title: Survival after heart transplantation for non-metastatic primary cardiac sarcoma.
abstract: BACKGROUND
  Heart transplantation is an uncommon treatment for unresectable and non-metastatic primary cardiac sarcomas, and the role of it is unclear. This study aims to offer a survival analysis of it.
  
  
  METHODS
  This study consists of 6 patients from our institution and 40 patients identified in a literature search who underwent heart transplantation for non-metastatic primary cardiac sarcomas. Seven patients with unresectable cardiac angiosarcoma who received palliative therapies at our institution were included for comparison. All the clinicopathologic data were collected, retrospectively reviewed and statistically analyzed.
  
  
  RESULTS
  Among the 46 patients receiving heart transplantation for primary cardiac sarcomas, the overall median survival was 16 months (2-112 months). The most common histologic type receiving heart transplantation was angiosarcoma. Its median survival time after heart transplantation (n = 14) was much less than that of other histologic types (n = 31) (9 vs 36 months; P = 0.002), which means it was not different from the median survival of 8 months for patients (n = 7) receiving palliative therapies (P = 0.768). The patients with grade 2 cardiac sarcomas (n = 5) survived much longer after heart transplantations than patients with grade 3 tumors (n = 15) (mean survival: 85 vs 18 months; P = 0.006). Neoadjuvant or adjuvant chemotherapy didn't provide survival benefits after heart transplantation.
  
  
  CONCLUSIONS
  Cardiac angiosarcoma seems to be not the proper indication of heart transplantation. The role of heart transplantation in other histologic subtypes still remains undefined. Lower grade and less aggressive histologic subtypes benefit more from heart transplantation.
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China, 200032.
authors.forename: Hua
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China, 200032.
authors.forename: Shouguo
authors.initials: S
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China, 200032.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China, 200032.
authors.forename: Zhaohua
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China, 200032.
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.affiliation: Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yingyong
authors.initials: Y
authors.lastname: Hou
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China, 200032. zscswang@hotmail.com.
authors.forename: Chunsheng
authors.identifier: http://orcid.org/0000-0003-1037-4543
authors.initials: C
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006338:Heart Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016027:Heart Transplantation / Q000401:mortality*; D006394:Hemangiosarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016019:Survival Analysis
keywords: Adjuvant/neoadjuvant therapy; Cardiac tumors (primary); Outcomes (survival); Sarcoma (heart); Transplantation, heart