Clinical insights into nonbacterial thrombotic endocarditis in cancer patients: A case-based systematic review.

Abstract

Background: Nonbacterial thrombotic endocarditis (NBTE) is a rare yet critical complication in cancer patients, with high embolic risk and poor prognoses. This systematic review investigates the clinical presentation, valve involvement, embolic risk, vegetation management, and prognostic variability across cancer types in NBTE cases.

Methods: Adhering to PRISMA guidelines, we conducted a comprehensive literature search in PubMed, Scopus, and Embase for studies from 2000 to September 2024. Extracted data included demographics; cancer type and site; NBTE diagnosis timing; valve characteristics; embolic events; and patient outcomes. Chi-square and regression analyses evaluated associations among clinical variables and outcomes. Quality was appraised using the Joanna Briggs Institute tool.

Results: From 38 studies comprising 40 cases, the mean patient age was 50.5 years (±12.5), with equal gender distribution (20 males, 20 females). Pancreatic adenocarcinoma (17.5%) and lung adenocarcinoma (15.0%) were most frequently associated with NBTE. Mortality rates varied significantly by cancer type, with gastrointestinal and urogenital cancers showing the highest rates. A significant association was found between cancer type and vegetation management strategy (χ² = 24.41, p = 0.018). Further correlations indicated that longer cancer histories necessitated more invasive management, and concurrent embolic events correlated with poorer prognoses. Quality assessment reinforced the findings' reliability (65% high quality).

Conclusion: NBTE in cancer patients shows distinct clinical and prognostic patterns, with cancer type impacting both management and outcomes. These insights highlight the importance of tailored management approaches and provide a basis for future research to enhance care and prognostic assessments in NBTE cases within oncology.