Kanhua Yin1, Rongkui Luo2, Yaguang Wei3, Fenglei Wang3, Yiwen Zhang3, Karl J Karlson4, Zhiqi Zhang5, Michael J Reardon6, Nikola Dobrilovic7. 1. Harvard T.H. Chan School of Public Health, Boston, Mass; Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. 2. Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China. 3. Harvard T.H. Chan School of Public Health, Boston, Mass. 4. Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. 5. Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China. 6. Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, Tex. 7. Division of Cardiac Surgery, Boston Medical Center, Boston University School of Medicine, Boston, Mass. Electronic address: nikola.dobrilovic@bmc.org.
Abstract
OBJECTIVE: We aim to evaluate the survival outcomes of primary cardiac sarcoma in a US nationwide cancer database. METHODS: The Surveillance, Epidemiology, and End Results database was queried to identify patients with primary cardiac sarcoma from 1973 to 2015. Kaplan-Meier analysis and log-rank tests were performed to compare overall survival for subpopulations, stratified on year at diagnosis (dichotomized into 2 periods: 1973-2005 and 2006-2015), pathological types, whether patients were treated with surgery or not, and surgery and chemotherapy combinations. Multivariable Cox regression was performed to estimate the adjusted hazard ratios and 95% confidence intervals of potentially clinically important factors. RESULTS: A total of 442 patients (mean age, 47.2 ± 18.7 years; male 52.0%) were identified. Most patients were white (78.1%) and diagnosed at age 20 to 60 years (70.2%). Angiosarcoma (43.2%) was the most common histologic type. Overall, the median survival was 7 months, and the 1-, 3-, and 5-year survivals were 40.7%, 15.6%, and 9.8%, respectively. Patients who were diagnosed within the recent decade (2006-2015) did not achieve a better overall survival (P = .13). Surgery (adjusted hazard ratio, 0.49; 95% confidence interval, 0.37-0.64; P < .001) and chemotherapy (adjusted hazard ratio, 0.70; 95% confidence interval, 0.54-0.92; P = .009) were independently associated with improved overall survival. Increasing age (adjusted hazard ratio of 5-year increment, 1.07; 95% confidence interval, 1.04-1.11; P < .001) was independently associated with worse survival. CONCLUSIONS: At the population level, primary cardiac sarcoma has a poor prognosis. Both surgery and chemotherapy are associated with improved survival, whereas increasing age at diagnosis was associated with worse survival.
OBJECTIVE: We aim to evaluate the survival outcomes of primary cardiac sarcoma in a US nationwide cancer database. METHODS: The Surveillance, Epidemiology, and End Results database was queried to identify patients with primary cardiac sarcoma from 1973 to 2015. Kaplan-Meier analysis and log-rank tests were performed to compare overall survival for subpopulations, stratified on year at diagnosis (dichotomized into 2 periods: 1973-2005 and 2006-2015), pathological types, whether patients were treated with surgery or not, and surgery and chemotherapy combinations. Multivariable Cox regression was performed to estimate the adjusted hazard ratios and 95% confidence intervals of potentially clinically important factors. RESULTS: A total of 442 patients (mean age, 47.2 ± 18.7 years; male 52.0%) were identified. Most patients were white (78.1%) and diagnosed at age 20 to 60 years (70.2%). Angiosarcoma (43.2%) was the most common histologic type. Overall, the median survival was 7 months, and the 1-, 3-, and 5-year survivals were 40.7%, 15.6%, and 9.8%, respectively. Patients who were diagnosed within the recent decade (2006-2015) did not achieve a better overall survival (P = .13). Surgery (adjusted hazard ratio, 0.49; 95% confidence interval, 0.37-0.64; P < .001) and chemotherapy (adjusted hazard ratio, 0.70; 95% confidence interval, 0.54-0.92; P = .009) were independently associated with improved overall survival. Increasing age (adjusted hazard ratio of 5-year increment, 1.07; 95% confidence interval, 1.04-1.11; P < .001) was independently associated with worse survival. CONCLUSIONS: At the population level, primary cardiac sarcoma has a poor prognosis. Both surgery and chemotherapy are associated with improved survival, whereas increasing age at diagnosis was associated with worse survival.