Clinicopathological study of cardiac tamponade due to pericardial metastasis originating from gastric cancer

Table 1 Reported cases of cardiac tamponade due to pericarditis carcinomatosa from gastric cancer.

Case	Author	Year	Sex	Age	Hist1	T	ly	v	n	Timeinterval2	Symptom	AST	ALT	ALP	LDH	CEA	CA19-9	Treat-ment3	Sur-vival4
1	Ohtomo	1982	F	33	ud	2	3	NA	NA	0	Cough	31	26	297	365	NA	NA	D	5.0
2	Koide	1984	M	67	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	D	2.0
3		1984	F	65	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	D	5.0
4	Usami	1989	F	44	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	L	1.3
5	Moriyama	1995	M	64	por	>2	NA	NA	>1	2.5 mo	Chest pain	38	11	4.2KA	832	240.1	26.7	S + L	1.5
6	Orihata	1996	M	51	sig	2	0	0	0	27.5 mo	Dyspnea	417	283	281	921	2.3	1 100	L	3.0
7	Sakusabe	1998	M	42	por	2	2	0	0	77 mo	Hypotension	25	35	142	154	0.6	2.7	L	3.5
8	Unno	1998	F	48	sig	NA	NA	NA	NA	7 mo	Dyspnea	51	56	503	235	0.7	47	L	1.5
9	Sakai	1999	M	45	sig	1	3	NA	3	0	Dyspnea	14	18	299	211	1.7	8.6	D	2.5
10	Kobayashi	2000	M	44	sig	1	2	1	2	19 mo	Dyspnea	22	94	456	216	2.5	56	S + L	5.0
11	Hiramatsu	2002	M	51	por	2	2	1	2	26 mo	Fatigue	1 224	1 087	NA	NA	3.0	27.9	S	10.0
12	Saitoh	2003	M	68	tub1	1	2	0	2	4 mo	Hypotension	NA	NA	NA	NA	12.5	238	S	2.5
13		2003	M	69	sig	2	3	3	2	50 mo	Cough	44	58	307	377	3.6	15.5	S + L	14.0
14	Sakusabe	2005	M	69	tub1	2	1	2	0	13 mo	Dyspnea	NOR	NOR	NOR	NOR	5.7		S	2.5
15	Suto	2003	F	52	sig	2	3	2	1	26 mo	Dyspnea	N	N	N	N	N	178.4	D	4.0
16		2003	M	68	tub2	3	3	2	3	32 mo	Dyspnea	N	N	N	N	41.6	894.1	D	1.0
17	Author		F	36	sig	2	2	1	2	27.5 mo	Vomit	95	152	312	272	0.76	9.78	S + L	13.0

NA: data not available, NOR: within normal range

¹Hist: Histology, ud: undifferentiated carcinoma, por: poorly differentiated adenocarcinoma, sig: signet-ring cell carcinoma, tub1: well differentiated tubular adenocarcinoma, tub2: moderately differentiated tubular adenocarcinoma

²Time interval: time interval from the diagnosis of gastric cancer to the onset of cardiac tamponade

³D: drainage only, L: local chemotherapy, S: systemic chemotherapy

⁴Survival: survival after onset of cardiac tamponade (months) Cases 11, 13 and 14 were cited from meeting proceedings.

Table 2 Clinicopathological analysis of cardiac tamponade due to PC from GC

Male:female	11:06
Mean age (yr; n = 17)	54.0 (range: 33-6)
Male	58.0 (range: 42-69)
Female	46.3 (range: 33-65)
Histological types (n = 14)
Sig	7
Por	3
Ud	1
Tub	3
T (n = 13)
1	3
2	9
3	1
ly (n = 12)
0	1
1	1
2	5
3	5
v (n = 10)
0	3
1	3
2	3
3	1
n (n = 12)
0	3
1	2

The histological types, “T”, “ly”, “v”, and “n”, are defined in the General Rules for the Gastric Cancer Study by Japanese Research Society for Gastric Cancer[26]. sig: signet-ring cell carcinoma; por: poorly differentiated carcinoma; ud: undifferentiated carcinoma; and tub: tubular adenocarcinoma. For T which represents depth of cancer invasion, 1: mucosal and submucosal layer; 2: proper muscular and subserosal layer; 3: expose to serosal layer; and 4: invasion to the adjacent organ. For ly and v which represent lymphatic permeation and venous permeation, respectively, 0: none; 1: slight; 2: moderate; and 3: massive.

Table 3 Treatment and corresponding mean survival time after the diagnosis of cardiac tamponade

Modalities	n		Mean survival (mo)
Drainage only	6	3.3
Drainage+chemotherapy
Local only	4	2.3
Systemic+local	4	8.4
Systemic only	3	5

Local: local infusion chemotherapy into pericardial space.

Table 4 Clinical characteristics of cardiac tamponade due to pericarditis carcinomatosa from GC

		Survival rate (%)
		1	5	10	Median survival
Characteristics	n		mo		in months (range)	P values
Overall	17	94.2	17.7	11.8	4.5 (1.0-14.0)
Gender
Male	11	90.9	18.2	9.1	4.3 (1.0-14.0)
Female	6	-	16.7	-	5.0 (1.3-13.0)	0.7614
Time interval
<24 mo	7	-	0	0	2.9 (1.5-5.0)
>24 mo	7	85.7	-	28.5	6.9 (1.0-14.0)	0.113
CEA (ng/mL)
<5	9	-	-	22.2	6.3 (1.5-14.0)
>5	4	75	0	0	1.9 (1.0-2.5)	0.0071
CA 19-9 (U/mL)
<40	6	-	33.3	16.7	7.4 (1.5-14.0)
>40	6	-	0	0	2.8 (1.0-5.0)	0.1074
CEA and/or CA	9-19
Normal	5	-	0	0	8.6 (2.5-14.0)
High	8	87.5	0	0	2.6 (1.0-5.0)	0.0244
Systemic chemotherapy
Done	7	-	42.9	28.6	6.9 (1.5-14.0)

Table 5 Relative risk of death as analyzed by Cox proportional Hazards model

Variables	B value	Relative risk (95%CI)	P values
CEA
<5.0 ng/mL
>5.0 ng/mL	1.9	6.7 (1.2–36.6)	0.029
CEA and/or CA-19-9
<5.0 ng/mL, <40 U/mL
>5.0 ng/mL, >40 U/mL	1.6	4.9 (1.0-23.7)	0.049

95%CI: confidence interval.