Survival and Related Prognostic Factors for Patients with Superior Vena Cava Syndrome in Palliative Settings Survival Factors for SVC Syndrome

Abstract

OBJECTIVE: The safety of upfront systemic treatment without radiation is questionable in patients with superior vena cava (SVC) syndrome. Whether steroids or loop diuretics can improve patients’ outcomes is unclear. This study aimed to evaluate the prognostic factors affecting overall survival (OS).
METHODS: Data of patients with SVC syndrome caused by neoplasm and treated with palliative intent were retrospectively collected. Cox proportional hazard regression was used to analyze the associations between variables and time until death.
RESULTS: A total of 104 patients were identified. The median follow-up time was 81 days. The mean age was 56.4 years (standard deviation (SD) 16.5 years). Among the patients, 22.1% received systemic therapy as an upfront treatment. Steroids and loop diuretics were administered in 50% and 34.6% of patients, respectively, and 7.7% were intubated. Multivariable analysis revealed intubation as an only significant independent factor for OS (hazard ratio 3.47; 95% confidence interval 1.2–10.05). Intubated and nonintubated patients had 1-year OS rates of 12.5% and 17.6%, respectively, and their median OS values were 6 and 86 days, respectively (p-value 0.02). For patients treated with radiotherapy and systemic treatment, 1-year OS rates were 17.1% and 17.4% (median survival of 86 and 71 days) (p-value 0.8). Symptomatic improvement was reported in 8 and 27 patients after receiving systemic therapy and radiation with mean duration of 9.4 (SD 5.4), and 8.2 (SD 4.7) days.
CONCLUSION: Intubation is a poor prognostic factor. No difference in OS was observed between the patients who received systemic treatment and radiotherapy as upfront therapy. Neither steroids nor loop diuretics showed any benefit in terms of survival.