Prognostic Role of Pericardial Fluid Cytology in Cardiac Tamponade Associated With Non-small Cell Lung Cancer

Background and study objectives

Cardiac tamponade is alife-threatening complication of non-small cell lung cancer (NSCLC).Malignant pericardial effusion signifies advanced disease, but thesignificance of a negative pericardial fluid cytology in patients withadvanced lung cancer is still controversial. The differential diagnosisof cytology-negative pericardial effusion is difficult and sometimesimpossible. The purpose of this study is to determine the prognosticrole of pericardial fluid cytology in patients with NSCLC and cardiactamponade.

Design

Retrospective review of patientswith concurrent NSCLC and cardiac tamponade over a 10-year period.

Methods and results

Eighty-two patients were included inthis study. Pericardial fluid cytology was positive in 60 patients and negative in 22 patients. The overall median survival was 74.5 days, and 1-year survival was 7.3%, with no survival difference between the twogroups (p = 0.2506). However, there was a significant survivaldifference after different treatment strategies. Patients receivingsystemic chemotherapy survived longer than those receiving localtherapy (p < 0.001), and these patients, in turn, survived longerthan those receiving supportive treatment (p < 0.001).

Conclusions

When patients have concurrent advanced NSCLCand cardiac tamponade, the most likely cause of the pericardialeffusion is the cancer itself, regardless of the results of thecytologic examination. Our results suggest that systemic chemotherapymight prolong survival in such patients, but further prospective, randomized study is necessary.