CARDIAC METASTASIS OF LUNG-CANCER - A STUDY OF METASTATIC PATHWAYS AND CLINICAL MANIFESTATIONS
CARDIAC METASTASIS OF LUNG-CANCER - A STUDY OF METASTATIC PATHWAYS AND CLINICAL MANIFESTATIONS
复制标题
DOI：
10.1002/1097-0142(19920715)70:2
复制
发表时间：
1992-07-15
期刊：
影响因子：
6.2
通讯作者：
AOKI, N
中科院分区：
文献类型：
--
作者：
TAMURA, A;MATSUBARA, O;AOKI, N
背景虽然肺癌经常扩散到心脏，但肺癌心脏转移的细节尚未得到充分讨论。本文通过对74例肺癌心脏转移的临床和尸检资料的分析，探讨了肺癌心脏转移的机制与其引起的各种临床表现之间的关系。对心脏转移病例，通过大体检查确定心脏转移途径，并分析转移途径与临床表现的关系。心包或心脏转移23例（31%）。淋巴转移途径18例（肺门淋巴转移12例，纵隔淋巴转移6例），血行转移5例。23例中有15例发生恶性心包积液。15例病例中有14例转移途径为淋巴途径（10例为肺门淋巴途径，4例为纵膈淋巴途径）。淋巴结转移组恶性心包积液发生率高于血行转移组（P < 0.05）。在23例心脏转移瘤中，1例因肿瘤压迫冠状动脉而发生心肌梗死。8例心脏转移瘤并发室上性心律失常。有心脏转移者心律失常发生率高于无心脏转移者（P < 0.05）。在心脏转移瘤患者中，有心律失常者的年龄明显高于无心律失常者（P < 0.01）。作者得出结论，肺门淋巴通路对于肺癌恶性心包积液的早期发展至关重要，衰老和心脏转移可能是肺癌患者心律失常的原因。
Background. Although lung cancer frequently spreads to the heart, details of cardiac metastases of lung cancer have not been fully discussed. The authors attempted to elucidate the relationship between the mechanisms of cardiac metastasis and a variety of clinical manifestations caused by cardiac metastasis.Methods, Clinical and autopsy records were reviewed in 74 autopsied cases of lung cancer. In cases with cardiac metastasis, the metastatic pathways to the heart were determined by the macroscopic examinations, and the relationship between the metastatic pathways and the clinical manifestations were studied.Results. Metastases to the pericardium or heart were seen in 23 cases (31%). A lymphatic metastatic pathway was detected in 18 cases (hilar lymphatic routing in 12 cases, and mediastinal lymphatic routing in 6 cases), and a hematogenous metastatic pathway was detected in 5 cases. Malignant pericardial effusion was documented in 15 of 23 cases. The metastatic pathway in 14 of 15 cases was lymphatic (hilar lymphatic routing in 10 cases, and mediastinal lymphatic routing in 4 cases). Patients showing lymphatic metastasis had higher incidence of malignant pericardial effusion than those with hematogenous metastasis (P < 0.05). Of 23 cases of cardiac metastasis, myocardial infarction was found in 1 case, resulting from the compression of the coronary arteries by the tumor. Concurrent supraventricular arrhythmias were recorded in eight cases with cardiac metastasis. Patients with cardiac metastasis had higher incidence of arrhythmia than those without cardiac metastasis (P < 0.05). In cases of cardiac metastasis, patients with arrhythmia were older (P < 0.01) than those without arrhythmia.Conclusions. The authors concluded that the hilar lymphatic pathway is essential for early development of malignant pericardial effusion in lung cancer and that aging and cardiac metastasis may be responsible for arrhythmia in patients with lung cancer.