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Metastasectomy Improves the Survival of Gastric Cancer Patients with Krukenberg Tumors: a Retrospective Analysis of 182 Patients

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Metastasectomy Improves the Survival of Gastric Cancer Patients with Krukenberg Tumors: a Retrospective Analysis of 182 Patients Cancer Management and Research Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Metastasectomy Improves the Survival of Gastric Cancer Patients with Krukenberg Tumors: A Retrospective Analysis of 182 patients This article was published in the following Dove Press journal: Cancer Management and Research Fuhai Ma 1 Purpose: There is no consensus regarding whether metastasectomy in gastric cancer Yang Li 1 patients with Krukenberg tumors (KTs) is associated with survival benefits. The aim of Weikun Li 1 this study was to evaluate the treatment of KTs of gastric origin in a large series of patients Wenzhe Kang 1 and to identify prognostic factors affecting survival. Hao Liu 1 Patients and Methods: All patients who were diagnosed with gastric cancer and ovarian metastases in a single medical center between January 2006 and December 2016 were Shuai Ma 1 identified and included. The patients were divided into two groups according to treatment Yibin Xie 1 1 modality: a metastasectomy group and a nonmetastasectomy group. Clinicopathological Yuxin Zhong features and overall survival (OS) were compared between the groups. 1 Quan Xu Results: In total, 182 patients were identified; 94 patients presented with synchronous KTs, and 2 Bingzhi Wang 88 developed metachronous KTs during follow-up. OS was significantly longer in the metasta- 2 Liyan Xue sectomy group than in the nonmetastasectomy group among those with synchronous (14.0 1 Yantao Tian months vs 8.0 months; p = 0.001) and metachronous (14 months vs 8 months; p = 0.018) KTs. fi 1Department of Pancreatic and Gastric Multivariate analysis indicated that metastasectomy (hazard ratio [HR] 0.537; 95% con dence Surgery, National Cancer Center/ interval [CI] 0.344–0.839; p = 0.006), ascites (HR 1.523; 95% CI 1.058–2.193; p = 0.024), linitis National Clinical Research Center for plastica (HR 1.995; 95% CI 1.115–3.571; p = 0.020), and systemic chemotherapy (HR 0.456; Cancer/Cancer Hospital, Chinese – Academy of Medical Sciences and Peking 95% CI 0.280 0.742; p = 0.002) were independent predictors of OS. Union Medical College, Beijing 100021, Conclusion: Metastasectomy combined with systemic chemotherapy should be performed ’ 2 People s Republic of China; Department in gastric cancer patients with synchronous or metachronous KTs. Metastasectomy, systemic of Pathology, National Cancer Center/ National Clinical Research Center for therapy, linitis plastica, and ascites are prognostic factors for OS. Further prospective Cancer/Cancer Hospital, Chinese randomized studies are needed. Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, Keywords: gastric cancer, ovarian metastasis, Krukenberg tumor, ovarian metastasectomy, People’s Republic of China survival benefit Introduction Gastric cancer is the fourth most common cancer worldwide and the second leading cause of cancer-related death.1,2 Although surgery remains the gold standard Correspondence: Yantao Tian therapy for this disease, locoregional relapse or distant metastasis occurs in Department of Pancreatic and Gastric Surgery, National Cancer Center/ a majority of patients after curative resection.3 Moreover, many patients are diag- National Clinical Research Center for Cancer/Cancer Hospital, Chinese nosed at advanced stages with synchronous or metachronous metastases in the Academy of Medical Sciences and Peking peritoneum, ovary, and liver.4 Despite multimodal therapy and improvement in Union Medical College, Chaoyang 5 District, Beijing 100021, People’s Republic systemic therapy, the outcomes of these patients remain extremely poor. of China A Krukenberg tumor (KT) is a malignancy that has metastasized to the ovaries, Tel\Fax +86-10-87787120 6,7 8 Email [email protected] and its prognosis is dismal. Gastric cancer is the leading primary origin of KT, submit your manuscript | www.dovepress.com Cancer Management and Research 2019:11 10573–10580 10573 DovePress © 2019 Ma et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php – http://doi.org/10.2147/CMAR.S227684 and incorporate the Creative Commons Attribution Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Ma et al Dovepress and ovarian metastasis is one of the most important causes presence or absence of gross residual disease, which was of treatment failure in gastric cancers among female classified as negative resection margins (R0), microscopic patients.7,9 Unfortunately, no optimal treatment strategies tumor infiltration (R1), and macroscopic residual tumor (R2). or guidelines for patients diagnosed with KTs of gastric Chemotherapy was administered in all synchronous KT origin have been clearly established. Moreover, only a few patients who did not undergo metastasectomy and 14 studies have assessed the value of metastasectomy for KTs metachronous KT patients who did not undergo metasta- of gastric origin, and the survival benefit of ovarian metas- sectomy (82.4%). 49 synchronous KT patients and 48 tasectomy remains controversial. Indeed, some studies metachronous KT patients who underwent metastasectomy have shown that resection of metastatic tumors can pro- received chemotherapy, while 8 patients with synchronous long survival,9–12 whereas others have found that aggres- KT and 23 patients with metachronous KT who underwent sive surgical therapy offers no benefit.13,14 metastasectomy did not receive chemotherapy due to poor Therefore, we conducted this study to investigate the performance status after metastasectomy or toxicity con- survival benefit of ovarian metastasectomy for gastric cerns. The majority of the patients received 2- or 3-drug patients with synchronous or metachronous KTs derived combinations, usually for 4–8 cycles. The main che- from gastric cancer and to identify prognostic factors motherapeutic drugs included cisplatin, carboplatin, oxali- affecting survival. platin, taxane, irinotecan and 5-fluorouracil. To compare overall survival (OS), patients were divided Materials and Methods into two groups according to the treatment modality they All patients who were diagnosed with gastric cancer and received: a metastasectomy group and a nonmetastasectomy ovarian metastases at the Cancer Hospital of the Chinese group. For patients with synchronous KTs, OS was defined Academy of Medical Sciences between January 2006 and as the time from the date of the pathologic diagnosis of December 2016 were enrolled in the study. gastric cancer to the date of death or last follow-up. For Clinicopathological features and treatment records were patients with metachronous KTs, OS was defined as the time reviewed in detail. The diagnosis of KT was based on from the date of KT diagnosis by imaging to the date of the pathological evaluation of metastasectomy specimens death or the last follow-up. Evaluation of patient survival or computed tomography (CT) or ultrasonography find- was performed by follow-up contact via telephone calls and ings. All patients with gastric cancer received using outpatient records. Patients were followed up until a pathological diagnosis. The cancer had been staged death or December 31, 2018. according to the American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) system. All study Statistical Analyses procedures were approved by the Institutional Review A chi-square test or Fisher’s exact test was applied to com- Board of our hospital. The datasets in the current study pare clinicopathologic data. Comparisons of continuous are available from the corresponding author on reasonable variables were performed using the t test. Cumulative survi- request. val rates were obtained using the Kaplan–Meier method and ≥ Clinicopathological variables included age ( 45 or <45 compared using the log rank test to evaluate statistically years), menopausal status (premenopausal or postmenopau- significant differences. Cox proportional hazards regression sal), primary tumor location, size of the ovarian metastasis, analysis was employed to evaluate factors affecting OS. A p ovarian involvement (unilateral or bilateral), pathology value < 0.05 was considered significant. The statistical ana- reports, other types of metastasis, extent of the disease, lysis was performed with SPSS for Windows version 22.0. ascites (presence or absence) before or during resection of the ovarian metastasis and systemic chemotherapy. Synchronous KT was defined as the initial presentation of Results ovarian metastasis; metachronous KT was defined as detec- Patient Clinicopathological tion of KTs upon relapse or disease progression after radical Characteristics gastrectomy. Ascites was determined by CT or ultrasonogra- A total of 94 patients with synchronous KTs were included phy before ovarian metastasectomy or was found during the in this study; 57 (60.6%) and 37 (39.4%) patients did and operation. At the completion of metastasectomy, the residual did not undergo metastasectomy for KTs, respectively. The disease state of each patient was recorded according to the clinical characteristics of the synchronous KT patients are 10574 submit your manuscript |
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