Author + information
- Received February 2, 2020
- Revision received March 11, 2020
- Accepted March 12, 2020
- Published online May 4, 2020.
- Ibrahim Sultan, MDa,b,∗∗ (, )@IbrahimSultanMD,
- Valentino Bianco, DO, MPHa,∗,
- Andreas Habertheuer, MD, PhDa,
- Arman Kilic, MDa,b,
- Thomas G. Gleason, MDa,b,
- Edgar Aranda-Michel, BSa,
- Matthew E. Harinstein, MDb,
- Deirdre Martinez-Meehan, BA, MPHa,
- George Arnaoutakis, MDc and
- Olugbenga Okusanya, MDa@okusanyamd
- aDepartment of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
- bHeart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
- cDepartment of Surgery, University of Florida, Gainesville, Florida
- ↵∗Address for correspondence:
Dr. Ibrahim Sultan, Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh; Center for Thoracic Aortic Disease, Heart and Vascular Institute, University of Pittsburgh Medical Center, 5200 Centre Avenue, Suite 715, Pittsburgh, Pennsylvania 15232.
Background Data on primary cardiac malignancies are limited to small single-center studies.
Objectives The aim of the current study was to provide detailed outcomes for treatment of primary cardiac malignancies from a multi-institutional database.
Methods Outcomes were acquired from the National Cancer Database for all solid primary cardiac malignancies from 2004 to 2016. The primary outcome was long-term survival. Logistic regression was used to determine factors associated with mortality.
Results A total of 100,317 cardiac tumors were identified, of which 826 (0.8%) were primary malignant tumors. After exclusion criteria, the cohort consisted of 747 patients (median age 53 years, 47.5% women). Most tumors were primary sarcomas (88.5%), the majority of which were hemangiosarcoma (40.4%). A total of 136 patients received no therapy, 113 received just chemotherapy, and 20 received just radiation. Surgery was performed in 442 (59.2%) patients including 255 patients undergoing multimodal therapy (surgery with chemotherapy, radiation, or chemoradiation). With surgery alone, 90-day mortality was 29.4%. Overall 30-day, 1-year, and 5-year survival rates were 81.2%, 45.3%, and 11.5%, respectively. The surgery group as compared with the no surgery groups had significantly better long-term survival (p < 0.0001). For stage III disease, there was a statistically significant improvement in survival with the addition of chemotherapy to surgery.
Conclusions Primary cardiac malignancies are rare cancers with dismal long-term survival despite mode of treatment. Patients who underwent surgery and those with stage III disease who received peri-operative chemotherapy had better survival compared with those who did not. However, there was likely a significant selection bias in patients chosen for surgical or medical therapy.
↵∗ Drs. Sultan and Bianco contributed equally to this work.
Dr. Sultan has received institutional research support from Atricure and Medtronic (no personal renumeration). Dr. Kilic has served on the Medical Advisory Board of Medtronic. Dr. Gleason has received institutional research support from Medtronic (no personal renumeration); and has served on the Medical Advisory Board of Abbott (minimal). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received February 2, 2020.
- Revision received March 11, 2020.
- Accepted March 12, 2020.
- 2020 American College of Cardiology Foundation
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