Prognostic role of pericardial fluid cytology in cardiac tamponade associated with non-small cell lung cancer

Background and study objectives: Cardiac tamponade is a life-threatening co mplication of non-small cell lung cancer (NSCLC). Malignant pericardial eff usion signifies advanced disease, but the significance of a negative perica rdial fluid cytology in patients with advanced lung cancer is still controv ersial, The differential diagnosis of cytology-negative pericardial effusio n is difficult and sometimes impossible. The purpose of this study is to de termine the prognostic role of pericardial fluid cytology in patients with NSCLC and cardiac tamponade, Design: Retrospective review of patients with concurrent NSCLC and cardiac tamponade over a 10-year period. Methods and results: Eighty-two patients mere included in this study. Peric ardial fluid cytology was positive in 60 patients and negative in 22 patien ts. 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 stra tegies. 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 concur-rent advanced NSCLC and cardiac tamp onade, the most likely cause of the pericardial effusion is the cancer itse lf, regardless of the results of the cytologic examination, Our results sug gest that systemic chemotherapy might prolong survival in such patients, bu t further prospective, randomized study is necessary.