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April 29, 2025, 14:59

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Title: Cardiac Metastatic Tumors: Revisiting Mechanisms and Future Perspectives To the Editor We read with great interest the article by Luo et al.[1] titled "Comprehensive understanding of a rare disease: Cardiac metastatic tumor, a double-center 10-year case review," recently published in World Journal of Cardiology. We congratulate the authors for providing valuable clinical insights into the rare and underrecognized entity of cardiac metastatic tumors (CMTs). The study's finding that intracardiac metastases are associated with a poorer prognosis compared to pericardial involvement aligns with prior autopsy-based observations[2,3], emphasizing the prognostic importance of metastatic localization within the cardiac structure. The authors' inclusion of cardiac biomarkers, such as BNP and troponin, as predictors of adverse outcomes is particularly commendable and may represent a step toward more precise risk stratification. Building upon these important findings, we wish to highlight several emerging directions that could deepen our understanding of CMTs: First, organotropism and pre-metastatic niche formation are increasingly recognized as critical determinants of metastatic dissemination[4,5]. Experimental studies have demonstrated that cardiac tissue exhibits a unique extracellular matrix composition and a dynamic immunological environment, which may preferentially attract circulating tumor cells[6]. Investigating the role of cardiac-specific chemokine axes, such as CXCL12-CXCR4 signaling, may provide new insights into the molecular determinants of cardiac colonization. Second, advanced imaging modalities warrant greater emphasis in the diagnostic pathway. While echocardiography remains the first-line modality, cardiac magnetic resonance (CMR) imaging and ^18F-FDG PET-CT possess superior tissue characterization capabilities, enabling differentiation between malignant and benign cardiac masses with higher sensitivity and specificity[7,8]. Early integration of these modalities could significantly alter the therapeutic trajectory for patients with occult cardiac involvement. Third, therapeutic approaches for CMTs remain largely individualized and empirical. Although palliative strategies predominate, isolated reports suggest that surgical resection or stereotactic radiotherapy may improve quality of life and survival in carefully selected patients[9]. Prospective studies incorporating molecular tumor profiling—such as HER2, EGFR, or ALK status—may refine patient selection and therapeutic planning[10]. Moreover, given the rising incidence of CMTs in the era of improved oncological survival, it is imperative to establish multicenter registries and collaborative research networks focusing specifically on cardiac oncology. Standardizing diagnostic criteria, staging systems, and treatment algorithms would provide an urgently needed framework for evidence-based clinical decision-making. In conclusion, Luo et al. have made a valuable contribution by elucidating the clinical and prognostic characteristics of CMTs. Future investigations integrating molecular oncology, advanced imaging, and standardized therapeutic strategies will be pivotal to improving the outcomes of patients with this rare but increasingly encountered condition. References 1.Luo LY, Yang TS, He Z, Lin L, Luo XL. Comprehensive understanding of a rare disease: Cardiac metastatic tumor, a double-center 10-year case review. World J Cardiol. 2025;17(2):101851. doi:10.4330/wjc.v17.i2.101851 2.Bussani R, De-Giorgio F, Abbate A, Silvestri F. Cardiac metastases. J Clin Pathol. 2007;60(1):27-34. doi:10.1136/jcp.2005.035105 3.Lam KY, Dickens P, Chan AC. Tumors of the heart: a 20-year experience with a review of 12,485 consecutive autopsies. Arch Pathol Lab Med. 1993;117(10):1027-1031. 4.Peinado H, Zhang H, Matei IR, et al. Pre-metastatic niches: organ-specific homes for metastases. Nat Rev Cancer. 2017;17(5):302-317. doi:10.1038/nrc.2017.6 5.Labelle M, Hynes RO. The initial hours of metastasis: the importance of cooperative host-tumor cell interactions during hematogenous dissemination. Cancer Discov. 2012;2(12):1091-1099. doi:10.1158/2159-8290.CD-12-0329 6.Shinde AV, Frangogiannis NG. Fibroblasts in myocardial infarction: a role in inflammation and repair. J Mol Cell Cardiol. 2014;70:74-82. doi:10.1016/j.yjmcc.2013.12.011 7.Bogaert J, Francone M. Cardiac tumors and masses: the role of cardiovascular magnetic resonance imaging. Eur Radiol. 2009;19(1):14-27. doi:10.1007/s00330-008-1161-0 8.Rahbar K, Seifarth H, Schäfers M, et al. Differentiation of malignant and benign cardiac tumors using 18F-FDG PET/CT. J Nucl Med. 2012;53(6):856-863. doi:10.2967/jnumed.111.099028 9.Yusuf SW, Bathina JD, Qureshi S, et al. Cardiac tumors in cancer patients: diagnosis, management, and prognosis. Oncologist. 2007;12(4):443-450. doi:10.1634/theoncologist.12-4-443 10.Nguyen DX, Bos PD, Massagué J. Metastasis: from dissemination to organ-specific colonization. Nat Rev Cancer. 2009;9(4):274-284. doi:10.1038/nrc2622

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