Prognostic trends of malignant cardiac tumors: insights from the Surveillance, Epidemiology, and End Results (SEER) registry

Aim: This study aims to evaluate how demographic and treatment variables, including age, tumor type, resectability, and metastasis, affect survival outcomes across prognostic subgroups of primary malignant cardiac tumors (PMCTs). Methods: PMCT cases diagnosed between 2000 and 2021 were identified from Surveillance, Epidemiology, and End Results (SEER) 18 registries. 730 patients were analyzed and categorized into prognosis groups based on 5-year survival (< 50%, 50–95%, > 95%). Demographic, histologic, and treatment varieties were examined using descriptive statistics, Kaplan-Meier estimates, and Cox proportional hazards models. Results: Among 730 patients, most were middle-aged (56.6%), male (52.5%), and White (60.1%). Soft tissue sarcomas predominated in the poorest-prognosis group (80.3%), while hematologic malignancies were most common in intermediate prognosis (52.0%). Younger age significantly reduced mortality risk [hazard ratio (HR) 0.49–0.52; p < 0.01]. Brain and lung metastases increased mortality (HR 2.04 and 1.89; p < 0.05). Surgical resection improved survival in sarcoma-dominant tumors, while systemic metastasis predicted poorer outcomes in hematologic malignancies. Chemotherapy improved survival in sarcomas (ρ = 0.457; p < 0.0001) but was associated with poorer outcomes in hematologic cancers (ρ = −0.337; p < 0.0001). Conclusions: PMCT prognosis is primarily influenced by histologic subtype and resectability. Sarcoma-dominant tumors benefit from aggressive surgical and chemotherapeutic management, conversely systemic control is key for hematologic malignancies. Younger age and absence of metastasis consistently predict better outcomes. Histology-specific and early intervention strategies are critical to improving survival in this rare malignancy.