2024年6月26日 (三) 20:12的版本

原文：https://pubmed.ncbi.nlm.nih.gov/24697499/

Published: 2014 May

© 2014年英国小动物兽医协会

1 Abstract

目的：报告以多柔比星为基础的化疗作为超声心动图识别为右心房肿块和心包积液的狗的唯一治疗方法的结果。

方法：对接受多柔比星治疗的右心房肿块狗的病例记录进行回顾性研究。如果狗进行了任何类型的手术，例如心包切除术或右心房肿块切除术，或者它们的化疗方案不包括多柔比星，则它们被排除在研究之外。收集的数据包括信号、病史、体格检查结果、诊断测试结果和长期生存率。

结果：仅接受多柔比星化疗的右心房肿块和心包积液的狗的中位生存期为 139.5 天（范围 2 到 302 天）。化疗副作用频繁但轻微。

临床意义：单独使用基于多柔比星的化疗似乎是超声心动图识别为右心房肿块和心包积液的狗的可行治疗选择。

Objective: To report the outcome of doxorubicin-based chemotherapy as the sole treatment for dogs with echocardiographically identified right atrial masses and pericardial effusion.

Methods: A retrospective study of case records of dogs with right atrial masses treated with doxorubicin. Dogs were excluded from the study if they had any type of surgery performed such as pericardiectomy or right atrial mass resection, or if their chemotherapy protocol did not include doxorubicin. The data collected included signalment, history, physical examination findings, diagnostic test results and long-term survival.

Results: Dogs with right atrial masses and pericardial effusion that received doxorubicin-based chemotherapy alone had a median survival of 139 · 5 days (range 2 to 302 days). Chemotherapy side effects were frequent but mild.

Clinical significance: Doxorubicin-based chemotherapy alone appears to be a viable treatment option for dogs with echocardiographically identified right atrial masses and pericardial effusion.

2 Introduction

狗心包积液 （PE） 最常见的原因是肿瘤或特发性疾病（Kersetetter 等人，1997 年，Dunning 等人，1998 年，Ware & Hopper 1999 年，Stafford Johnson 等人，2004 年，Weisse 等人，2005 年，MacDonald 等人，2009 年，Rajagopalan 等人，2013 年）。右心房和心脏底部是 PE 狗发现肿瘤的两个最常见位置。当发现源自右心房的肿块时，血管肉瘤 （HSA） 是迄今为止最常见的组织病理学诊断，尽管偶尔会发现其他肿瘤，包括神经内分泌肿瘤、甲状腺腺癌、间皮瘤和淋巴瘤（Ware & Hopper 1999， MacDonald et al. 2009， Rajagopalan et al. 2013）。虽然心包穿刺术可以缓解体征，但 PE 经常在存在右心房 （RA） 肿块的情况下迅速复发，并且长期预后较差，大多数狗在诊断后 30 天内死亡或被安乐死（Kersetetter 等人，1997 年，Dunning 等人，1998 年，Stafford Johnson 等人，2004 年，Weisse 等人，2005 年，MacDonald 等人，2009 年）。因此，已经评估了进一步的治疗方案，包括心包切除术（Kersetetter 等人，1997 年）和手术切除 RA 肿块，联合或不联合辅助化疗（Weisse 等人，2005 年）。与单独手术相比，手术切除 RA 肿块后给予基于多柔比星的化疗显着缩短了生存时间（Weisse 等人，2005 年）。然而，手术通常昂贵、侵入性强，并且经常与并发症有关（Weisse 等人，2005 年）。因此，本研究旨在评估基于多柔比星的化疗作为超声心动图检查中发现 RA 肿块和 PE 的狗的唯一治疗方法。

The most common cause of pericardial effusion (PE) in dogs is neoplasia or idiopathic disease (Kersetetter et al. 1997, Dunning et al. 1998, Ware & Hopper 1999, Stafford Johnson et al. 2004, Weisse et al. 2005, MacDonald et al. 2009, Rajagopalan et al. 2013). The right atrium and the heart base are the two most common locations where neoplasia is identified in dogs with PE. When a mass is identified originating from the right atrium, haemangiosarcoma (HSA) is by far the most common histopathological diagnosis although other neoplasms are occasionally identified including neuroendocrine tumours, thyroid gland adenocarcinoma, mesothelioma and lymphoma (Ware & Hopper 1999, MacDonald et al. 2009, Rajagopalan et al. 2013). While pericardiocentesis can relieve the signs, PE frequently rapidly recurs in the presence of a right atrial (RA) mass and the long-term prognosis is poor with most dogs dying or being euthanased within 30 days of diagnosis (Kersetetter et al. 1997, Dunning et al. 1998, Stafford Johnson et al. 2004, Weisse et al. 2005, MacDonald et al. 2009). Consequently, further treatment options have been evaluated including pericardiectomy (Kersetetter et al. 1997) and surgical resection of the RA mass with or without adjuvant chemotherapy (Weisse et al. 2005). The administration of doxorubicin-based chemotherapy after surgical resection of the RA mass significantly improved survival time compared with surgery alone (Weisse et al. 2005). However, surgery is typically expensive, invasive and frequently associated with complications (Weisse et al. 2005). As such, this study was designed to evaluate the administration of doxorubicin-based chemotherapy as the only treatment for dogs identified with a RA mass and PE on echocardiographic examination.

3 材料与方法 (MATERIALS AND METHODS)

3.1 Case selection

对美国洛杉矶周边四家小动物专科医院（高级兽医护理中心、VCA 西洛杉矶动物医院、洛杉矶高级重症监护和奥兰治县兽医癌症小组）的病历数据库进行了审查，以寻找超声心动图识别出 RA 肿块和 PE 的狗。必须通过超声心动图识别源自右心房、RA 附属物或右房室 （AV） 沟的肿块才能纳入研究。超声心动图必须由董事会认证的心脏病专家或心脏病学住院医师在董事会认证的心脏病专家的监督下进行。由于对生存的潜在影响，对 RA 肿块进行任何手术（包括心包切除术或肿块切除术）的狗被排除在外（Kersetetter 等人，1997 年，Weisse 等人，2005 年）。未接受多柔比星作为化疗方案一部分的狗也被排除在研究之外。从病历中收集的数据包括信号、临床体征、体格检查结果、诊断测试结果和长期生存率。当病历中没有长期存活记录时，会向转诊兽医或狗的主人拨打后续电话。生存数据从超声心动图确定 RA 肿块后出院之日开始计算。

The medical record database from four small animal specialty hospitals (Advanced Veterinary Care Center, VCA West Los Angeles Animal Hospital, Advanced Critical Care of Los Angeles and Veterinary Cancer Group of Orange County) around Los Angeles in the USA was reviewed for dogs that had echocardiographically identified RA masses and PE. A mass originating from the right atrium, RA appendage or right atrioventricular (AV) groove had to be identified echocardiographically for inclusion in the study. The echocardiogram had to have been performed by a board-certified cardiologist or a cardiology resident under supervision of a board-certified cardiologist. Dogs that had any surgery for the RA mass including pericardiectomy or mass resection were excluded owing to the potential effect on survival (Kersetetter et al. 1997, Weisse et al. 2005). Dogs that did not receive doxorubicin as part of their chemotherapy protocol were also excluded from the study. Data collected from the medical record included signalment, clinical signs, physical examination findings, diagnostic test results and long-term survival. When long-term survival was not available in the medical record, follow-up phone calls were made to the referring veterinarian or to the owner of the dog. Survival data were calculated from the date of discharge from the hospital after identification of the RA mass on echocardiography.

3.2 Statistical analysis

使用标准统计软件包（SPSS 14.0 for Windows，Microsoft）进行统计分析。计算了从诊断到死亡的分布的Kaplan-Meier估计值。除非另有说明，否则结果以中位数和范围表示。

Statistical analyses were performed using a standard statistical software package (SPSS 14.0 for Windows, Microsoft). The Kaplan–Meier estimates of the distribution from diagnosis to death were computed. Results are presented as median and range unless indicated otherwise.

4 Results

16只狗符合该研究的纳入标准。代表的品种包括金毛猎犬（n = 4）、杂交品种（n = 2）和以下品种各一只狗：挪威麋鹿猎犬、罗威纳犬、拳击手、比格犬、德国短毛指针犬、澳大利亚牧羊犬、西伯利亚雪橇犬、澳大利亚牧牛犬、莱昂伯格犬和红色法老猎犬。信号、主诉和体格检查结果见表 1-3。

Sixteen dogs met the inclusion criteria for the study. Breeds represented included golden retriever (n = 4), crossbreed (n = 2) and one dog each of the following breeds: Norwegian elkhound, Rottweiler, boxer, beagle, German shorthaired pointer, Australian shepherd, Siberian husky, Australian cattle dog, Leonberger and red Pharaoh hound. Signalment, presenting complaints and physical examination findings are shown in Tables 1-3.

对所有 16 只狗进行了胸片检查，对 14 只狗进行了心电图检查，对 12 只狗进行了腹部超声检查。胸片、心电图和腹部超声检查发现的异常频率见表 4。八只狗的心脏肿块来自右心房，四只狗的 RA 附属物和四只狗的右房室沟。中位质量大小为 2.8 厘米 × 3.8 厘米（范围 1.8 厘米×2.2 厘米至 6.97 厘米×4.86 厘米）。提交了 14 只狗的 PE 样本进行分析，所有 14 只狗的出血性积液一致。在接受化疗的 16 只狗中，10 只狗接受多柔比星和环磷酰胺，4 只狗单独接受多柔比星，1 只狗接受多柔比星和异环磷酰胺，最后一只狗接受多柔比星和达卡巴嗪。化疗的副作用很常见，但通常被描述为轻度和自限性。

Thoracic radiographs were performed in all 16 dogs, while electrocardiography was performed in 14 dogs and abdominal ultrasonography was performed in 12 dogs. The frequency of abnormalities identified on thoracic radiographs, electrocardiography and abdominal ultrasound is shown in Table 4. The cardiac mass was identified originating from the right atrium in eight dogs, RA appendage in four dogs and in the right AV groove in four dogs. The median mass size was 2 · 8 cm×3 · 8 cm (range 1 · 8 cm×2 · 2 cm to 6 · 97 cm×4 · 86 cm). A sample of PE was submitted for analysis in 14 dogs and was consistent with a haemorrhagic effusion in all 14 dogs. Of the 16 dogs that received chemotherapy, 10 dogs received doxorubicin with cyclophosphamide, 4 dogs received doxorubicin alone, 1 dog received doxorubicin and ifosfamide and the last dog received doxorubicin and dacarbazine. Side effects attributed to chemotherapy were common but were typically described as mild and self-limiting.