Treatment strategy and prognostic factors for Krukenberg tumors of gastric origin: report of a 10-year single-center experience from China
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Pengfei Yu1, Ling Huang1, Guoping Cheng2, Litao Yang1, Gaiguo Dai1, Jieer Ying3 and Yian Du1
1Department of Abdominal Surgery, Zhejiang Cancer Hospital, Hangzhou 310022, China
2Department of Pathology, Zhejiang Cancer Hospital, Hangzhou 310022, China
3Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
Pengfei Yu, email: [email protected]
Yian Du, email: [email protected]
Keywords: Krukenberg tumors, gastric cancer, metastasectomy, chemotherapy, prognosis
Abbreviations: OS: overall survival; HIPEC: hyperthermic intraperitoneal chemotherapy; ER: estrogen receptor; PR: progesterone receptor; IHC: immunohistochemistry
Received: May 16, 2017 Accepted: June 30, 2017 Published: August 01, 2017
Background: Gastric cancer patient with ovarian metastasis is common in clinical practice, but it is still uncertain whether surgical resection of ovarian metastasis could improve the outcome. This study aimed to explore the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone in the treatment of Krukenberg tumors arising from gastric cancer and to identify prognostic factors.
Results: A total of 152 patients were identified, including 93 patients with synchronous ovarian metastasis and 59 patients with metachronous ovarian metastasis. Overall survival (OS) was significantly better in metastasectomy group relative to the non-metastasectomy group for patients with synchronous ovarian metastasis (19.0 months vs. 11.8 months; P < 0.001) and those with metachronous ovarian metastasis (24.6 months vs. 14.3 months; P = 0.02), respectively. Metastasectomy (hazard ration [HR] 0.486; 95% confidence interval [CI] 0.323–0.729; P < 0.001), peritoneal carcinomatosis (HR 1.934; 95% CI 1.230–3.049; P = 0.004), and expression status of ER-β (HR 0.404; 95% CI 0.251–0.648; P < 0.001) and PR (HR 0.496; 95% CI 0.301–0.817; P < 0.001) were independent predictors of OS.
Methods: All patients who were diagnosed with gastric cancer and ovarian metastases between January 2005 and December 2014 were included in the current study. Patients were subdivided according to treatment modality: the metastasectomy group (metastasectomy plus chemotherapy) and the non-metastasectomy group (chemotherapy alone). The clinicopathological features and the treatment records were reviewed in detail and their association with survival were analyzed.
Conclusion: Metastasectomy plus chemotherapy was associated with survival benefits in patients with Krukenberg tumors from gastric cancer. Metastasectomy, peritoneal carcinomatosis, and expression status of ER-β and PR were independent prognostic factors for survival.
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