Pericarditis: A Marker of Occult Cancer, Predictor of Mortality?
Patients with newly diagnosed pericarditis had a higher risk of being diagnosed with cancer in the subsequent three months, and for some cancers this risk persisted for one year, and they had worse survival, according to a study published June 29 in Circulation.
In this Danish national cohort study using medical databases, Kirstine Kobberøe Søgaard, PhD, et al., calculated the risk and standardized incidence ratios (SIR) of cancer in patients with a new diagnosis of pericarditis between 1994 and 2013 and no history of cancer and in the general population using a matched comparison cohort.
Results of the analysis showed that among 13,759 patients with acute pericarditis, 1,550 were subsequently diagnosed with cancer during follow-up. The overall SIR for cancer was 1.5 (95 percent confidence interval [CI], 1.4-1.5), driven predominantly by increased rates of lung, kidney and bladder cancer, lymphoma, leukemia and unspecified metastatic cancer.
The risk of cancer in the initial three months after pericarditis diagnosis was 2.7 percent and the SIR was 12.4. For the period of three to 12 months, the cancer SIR was 1.5 (95 percent CI, 1.2-1.7) and this decreased to an SIR of 1.1 (95 percent CI, 1.0-1.2).
Survival at three months after a cancer diagnosis was 80 percent and 86 percent in those with and without pericarditis, respectively (hazard ratio, 1.5; (95 percent CI, 1.3-1.8). At one year, survival was 65 percent and 70 percent, respectively.
Pericardial effusion was associated with a high risk of lung cancer and non-Hodgkin lymphoma and a higher short-term risk of lung cancer, breast cancer, non-Hodgkin lymphoma and unspecified metastatic cancer. Patients with pericardial effusion were older and had a higher prevalence of heart failure, pacemaker implants, chronic obstructive pulmonary disease and recent thoracic surgery.
“Clinically, it is important to know whether patients presenting with first-time pericarditis should be investigated more thoroughly to rule out specific cancers,” the study authors wrote. “We speculate that if the standard work-up in our cohort of patients had included such test as complete blood count, liver enzyme level, and CT scan, then additional cancers might have been detected earlier.”
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