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

晚期肺癌病人併發心包膜積水經心包膜穿刺引流術之預後探討

高劍虹(Chien-Hung Gow) ； 施金元(Jin-Yuan Shih) ； 余忠仁(Chong-Jen Yu) ； 楊泮池(Pan-Chyr Yang) ； 郭壽雄(Sow-Hsong Kuo)

《胸腔醫學》 20卷5期 (2005/10) Pp. 411-421

https://doi.org/10.29806/TM.200510.0008

摘要

背景：臨床醫師在處置晚期肺癌病人併發心包膜積水是相當複雜且具挑戰性的。本研究對心包膜積液之細胞學檢查呈現陽性癌細胞與陰性患者對於肺癌預後做一探討，同時分析臨床處置與各項預後因子對於病人存活之影響。
方法：本研究自西元2000年7月至西元2003年12月收集臺大醫院末期肺癌病人併發心包膜積水且接受過心包膜穿刺引流術之患者。回溯分析心包膜積液之細胞學檢查呈現陽性癌細胞與陰性病患對於臨床治療成果，心臟超音波檢查，心包膜積液之特性，以及存活之差異。
結果：總共分析54位肺癌病人接受治療性心包膜穿刺引流術，其中47位(87%)只接受一次心包膜穿刺引流，7位患者需重複施行手術，另外有47位(87%)患者接受引流後雙氣球心包膜穿刺放液術。心包膜積液之細胞學檢查發現40位患者有陽性癌細胞，14位患者則無。有較多的細胞學檢查陽性病患比陰性患者同時伴有惡性肋膜積液(60% vs 14%, P=0.003)。此兩組病患之心包膜積液生化檢查，心臟超音波檢查都沒有顯著差異。與心包膜積液細胞學檢查陰性病患比較，陽性患者在診斷肺癌後之存活時間較短（中間值13.6 vs 20.3個月，P=0.052）。所有病人在首次接受治療性心包膜穿刺引流術之存活中間值為6.2個月。我們將病患分成預後差組（首次接受治療性心包膜穿刺引流術後存活時間＜6.2個月）與預後佳組（≥6.2個月），比較兩組之預後因子，包括心包膜積液的細胞及生化檢查，心臟超音波檢查，以及診斷心包膜積液與首次接受穿刺引流術時間。結果發現從肺癌診斷後之存活時間，預後佳組病患比預後差組較長（中間值18.8 vs 8.6個月，P=0.004）；而從診斷肺癌到發現心包膜積液之間隔在預後差組病志比預後佳組較長（中間值 2.1 vs 0.5個月，P=0.046）。
結論：心包膜積液之細胞學檢查陽性惡性細胞患者在診斷肺癌後之存活時間較短。肺癌患者從診斷肺癌到發現心包膜積液之時間在首次接受治療性心包膜穿刺引流術後存活時間少於6.2個月一組之病患可能有延遲心包膜積液之診斷。

關鍵字

肺癌 ； 心包膜積液 ； 細胞學檢查

並列摘要

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.

並列關鍵字

lung cancer ； pericardial effusion ； cytology