Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion.
BACKGROUND
Pericardial effusion (PE) is common in cancer patients, but the optimal therapeutic approach is not well defined. Percutaneous pericardiocentesis is less invasive than surgery, but its long-term effectiveness and safety have not been well documented.


OBJECTIVE
The goal of this study was to evaluate outcomes of cancer patients undergoing percutaneous pericardiocentesis for PE and assess the procedure's safety in patients with thrombocytopenia.


METHODS
Cancer patients who underwent percutaneous pericardiocentesis for PE between November 2009 and October 2014 at the MD Anderson Cancer Center were included. Procedure-related complications, effusion recurrence rate, and overall survival were analyzed.


RESULTS
Of 1,645 cancer patients referred for PE, 212 (13%) underwent percutaneous pericardiocentesis. The procedure was successful in 99% of the cases, and there were no procedure-related deaths. Four patients had major procedure-related bleeding that did not vary by platelet count <50,000/μl or ≥50,000/μl (p = 0.1281). Patients with catheter drainage for 3 to 5 days had the lowest recurrence rate (10%). Median overall survival was 143 days; older age (i.e., >65 years), lung cancer, platelet count <20,000/μl, and malignant pericardial fluid were independently associated with poor prognosis. Lung cancer patients with proven malignant effusions had a significantly shorter median 1-year survival compared with those with nonmalignant effusions (16.2% vs. 49.0%, respectively; log-rank test p = 0.0101). A similar difference in 1-year survival was not observed in patients with breast cancer (40.2% vs. 40.0%; log-rank test p = 0.4170).


CONCLUSIONS
Percutaneous pericardiocentesis with extended catheter drainage was safe and effective as the primary treatment for PE in cancer patients, including in those with thrombocytopenia. Malignant PE significantly shortened the survival outcome of patients with lung cancer but not those with breast cancer.
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Danielle
D
El Haddad
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Cezar
C
Iliescu
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Syed Wamique
SW
Yusuf
Department of Thoracic/Head & Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
William Nassib
WN
William
Department of Cardiology, The University of Texas Medical School at Houston, Houston, Texas.
Tarif H
TH
Khair
Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Juhee
J
Song
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: emouhayar@mdanderson.org.
Elie N
EN
Mouhayar
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D002173:Cancer Care Facilities; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D010490:Pericardial Effusion / Q000209:etiology / Q000401:mortality* / Q000628:therapy*; D020519:Pericardiocentesis / Q000379:methods / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013781:Texas; D013921:Thrombocytopenia / Q000150:complications / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
catheter drainage; prothrombin time; safety; thrombocytopenia