Background
Lung cancer with direct cardiac invasion (LCCI+) exerts a significant influence on the survival of patients. There is a paucity of
comparative research into the prognosis of advanced lung cancer with and without direct
cardiac invasion.
Method
In this study, 50 LCCI+ patients and 50 sex-, age-, and TNM stage-matched patients without direct cardiac
invasion (LCCI–) were retrospectively analysed. LCCI+ was defined as lung cancer directly invading the heart by penetrating mediastinum
or extending into the atrium via the pulmonary vein. The study endpoint was all-cause
death. In this study, the survival time was defined as the time from the first detection
of direct cardiac invasion to the end of the event.
Results
During a median follow-up period of 31 months, all-cause death occurred in 44 patients
(88.0%) in the LCCI+ group and in 36 patients (72.0%) in the LCCI– group; the overall survival (OS) time among patients in the LCCI+ group was significantly lower compared with those in the LCCI– group (5.0 [interquartile range (IQR), 2.0–12.0] vs 13.8 [IQR, 4.0–18.4] mo; p<0.001);
the OS rate in the LCCI+ group was significantly lower compared with patients in the LCCI– group (log-rank, p=0.0002). Multivariate Cox regression analysis showed that direct
cardiac invasion was an independent predictor of survival in patients with advanced
lung cancer (hazard ratio, 2.255; 95% confidence interval, 1.443–3.524). Further analysis
indicated that in patients with small cell lung cancer, the survival rate between
the LCCI+ group and LCCI– group was insignificant (log-rank, p=0.075; survival time: 4.0 [IQR, 2.0–11.5] vs
11.5 [IQR, 5.0–18.3] mo); in patients with non-small cell lung cancer (NSCLC), the
survival rate in the LCCI+ group was lower than that of the LCCI– group (log-rank, p=0.01; survival time: 6.0 [IQR, 3.0–13.3] vs 16.3 [IQR, 10.4–27.2]
mo).
Conclusions
Direct cardiac invasion from lung cancer was an independent prognostic factor for
survival time in patients with lung cancer. Patients with direct cardiac invasion
by NSCLC have a poorer clinical outcome than those without direct cardiac invasion.
A careful preoperative evaluation is mandatory and appropriate management of cardiac
involvement should be considered in the treatment of NSCLC.
Keywords
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Article info
Publication history
Published online: November 25, 2021
Accepted:
October 29,
2021
Received in revised form:
October 27,
2021
Received:
July 2,
2021
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ).
