Background and study objectives: Cardiac tamponade is a
life-threatening complication of non-small cell lung cancer (NSCLC).
Malignant pericardial effusion signifies advanced disease, but the
significance of a negative pericardial fluid cytology in patients with
advanced lung cancer is still controversial. The differential diagnosis
of cytology-negative pericardial effusion is difficult and sometimes
impossible. The purpose of this study is to determine the prognostic
role of pericardial fluid cytology in patients with NSCLC and cardiac
Design: Retrospective review of patients
with concurrent NSCLC and cardiac tamponade over a 10-year period.
Methods and results: Eighty-two patients were included in
this study. Pericardial fluid cytology was positive in 60 patients and
negative in 22 patients. The overall median survival was 74.5 days, and
1-year survival was 7.3%, with no survival difference between the two
groups (p = 0.2506). However, there was a significant survival
difference after different treatment strategies. Patients receiving
systemic chemotherapy survived longer than those receiving local
therapy (p < 0.001), and these patients, in turn, survived longer
than those receiving supportive treatment (p < 0.001).
Conclusions: When patients have concurrent advanced NSCLC
and cardiac tamponade, the most likely cause of the pericardial
effusion is the cancer itself, regardless of the results of the
cytologic examination. Our results suggest that systemic chemotherapy
might prolong survival in such patients, but further prospective,
randomized study is necessary.