Case Control Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2025; 17(2): 101851
Published online Feb 26, 2025. doi: 10.4330/wjc.v17.i2.101851
Comprehensive understanding of a rare disease: Cardiac metastatic tumor, a double-center 10-year case review
Ling-Yun Luo, Tian-Shu Yang, Zhen He, Li Lin, Xue-Lian Luo
Ling-Yun Luo, Tian-Shu Yang, Department of Cardiology, Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430034, Hubei Province, China
Zhen He, Department of Cardiac Surgical Intensive Care Unit, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, Guangdong Province, China
Li Lin, Department of Internal Medicine, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
Xue-Lian Luo, Department of Oncology, Chongqing Medical University Affiliated Third Hospital, Chongqing 400020, China
Co-first authors: Ling-Yun Luo and Tian-Shu Yang.
Co-corresponding authors: Li Lin and Xue-Lian Luo.
Author contributions: Luo LY and Yang TS contribute equally to this study as co-first authors; Lin L and Luo XL contribute equally to this study as co-corresponding authors; Luo LY was responsible for conceptualization, methodology, and software; Yang TS was responsible for data curation and writing-original draft preparation; Luo XL was responsible for visualization and investigation; Lin L was responsible for supervision, software and validation; He Z was responsible for writing- reviewing and editing.
Institutional review board statement: Ethics Committee of the Third Affiliated Hospital of Chongqing Medical University (Reference number: No. 46 of 2024).
Informed consent statement: The informed consent was waived by the Ethics Committee.
Conflict-of-interest statement: The authors declare that there is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Data sharing statement: Our research data will be made available for sharing in accordance with the following principles and procedures: Data will be shared upon reasonable request after the publication of the related research findings. The data will be anonymized to protect the privacy and confidentiality of the participants. The format of the shared data will be in a commonly used and machine-readable format, such as CSV or Excel files. Requests for data sharing should be directed to the corresponding author, who will review and process the requests within (a specific time frame, e.g., two weeks). The corresponding author will ensure that the requester complies with any ethical and legal obligations associated with the use of the data. We believe that data sharing promotes scientific progress and reproducibility, and we are committed to facilitating access to our research data in a responsible and ethical manner.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Lian Luo, MA, Master's Student, Department of Oncology, Chongqing Medical University Affiliated Third Hospital, Huixing Street, Yubei District, Chongqing 400020, China. 806850653@qq.com
Received: September 28, 2024
Revised: December 24, 2024
Accepted: February 6, 2025
Published online: February 26, 2025
Processing time: 149 Days and 16.5 Hours
Abstract
BACKGROUND

Cardiac metastatic tumors (CMTs) are rare yet pose significant medical concerns. Clinical studies on CMT are limited, particularly those involving multicenter data analysis.

AIM

To systematically analyze the etiology, sources, classification, treatment, and prognosis of CMT.

METHODS

A total of 226 CMT patients from two centers (2013 to 2023) were reviewed, and 153 tumor patients from China Health and Retirement Longitudinal Study were used as controls. The survival rates of 96 CMT patients were tracked through medical records and telephone follow-ups. Logistic regression and survival analyses were conducted to characterize CMT.

RESULTS

CMTs were predominantly male (67.26% vs 39.47%, P < 0.001). Intracardiac metastasis patients had worse heart and coagulation function than pericardial metastasis patients (prothrombin time: 13.90 vs 13.30, P = 0.002), D-dimer levels (2.16 vs 0.85, P = 0.001), B-type natriuretic peptide (BNP) levels (324.00 vs 136.50, P = 0.004), and troponin levels (5.35 vs 0.03, P < 0.001)). Lung and liver cancers were the predominant primary tumor types in CMT. Patients with lung cancer (76.40% vs 30.77%) and thymoma (7.45% vs 1.54%) exhibited a higher prevalence of pericardial metastasis, while those with liver cancer (35.38% vs 0.62%) showed a higher prevalence of intracardiac metastasis. Overall survival was better for pericardial metastasis than for intracardiac metastasis patients (median survival: 419 days vs 129 days, log-rank test P = 0.0029). Cox proportional hazards model revealed that advanced age [hazard ratio (HR) = 1.034, 95% confidence interval (95%CI): 1.011-1.057] and higher BNP and troponin levels (HR = 1.011, 95%CI: 1.004-1.018) were associated with worse survival. Surgery significantly improved the survival rate of patients. The median survival time was 275 days for patients who did not undergo surgery and 708 days for those who had surgery (log-rank test P = 0.0128)

CONCLUSION

Clinicians should consider CMT in the male lung or liver cancer patients with cardiac symptoms. Abnormal coagulation, impaired heart function, tumor location, and age are key prognostic factors for CMT. Surgical intervention is the preferred treatment option, as it significantly prolongs median survival.

Keywords: Cardiac metastatic tumor; Subtype; Prognosis; Coagulation; Primary tumor

Core Tip: Cardiac metastatic tumor (CMT) is a rare disease often accompanied by a poor prognosis. Currently, there is a dearth of clinical studies with sufficient cases to provide comprehensive insights. The present research has thoroughly characterized CMT, including its etiology, sources, classification, treatment options, and prognosis. It was found that CMT is predominant in male patients with liver cancer (often as intracardiac metastasis) and lung cancer (primarily involving the pericardium). Moreover, abnormal coagulation, heart function, tumor location, and age are key prognostic factors for CMT.