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Pericarditis as a Marker of Occult Cancer
Study Questions:
What is the risk of subsequent cancer among patients with a first-time diagnosis of pericarditis with or without pericardial effusion, compared with the general population?
Methods:
The investigators conducted a nationwide cohort study of all patients with a first-time diagnosis of pericarditis during 1994-2013, using Danish medical databases. Patients with previous cancer were excluded, and the remaining patients were followed for subsequent cancer diagnosis until November 30, 2013. The calculated risks and standardized incidence ratios (SIRs) of cancer for patients with pericarditis were compared with the general population. The investigators assessed whether pericarditis predicts cancer survival by the Kaplan-Meier method and Cox regression, using a matched comparison cohort of cancer patients without pericarditis.
Results:
Among 13,759 patients with acute pericarditis, 1,550 subsequently were diagnosed with cancer during follow-up. The overall cancer SIR was 1.5 (95% 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 <3-month cancer risk among patients with pericarditis was 2.7% and the SIR was 12.4 (95% CI, 11.2-13.7). The 3-<12-month SIR of cancer was 1.5 (95% CI, 1.2-1.7), subsequently decreasing to 1.1 (95% CI, 1.0-1.2). Three-month survival following cancer diagnosis was 80% and 86% among those with and without pericarditis, and the hazard ratio (HR) was 1.5 (95% CI, 1.3-1.8). One-year survival was 65% and 70%, respectively, corresponding to a 3-<12 month HR of 1.3 (95% CI, 1.1-1.5).
Conclusions:
The authors concluded that pericarditis may be a marker of occult cancer and augurs increased mortality following a cancer diagnosis.
Perspective:
This population-based nationwide cohort study reports that pericarditis was a marker for occult cancer. In particular, there was a higher than expected rate of lung cancer, non-Hodgkin lymphoma, and myeloid leukemia during the first 3 months after an incident pericarditis diagnosis both in patients with and without pericardial effusion. Furthermore, pericarditis was a prognostic factor for both short-term cancer survival after lung cancer, and long-term cancer survival after bladder and breast cancer. It would seem reasonable that patients with pericarditis be considered for workup targeted at diagnosing or ruling out cancer. Future studies should evaluate the economic and patient-related costs, including exposure to radiation and anxiety associated with the diagnostic workup versus potential detection rates and impact on outcomes with earlier detection.
Keywords: Breast Neoplasms, Cardiotoxicity, Incidence, Kidney Neoplasms, Leukemia, Myeloid, Lymphoma, Lymphoma, Non-Hodgkin, Lung Neoplasms, Pericardial Effusion, Pericarditis, Primary Prevention, Prognosis, Risk, Survival, Urinary Bladder Neoplasms
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