrent malignant pleural effusion than those of the cytology-negative group (60% versus 14%; P=0.003). There was no significant difference in the biochemistry of the pericardial effusion and echocardiography between the cytology-positive and cytology-negative groups. The cytology-positive group tended toward a shorter overall survival after diagnosis of lung cancer (median 13.6 months), compared to the cytology-negative group (median 20.3 months; P=0.052). The median survival after diagnosis of pericardial effusion was 6.2 months in all patients. We analyzed the prognostic factors in 27 patients with a shorter survival (＜6.2 months) and another 27 patients with a longer survival (≥6.2 months) after the first pericardiocentesis. The period from the diagnosis of lung cancer to the noting of pericardial effusion in the patients with a survival of less than 6.2 months was longer than in those with a survival equal to or more than 6.2 months (median 2.1 months versus 0.5 months; P=0.046). Conclusion: The overall survival period after diagnosis of lung cancer tended to be shorter in the cytology-positive group. Those lung cancer patients who had a survival of less of than 6.2 months after initial pericardiocentesis may have had a delayed diagnosis of the pericardial effusion.