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Thakur P, Sharma M, Chauhan A, Pal KM, Thakur S, Gupta M, Kaushal S. Colorectal Origin: A Marker of Favorable Outcome in Krukenberg Tumor? Results from Clinical and Prognostic Analysis. South Asian J Cancer 2024; 13:99-105. [PMID: 38919659 PMCID: PMC11196140 DOI: 10.1055/s-0043-1776789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Purnima Thakur This study aimed to identify the prognostic factors affecting the survival of patients suffering from Krukenberg tumor (KT) and also to determine the survival in these patients. A retrospective review of patients diagnosed with KT between January 2015 and December 2021 was conducted at a tertiary cancer center. Clinicopathological variables were scrutinized, and survival analysis was performed. Thirty-six patients were enrolled in this study. The median age at diagnosis was 48 years (ranging from 22 to 71 years). The median overall survival (OS) was 9.9 months (95% confidence interval [CI]: 6.6 to 13 months). The mean OS for tumors originating in the colorectal region was longer compared to that for tumors of other sites (15.4 vs. 9 months, respectively; p = 0.048). In univariate analysis, patients who received chemotherapy had better survival, while those presenting with ascites had a poor prognosis. No correlation was observed between age, menstrual status, bilaterality, size of ovarian metastases, extent of metastatic disease, metastasectomy, and survival. Multivariate Cox regression analysis showed that chemotherapy predicted a favorable survival outcome (hazard ratio [HR] = 0.200, 95% CI: 0.046-0.877, p -value = 0.033). KT is an aggressive tumor with a median OS of less than a year. Chemotherapy may improve survival. Patients with a primary tumor in the colorectal region have a better outcome, while those presenting with ascites indicate a poor prognosis.
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Affiliation(s)
- Purnima Thakur
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Mukesh Sharma
- Department of Radiotherapy, Dr. Yashwant Singh Parmar Government Medical College, Nahan, Sirmaur, Himachal Pradesh, India
| | - Ashish Chauhan
- Department of Gastroenterology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Kapil M. Pal
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Shabnam Thakur
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Manish Gupta
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Shilpa Kaushal
- Department of Radiotherapy, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
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Yang Z, Lu S, Shi M, Yuan H, Wang Z, Ni Z, He C, Zheng Y, Zhu Z, Liu W, Yao X, Zhang J, Li C, Yan M, Yan C, Zhu Z. Oncological outcomes of conversion therapy in gastric cancer patients with peritoneal metastasis: a large-scale retrospective cohort study. Gastric Cancer 2024; 27:387-399. [PMID: 38143257 PMCID: PMC10896904 DOI: 10.1007/s10120-023-01452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Data on the long-term oncological outcomes of patients who undergo conversion surgery (CS) in gastric cancer (GC) patients with peritoneal metastasis (PM) are limited. METHODS GC patients with PM who received intraperitoneal (ip) and systemic chemotherapy between April 2015 and January 2021 were enrolled. Multivariate analysis was performed to identify risk factors associated with survival. Clinicopathological and survival outcomes were compared between those with CS and those without CS (NCS). The paclitaxel (PTX) plus tegafur-gimeracil-oteracil potassium capsules (S-1) (PS) + ip PTX and oxaliplatin plus S-1 (SOX) + ip PTX groups were matched in a 1:1 ratio using propensity score matching. Oncological and survival data were collected and analyzed. RESULTS A total of 540 patients who received ip chemotherapy via subcutaneous port and systemic chemotherapy were analyzed and 268 patients were enrolled, including 113 who underwent CS and 155 who did not. Overall survival (OS) were 27.0 months and 11.8 months in the CS and NCS groups (P < 0.0001), respectively. R0 resection was an independent prognostic factor for patients who underwent CS. The OS of patients with or without ovariectomy was 21.3 or 12.0 months (P < 0.0001). No difference of clinicopathological and survival outcomes was found between the PS + ip PTX and SOX + ip PTX groups. CONCLUSION Conversion therapy is safe and adverse events were manageable. CS improves the survival of GC patients with PM after ip and systemic chemotherapy. R0 is an important prognostic factor. Furthermore, outcomes are comparable between the PS + ip PTX and SOX + ip PTX groups.
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Affiliation(s)
- Zhongyin Yang
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Sheng Lu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Min Shi
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Yuan
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenqiang Wang
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Zhentian Ni
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Changyu He
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Yanan Zheng
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Zhenglun Zhu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Wentao Liu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Xuexin Yao
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Jun Zhang
- Department of Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Li
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Min Yan
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
| | - Chao Yan
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China.
| | - Zhenggang Zhu
- Shanghai Key Laboratory of Gastric Neoplasms, Department of General Surgery, Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197 Ruijin er Road, Shanghai, China
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Shi J, Huang A, Song C, Li P, Yang Y, Gao Z, Sun F, Gu J. Effect of metastasectomy on the outcome of patients with ovarian metastasis of colorectal cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106961. [PMID: 37355393 DOI: 10.1016/j.ejso.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/21/2023] [Accepted: 06/15/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Patients with ovarian metastasis of colorectal cancer (CROM) usually have poor prognosis. Metastasectomy is controversial in patients with CROM. This study aims to evaluate the prognostic value of ovarian metastasectomy and other factors in CROM patients. METHODS We searched literature up to November 1, 2021 in MEDLINE (PubMed), Embase, Cochrane Library, and Clinicaltrials.gov. Retrospective studies were assessed if survival outcome of CROM patients was reported. Results were pooled in a random-effects model and reported as hazard ratios (HRs) with 95% confidence intervals (CI). Sensitivity was analyzed. RESULTS Among 2497 studies screened, 15 studies with 997 patients, published between 2000 and 2021, were included. Longer overall survival (OS) was correlated with ovarian metastasectomy (pooled HR = 0.44, 95% CI: 0.34-0.58, P < 0.05) and R0 resection (pooled HR = 0.26, 95% CI: 0.16-0.41, P < 0.05). Longer disease-specific survival (DSS) was associated with systematic chemotherapy (pooled HR = 0.26, 95% CI: 0.15-0.45, P < 0.0001). Shorter OS was associated with extraovarian metastases (pooled HR = 3.00, 95% CI 1.68-5.36, P < 0.05) and bilateral OM (pooled HR = 1.66, 95% CI: 1.09-2.51, P < 0.05). No significant difference in OS was observed among patients with systematic chemotherapy (pooled HR = 0.68, 95% CI: 0.35-1.31, P > 0.05). CONCLUSION Metastasectomy achieving R0 resection can significantly prolong OS and DSS of CROM patients as a reasonable treatment modality. Primary tumor resection and systematic chemotherapy can improve patients' outcomes. REGISTRATION NUMBER CRD42022299185 (http://www.crd.york.ac.uk/PROSPERO).
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Affiliation(s)
- Jingyi Shi
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery III, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - An Huang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery III, Peking University Cancer Hospital & Institute, Beijing, 100142, China
| | - Can Song
- School of Life Science, Tsinghua University, Beijing, 100142, China; PekingTsinghua Center for Life Science, Peking University International Cancer Center, Beijing, 100142, China
| | - Pei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China; The Department of Nosocial Infection Management, Peking University Third Hospital, Beijing, 100191, China
| | - Yong Yang
- Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, 100144, China
| | - Zhaoya Gao
- Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, 100144, China; Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Feng Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, 100191, China
| | - Jin Gu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Surgery III, Peking University Cancer Hospital & Institute, Beijing, 100142, China; PekingTsinghua Center for Life Science, Peking University International Cancer Center, Beijing, 100142, China; Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, 100144, China.
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Fang J, Huang X, Chen X, Xu Q, Chai T, Huang L, Chen H, Chen H, Ye Z, Du Y, Yu P. Efficacy of chemotherapy combined with surgical resection for gastric cancer with synchronous ovarian metastasis: A propensity score matching analysis. Cancer Med 2023; 12:17126-17138. [PMID: 37519112 PMCID: PMC10501252 DOI: 10.1002/cam4.6362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/01/2023] [Accepted: 07/10/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Ovarian metastasis from gastric cancer (GC) is characterized by aggressive biological behavior and poor outcome. Currently, there is no standard treatment mode for such patients. Thus, we evaluated the efficacy of conversion therapy in patients with synchronous ovarian metastasis from GC in this study. METHODS About 219 GC patients with ovarian metastasis in 2011-2020 were enrolled. Two groups were established based on the different treatment: the conversion therapy group (chemotherapy combined with surgical resection, CS group) and the non-conversion therapy group (NCS group). Propensity score matching (PSM) was used to analyze the efficacy of different treatment modes on the prognosis of these patients. RESULTS Ninety-two patients were included according to PSM results, with 46 patients each in CS and NCS groups. The median overall survival (OS) in the CS group was notably better than that in the NCS group (p < 0.001). Twenty-six patients (56.52%) in the CS group achieved R0 resection, and they had a better prognosis (p = 0.003). Compared with patients who underwent simultaneous gastrectomy and ovarian metastasectomy (CSb group), those who underwent ovarian metastasectomy before systemic chemotherapy (CSa group) had a higher R0 resection rate (p = 0.016) and longer survival time (p = 0.002). A total of 38 patients (41.30%) across both groups received hyperthermic intraperitoneal chemotherapy (HIPEC), and these patients had a better survival (p = 0.043). CONCLUSION The conversion therapy is safe and effective for patients with synchronous ovarian metastasis from GC and can improve their prognosis. However, our results need to be confirmed by more randomized controlled clinical studies.
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Affiliation(s)
- Jingquan Fang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
- Zhejiang Chinese Medical UniversityHangzhouChina
| | - Xingmao Huang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
- Wenzhou Medical UniversityWenzhouChina
| | - Xiangliu Chen
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Qi Xu
- Department of Medical oncology, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Tengjiao Chai
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Ling Huang
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Han Chen
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Hang Chen
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Zeyao Ye
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Yian Du
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
| | - Pengfei Yu
- Department of Gastric Surgery, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC)Chinese Academy of SciencesHangzhouChina
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Zhang Y, Du H, Li T, Li H, Deng Y, Wu R. Krukenberg Tumor of Gastric Origin in Pregnant Women with Preeclampsia. Case Rep Oncol 2023; 16:718-727. [PMID: 37936663 PMCID: PMC10626216 DOI: 10.1159/000531991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/06/2023] [Indexed: 11/09/2023] Open
Abstract
Krukenberg tumor refers to a malignancy in the ovary that metastasizes from a primary site, classically the gastrointestinal tract. Pregnancy complicated with a Krukenberg tumor is very rare. In this report, we present two unusual cases of pregnant women with Krukenberg tumors of gastric origin. One case was a full-term pregnant woman with preeclampsia (PE) who underwent a caesarean section when bilateral enlarged ovaries were incidentally identified. Histopathology of the wedge resection biopsy showed single-ring cell carcinoma; this was followed by gastroscopy, which indicated a gastric origin. The woman received chemotherapy but died 6 months later. Another case was a pregnant woman at 30 gestational weeks with abdominal pain complicated with early-onset PE. Ultrasonography and magnetic resonance imaging showed bilateral enlarged ovaries and elevated tumor markers. Gastroscopy indicated linitis plastica. After an emergency caesarean section, adnexectomy was performed, and postoperative histopathology confirmed a Krukenberg tumor. The woman died 2 months after delivery. Gastrointestinal symptoms during pregnancy may indicate a malignancy of rare gastrointestinal origin. PE complicated with Krukenberg tumors in pregnancy should be considered in future studies.
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Affiliation(s)
- Yongke Zhang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Taili Li
- Department of Pathology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Huan Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Yuqing Deng
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
| | - Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, China
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Imaging of Metastatic Disease to the Ovary/Adnexa. Magn Reson Imaging Clin N Am 2022; 31:93-107. [DOI: 10.1016/j.mric.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lionetti R, DE Luca M, Raffone A, Travaglino A, Coppellotti A, Peltrini R, Bracale U, D'Ambra M, Insabato L, Zullo F, D'Armiento M, Corcione F. Clinics and pathology of Krukenberg tumor: a systematic review and meta-analysis. Minerva Obstet Gynecol 2022; 74:356-363. [PMID: 33944524 DOI: 10.23736/s2724-606x.21.04797-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Krukenberg tumor (KT) is defined as a secondary neoplasm of the ovary. While ovarian metastases account for about 30% of ovarian tumors, KTs are rare, accounting for about 1-2% of the total. The rarity of KT is at least in part responsible for the lack of a precise clinic-pathological characterization of these tumors. Clinically, KT may have a subtle clinical presentation, with few symptomatic manifestations and nonspecific clinical signs, even though in literature there is disagreement about the clinical presentation of these patients; such difficulties in the diagnostic framework often leads to a delayed diagnosis with serious consequences on the patient outcome. We aimed to provide a clinico-pathological characterization of Krukenberg Tumor (KT) through a systematic review and meta-analysis to improve the diagnosis and management of KT. EVIDENCE ACQUISITION Electronic databases were searched for all studies assessing clinico-pathological features of KT series. Pooled prevalence of each clinical or pathological factor was calculated according to the random-effect model. EVIDENCE SYNTHESIS Forty-eight studies with 3025 KT patients were included; 39.7% of patients were ≥50 and 39.8% were postmenopausal. The most common primary tumor sites were stomach (42.5%), colon-rectum (26.1%), breast (9.3%), and appendix (5%); 48.7% of KTs were synchronous with the primary tumor, 64.3% were bilateral, 40.5% had a diameter ≥10 cm; 55.3% showed extraovarian extent and 49% showed peritoneal involvement. The most common presenting symptoms were ascites (51.7%), palpable mass (31.3%), pain (29.3%), abdominal distention (28.7%), irregular bleeding (9.1%), asymptomatic (11.2%). CONCLUSIONS KT shows a highly variable presentation. Understanding the prevalence of clinico-pathological factors may be helpful to improve the diagnosis and management of KT.
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Affiliation(s)
- Ruggero Lionetti
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Marcello DE Luca
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy -
| | - Antonio Raffone
- Service of Obstetrics and Gynecology, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Service of Pathological Anatomy, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Alberto Coppellotti
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Roberto Peltrini
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Umberto Bracale
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Michele D'Ambra
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Luigi Insabato
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Fulvio Zullo
- Service of Obstetrics and Gynecology, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maria D'Armiento
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Corcione
- Service of Minimally Invasive Oncological and General Surgery, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
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Lin X, Han T, Zhuo M, Liu T, Liu Z, Xiang D, Li H, Xiao X. A retrospective study of clinicopathological characteristics and prognostic factors of Krukenberg tumor with gastric origin. J Gastrointest Oncol 2022; 13:1022-1034. [PMID: 35837152 PMCID: PMC9274061 DOI: 10.21037/jgo-22-464] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/14/2022] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Krukenberg tumor (KT) of gastric origin has a poor prognosis. The present study of KTs are mainly case reports and clinical analysis with few samples. Therefore, it is urgent to explore the clinicopathologic characteristics of KTs through large sample studies. To improve the understanding of the clinical diagnosis and treatment of KT, this paper retrospectively analyzed 10 years of gastric cancer (GC) database data, including clinicopathological and prognostic features, aiming to provide a clinical reference for the diagnosis and treatment of the tumor. METHODS The clinicopathological characteristics, treatments, and survival data were collected and analyzed from 130 patients with KTs of GC. Clinicopathological data included clinical manifestations, laboratory findings, imaging reports, pathology and immunohistochemistry (IHC) reports. We collected treatment regimens information on whether they had undergone surgery and chemotherapy and performed survival follow-up. Univariate and multivariate analysis were used to investigate the risk factors of KTs with gastric origin. RESULTS The median age of the patients was 41 years. A total of 63.1% of patients had synchronous ovarian metastasis, 70.8% had bilateral ovarian metastasis, 68.5% had peritoneum metastasis, and 98.5% had pathologically poorly differentiated adenocarcinoma. The positive rate of human epidermal growth factor receptor 2 (HER-2) was 1.8%. The follow-up rate was 90.8%, and the median overall survival (mOS) of ovarian metastasis was 13.0 months. Univariate analysis showed statistically significant prognostic factors including menstrual status, size of the gastric lesions and ovarian metastases, number of lymph node metastasis, interval to ovarian metastasis, resection of gastric lesions, peritoneal metastasis, oophorectomy, chemotherapy after ovarian metastases, two-drug regimen chemotherapy, albumin, serum cancer antigen 125 (CA-125) levels, platelet count, D-dimer, fibrinogen, and high pretreatment platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII). Fibrinogen [hazard ration (HR) =0.483; 95% confidence interval (CI): 0.300-0.777; P=0.003], size of ovarian metastasis (HR =1.808; 95% CI: 1.178-2.776; P=0.007), chemotherapy after ovarian metastasis (HR =0.195; 95% CI: 0.101-0.379; P=0.000), peritoneal metastasis (HR =2.742; 95% CI: 1.606-4.682; P=0.000) and oophorectomy (HR =1.720; 95% CI: 1.066-2.778; P=0.026) were independent prognostic factors. CONCLUSIONS GC patients with KTs have some unique clinical features. Hypercoagulable states, peritoneal metastasis, and untimely chemotherapy and oophorectomy might be a worse predictor for KTs derived from gastric origin.
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Affiliation(s)
- Xiaolin Lin
- Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Han
- Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Zhuo
- Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tengfei Liu
- Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zebing Liu
- Department of Pathology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dongxi Xiang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Li
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiuying Xiao
- Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Mendoza-Rosado F, Nunez-Isaac O, Espinosa-Marrón A, Lopez-Arjona K, Davila-Martinez F. Krukenberg tumor as an incidental finding in a full-term pregnancy: a case report. J Med Case Rep 2021; 15:304. [PMID: 34049591 PMCID: PMC8164271 DOI: 10.1186/s13256-021-02875-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Krukenberg tumor is a rare metastatic tumor of the ovary with histopathological features known as signet ring cells. It usually develops in women around 45 years of age. However, here we describe an uncommon case in a 38-year-old pregnant woman. We report this case due to our unusual findings, the uncommon presentation in this younger age bracket, its diagnostic challenge, and poor prognosis. Case presentation We describe a unique case of a young Mexican woman with a history of painful vaginal bleeding at 13 weeks of pregnancy and treated for abruptio placentae. In her routine prenatal visit at week 20 of pregnancy, she was found to have a uterine fundus exceeding the expected measure for her gestational age and was referred to the hospital to discard polyhydramnios. Upon admission, a pelvic ultrasound was performed displaying normal findings in a 25-week pregnancy, and also showing bilateral enlarged ovaries with heterogeneous echogenicity. Magnetic resonance imaging revealed a left tumoral lesion with dimensions of 22.1 × 13.6 × 16.3 cm presenting regular lobulated contours with displacement of peripheral structures and mild compression of the bladder, the left ureter, and the inferior vena cava. The lesion was heterogeneous with irregular borders. The patient was scheduled for a cesarean section; during the operation, the abdominal cavity showed bilateral tumors compatible with MRI findings. The ovarian tumors were sent to pathology, and the results showed poorly differentiated mucinous adenocarcinoma (World Health Organization grade III) with extensive signet ring cells, indicative of a Krukenberg tumor. Conclusion This case report describes an uncommon example of a young pregnant woman without identifiable risk factors for gastric cancer who manifested a Krukenberg tumor. This incidental finding suggests that pregnancy obscured the cancer’s clinical appearance. The rapid deterioration in the patient’s condition corresponds to what is described in the literature. The limited information regarding this neoplasm in Mexico and the torpid evolution of the case highlight the importance of conducting additional studies to generate therapeutic interventions aimed at increasing overall survival.
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Affiliation(s)
| | | | - Alan Espinosa-Marrón
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Fernando Davila-Martinez
- Department of Gynecology and Obstetrics, Hospital Regional Ignacio García Téllez, Merida, Mexico
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Xie H, Erickson BJ, Sheedy SP, Yin J, Hubbard JM. The diagnosis and outcome of Krukenberg tumors. J Gastrointest Oncol 2021; 12:226-236. [PMID: 34012621 DOI: 10.21037/jgo-20-364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Accurate diagnostic tools are crucial to distinguish patients with Krukenberg tumors from those with ovarian cancers before decision on initial management. To address this unmet need, we aimed to evaluate the diagnostic utility of clinical, biochemical, and radiographic factors in this patient population. Methods Patients with Krukenberg tumors or primary ovarian cancers were retrospectively identified from institutional cancer registry. Kaplan-Meier method and Cox proportional hazards models were used for survival analysis. Logistic regression evaluated clinical, biochemical, and radiographic factors; residual deep neural network model evaluated features in computed tomography images as predictors to distinguish Krukenberg tumors from ovarian cancers. Model performance was summarized as accuracy and area under the receiver operating characteristic curve (AUC). Results This study included 214 patients with Krukenberg tumors with median age of 52 years. Among 104 (48.6%) patients with colorectal cancer, those who received palliative surgery had significantly higher median overall survival (48.1 versus 30.6 months, P=0.015) and progression-free survival (22.2 versus 6.7 months, P<0.001) than those with medical management only. The accuracy of radiology reports to make either diagnosis of Krukenberg tumors or primary ovarian cancers was 60.7%. In contrast, multivariable logistic regression model with age [odds ratio (OR) 2.98, P<0.001], carbohydrate antigen 125 (OR 1.57, P=0.004), and carcinoembryonic antigen (OR 0.03, P=0.031) had 87.5% [95% confidence interval (CI): 75.0-100.0%] accuracy with AUC 0.96 (95% CI: 0.87-1.00). The neural network model had 62.8% (95% CI: 51.8-74.5%) accuracy with AUC of 0.61 (95% CI: 0.53-0.72). Conclusions We developed a diagnostic model with clinical and biochemical features to distinguish Krukenberg tumors from primary ovarian cancers with promising accuracy.
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Affiliation(s)
- Hao Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.,Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | | | | | - Jun Yin
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
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Okamoto T, Suzuki H, Fukuda K. Gastric linitis plastica due to signet-ring cell carcinoma with Krukenberg tumors diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Clin J Gastroenterol 2021; 14:994-1003. [PMID: 33740238 DOI: 10.1007/s12328-021-01387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/12/2021] [Indexed: 11/30/2022]
Abstract
Gastric linitis plastica is a rare condition characterized by the stiffening and thickening of the gastric wall, presenting a "leather bottle" appearance. It is generally associated with infiltration of poorly differentiated gastric cancer cells, but similar findings can arise due to metastases from other cancers and benign inflammatory processes. Despite advances in imaging modalities, pathological evaluation is required for diagnosis. As endoscopic mucosal biopsies may not be diagnostic, endoscopic ultrasound-guided fine-needle aspiration of the thickened stomach wall presents a potential diagnostic option. We report a case which presented with bilateral ovarian tumors and was ultimately diagnosed as gastric signet-ring cell carcinoma with Krukenberg tumors by endoscopic ultrasound-guided fine-needle aspiration of the stomach wall. The preoperative diagnosis allowed the patient to avoid surgery and to start chemotherapy for gastric cancer. We also review the existing literature on endoscopic ultrasound-guided fine-needle aspiration in the context of gastric linitis plastica.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan. .,Department of Gastroenterology and Hepatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan.
| | - Hidekazu Suzuki
- Department of Gastroenterology and Hepatology, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1143, Japan
| | - Katsuyuki Fukuda
- Department of Gastroenterology, St. Luke's International Hospital, 9-1 Akashicho, Chuo-ku, Tokyo, 104-8560, Japan
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Affiliation(s)
- Bifica Sofia Lyngdoh
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Department of Pathology. Shillong, India
| | - Biswajit Dey
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Department of Pathology. Shillong, India
| | - Jaya Mishra
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Department of Pathology. Shillong, India
| | - Evarisalin Marbaniang
- North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Department of Pathology. Shillong, India
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