Age and treatment disparities in survival of primary malignant cardiac tumors: an analysis of over 40 years and 500 patients

Our plain-English summary of Age and treatment disparities in survival of primary malignant cardiac tumors: an analysis of over 40 years and 500 patients, by W. Wang, L. Kang, J. Zhang, et al (Journal of Thoracic Disease, 2023).

The study

• Authors: W. Wang, L. Kang, J. Zhang, H. Li, T. Cao, S. He
• Journal: Journal of Thoracic Disease
• Published: 2023;15(8):4434-4444
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary malignant cardiac tumors (PMCTs) are rare and tend to have a poor prognosis, due to their aggressive biological behavior and the inadequate expertise with the disease. This article compares the survival of patients with PMCT subtypes in the United States across age and treatment groups.

Methods: Data of 529 patients diagnosed with PMCTs were analyzed. Chi-squared test was used to assess significance of the differences between proportions in demographic and tumor characteristics by age and treatment. Cox regression analysis was used to estimate survival from the Surveillance, Epidemiology, and End Results (SEER) follow-up data.

Results: Survival rates for PMCTs differed significantly between age groups, with patients younger than 20 years surviving significantly longer than those older than 80 years. The median survival times of all patients with PMCTs were 22.5, 11, 5, and 1 month for ages less than 20, 20-50, 51-80, and greater than 80 years, respectively (global log-rank P=0.0026). In the treatment cohort, for all tumors [hazard ratio (HR) 1.52, P<0.001], sarcomas (HR 1.83, P=0.002), and other tumors (HR 2.24, P=0.017), survival was lower in patients who did not receive treatment than in those who received only surgery. Survival after diagnosis of sarcoma was lower in patients who received radiotherapy only than in those who received surgery only (HR 1.49, P=0.046). However, there was no significant association between treatment and survival for lymphoma and mesothelioma.

Conclusions: This study confirms that PMCTs have limited treatment options and poor patient survival, especially for elderly patients and patients who receive no treatment. And patients with PMCTs of any age, whether treated or not, have poor survival rates. Techniques for early diagnosis and treatment may be necessary. Surgical treatment should have a higher priority for future treatment of patients with sarcomas.

2023 Journal of Thoracic Disease. All rights reserved.

In plain English

This retrospective study used United States SEER cancer registry data on 529 patients diagnosed from 1973 to 2013 with a primary malignant tumor of the heart. Most tumors were sarcomas (324). Thirty-two were mesotheliomas. The study did not examine asbestos or any other cause. It compared survival by age group and by treatment: surgery only, radiation only, both, or none. Chemotherapy data were not available. There were 436 deaths over a median follow-up of 80 months. Median survival for all tumors was 22.5, 11, 5 and 1 months for patients under 20, 20 to 50, 51 to 80 and over 80. Compared with surgery only, no treatment was linked to worse survival for all tumors (HR 1.52; 95% CI 1.22 to 1.89). For mesothelioma, no significant association between treatment and survival was found. The authors concluded that survival was poor at any age, with or without treatment, and that surgery alone appeared the better choice for sarcomas. They noted unavoidable confounding in data gathered over five decades.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective population-based registry study (SEER cancer registries) of survival by age group and treatment group
• Who was studied: 529 patients with primary malignant cardiac tumors (primary site coded as heart) diagnosed 1973 to 2013 in 18 US SEER registries: 324 sarcomas, 122 lymphomas, 32 mesotheliomas, 51 others. 696 were identified; 167 were excluded for loss to follow-up, secondary or multiple primary tumors, or unknown treatment.
• Exposure: No asbestos or other causal exposure was studied. The factors compared were age at diagnosis (under 20, 20 to 50, 51 to 80, over 80) and treatment (surgery, radiation, surgery and radiation, no treatment).
• Main results:
  • There were 436 deaths among the 529 patients over a median follow-up of 80 months.
  • Median survival for all primary malignant cardiac tumors was 22.5, 11, 5 and 1 months for patients aged under 20, 20 to 50, 51 to 80 and over 80 years (global log-rank P=0.0026).
  • After adjustment, compared with the 20 to 50 year group, all tumors combined: under 20 HR 0.49 (95% CI 0.30 to 0.78; P=0.002); over 80 HR 1.83 (95% CI 1.25 to 2.68; P=0.002); 51 to 80 HR 1.10 (95% CI 0.89 to 1.37; P=0.36), no difference.
  • For mesothelioma, survival curves showed no significant difference by age (P=0.62). In the adjusted analysis, patients over 80 had worse survival than the 20 to 50 group (HR 19.70; 95% CI 1.57 to 247.05; P=0.021). Table 1 shows only 1 mesothelioma patient was over 80.
  • All tumors combined, compared with surgery only: no treatment was associated with worse survival (HR 1.52; 95% CI 1.22 to 1.89; P<0.001).
  • Sarcomas, compared with surgery only: no treatment HR 1.99 (95% CI 1.51 to 2.62; P<0.001); radiation only HR 1.49 (95% CI 0.95 to 2.34; P printed as less than 0.046).
  • No significant association between treatment and survival was observed for lymphomas or mesothelioma. For mesothelioma, no treatment versus surgery only: HR 1.34 (95% CI 0.47 to 3.83; P=0.591).
• The authors' conclusion: The authors concluded that survival was poor at any age and with or without treatment. They found that untreated and older patients often had worse survival, and that surgery alone appeared to be a better choice for sarcomas than radiation or combined treatment.
• Limitations the authors state:
  • As a retrospective study using data collected over 5 decades, it had unavoidable confounding even after adjustment, for example from histopathologic classification, diagnosis and treatment methods.
  • Because these tumors are rare, the study had to rely on public database data.
  • SEER does not provide chemotherapy data, so the role of chemotherapy was not examined.
  • There was no information on the details of surgery or radiation, or on the mode of death; these are potential confounders.

Topics

Medical terms in this study, explained in our Lexicon: Prognosis, Epidemiology, SEER, Median Overall Survival, Hazard Ratio, Sarcoma, Mesothelioma.

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