title: Effectiveness and prognosis of initial pericardiocentesis in the primary management of malignant pericardial effusion.
abstract: We retrospectively reviewed the records of 100 patients with malignant disease and symptomatic pericardial effusion initially treated with pericardiocentesis at the National Cancer Institute of Mexico between 1985 and 2009. We analyzed predictive factors for recurrence of pericardial effusion by bi- and multivariate analyses. The group comprised 74 women and 26 men. Twenty patients had developed malignant pericardial effusion at the time of primary cancer diagnosis. Recurrence rate after pericardiocentesis was 33%. Progression-free survival for pericardial effusion at one year was 59% (range, 47-71%). Median overall survival (OS) after pericardiocentesis was 40.3+/-7.9 weeks (95% Confidence interval, 24.9-55.7). The sole factor that correlated with increased progression-free survival for pericardial effusion was the presence of bloody pericardial effusion. For OS, multivariate analysis yielded that female gender and presence of pericardial effusion at time of primary malignancy diagnosis were associated with higher life expectancy. Initial pericardiocentesis can provide successful management of patients with a control rate of 67%. In spite of the high effectiveness of the primary management of pericardial effusion with pericardiocentesis in oncologic patients, it might be considered for initial treatment, especially those with poor prognosis, leaving pericardial window as a secondary strategy for recurrence.
authors.affiliation: Department of Internal Medicine, Instituto Nacional de Cancerología, Mexico City, Mexico.
authors.forename: Angel
authors.initials: A
authors.lastname: Apodaca-Cruz
authors.forename: Cynthia
authors.initials: C
authors.lastname: Villarreal-Garza
authors.forename: Beatriz
authors.initials: B
authors.lastname: Torres-Avila
authors.forename: Jorge
authors.initials: J
authors.lastname: Torres
authors.forename: Abelardo
authors.initials: A
authors.lastname: Meneses
authors.forename: Diana
authors.initials: D
authors.lastname: Flores-Estrada
authors.forename: Fernando
authors.initials: F
authors.lastname: Lara-Medina
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000401:mortality; D010490:Pericardial Effusion / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D020519:Pericardiocentesis / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult