Comprehensive understanding of a rare disease: Cardiac metastatic tumor, a double-center 10-year case review.

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.