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 complication of non-small cell lung cancer (NSCLC). Malignant pericardial effusion signifies advanced disease, but the significance of a negative pericardial fluid cytology in patients with advanced lung cancer is still controversial. The differential diagnosis of cytology-negative pericardial effusion is difficult and sometimes impossible. The purpose of this study is to determine 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 were included in this study. Pericardial fluid cytology, was positive in 60 patients and negative in 22 patients. 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 strategies. 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 concurrent advanced NSCLC and cardiac tamponade, the most likely cause of the pericardial effusion is the cancer itself, regardless of the results of the cytologic examination. Our results suggest that systemic chemotherapy might prolong survival in such patients, but further prospective, randomized study is necessary.