Surgical treatment for improved 1-year survival in patients with primary cardiac sarcoma

OBJECTIVE: Surgery is considered a relative contraindication in sarcoma tumor. Because of the unique characteristics of heart, whether surgery is optimally chosen in primary cardiac sarcoma (PCS) is unknown. In this study, we aimed to evaluate the 1-year survival after surgery for PCS. METHODS: Patients with PCS from the Surveillance, Epidemiology, and End Results Database (SEER) between 1975 and 2015 were recruited. The endpoints were defined as 1-year all-cause mortality (ACM) and 1-year cancer-specific mortality (CSM). RESULTS: The study population consisted of 335 patients diagnosed with PCS. The 1-year ACM and CSM were 49.0% and 42.1% respectively. The Kaplan-Meier curves revealed that decreased 1-year ACM-CSM were significantly associated with surgical treatment. Multiple COX regression analysis, surgery, and chemotherapy showed a significantly decreased rate of 1-year ACM and CSM. The adjusted hazard ratio of surgery was significant when the year of diagnosis was ≥2000, patients were aged <50 years, SEER stage was localized, and patients did not undergo chemotherapy (all p<0.05), and was insignificant when the year of diagnosis was <2000, patients were aged ≥50 years, SEER stage was distance, regional, and unstaged/unknown, and the patients underwent chemotherapy (all p>0.05). No interaction effects were detected between the variables and surgery (all p for interaction >0.05). CONCLUSION: Surgery should be highly recommended in patients with PCS to improve the 1-year survival rate, especially in younger patients with localized SEER stage and non-chemotherapy management.