Mid- and long-term follow-up experience in patients with malignant superior vena cava obstruction

Superior vena cava obstruction (SVCO) due to mitotic diseases is a serious condition with significant morbidity and mortality. The aim of this study was to examine the follow-up data and demographics of patients with SVCO admitted to the Department of Surgery, Queen Mary Hospital, over a 14-year period.

The prospectively entered clinical data of patients with SVCO in Queen Mary Hospital from October 1997 to September 2011 were retrospectively analysed. All patient records were electronically and manually searched. Survival was calculated using Kaplan-Meier survival curves analysis. The Mantel-Cox log-rank test was used to test for statistically significant differences. Demographic data, associated aetiology, intervention and outcome were studied. Only patients with malignant aetiologies were included.

A total of 104 patients (81 males and 23 females) were recruited in our study period. Median age at presentation was 65 (range 3-91 years). The median follow-up period was 2 months. The commonest cause of SVCO was bronchogenic carcinoma (71%), followed by extrathoracic malignancies (16%), lymphoma (8%) and thymic malignancy (3%). The mean time from the onset of symptoms to presentation was 34 days. Steroids were prescribed for most (93.9%) of the patients. About half (54.4%) of the patients were given radiotherapy. Only 7 patients had angioplasty and all of them had stents inserted. The overall survival was poor. The mean and median survivals were 8.4 and 1.6 months, respectively. Seventeen percent of patients died in the same hospitalization as for their initial presentations. Younger age (50 years or below; P = 0.000), never smoker (P = 0.012), not using steroids (P = 0.007) and certain primary aetiologies (e.g. lymphoma; P = 0.008) were associated with longer overall survival on univariate analysis. However, on multivariate analysis, none of these factors reached statistical significance. The mean survival for cases with lymphoma, extrathoracic malignancies, bronchogenic tumours and thymic tumours was 80.1, 3.4, 3.1 and 1.8 months, respectively. Angioplasty did not show a statistically significant association with the overall survival.

This study, to the best of our knowledge, is the first to study the prognostic factors that may affect survival outcome in malignant SVCO. We showed that in patients with malignant aetiology for SVCO, advanced age (more than 50), history of smoking and use of steroids were statistically significantly associated with a poor outcome. The underlying primary malignant aetiology also has an important prognostic significance. Despite advances in medicine, the prognosis of patients with SVCO is still grave.