Prognostic factors of secondary ovarian carcinoma

Is a Surgical Approach Justified in Metachronous Krukenberg Tumor from Gastric Cancer? A Systematic Review

BACKGROUND

The treatment of metachronous Krukenberg tumor (mKT) from gastric cancer remains unexplored. We performed a literature review to evaluate whether or not surgical treatment improves survival.

METHODS

A systematic review according to PRISMA guidelines was performed. Studies reporting on patients who underwent surgical treatment for mKT from gastric cancer were selected. Metachronous disease was divided as follows: confined to the ovaries, confined to the pelvis, or beyond the pelvis. Outcomes evaluated included overall survival (OS), progression-free survival (PFS), resection rate (R0), and factors predicting survival.

RESULTS

13 retrospective reports fulfilled the selection criteria (512 patients). Most of the patients presented at a premenopausal age. The median presentation interval from gastrectomy ranged from 16 to 21.4 months. Median OS ranged between 9 and 36 months. 1-year OS ranged between 52.5 and 59%, and 3-years OS between 9.8 and 36.5%. Resection margin, peritoneal seeding, and chemotherapy regimen and cycles influenced survival.

CONCLUSION

Surgical treatment and adjuvant chemotherapy in patients with mKT from gastric cancer seems to be associated with improved survival and is justified especially in young patients. Disease location and R0 resection should be considered when selecting patients.

LAPTM4B overexpression is a novel independent prognostic marker for metastatic ovarian tumors

OBJECTIVE

Metastatic ovarian tumors are a series of lethal carcinomas that almost always have bad prognosis. Their prognoses, however, vary depending on the primary tumor malignancies of each. It has been reported that LAPTM4B, a novel tumor-associated gene, might indicate a worse prognosis when it was overexpressed in other carcinomas. Therefore, the authors expected to investigate whether LAPTM4B overexpression is an independent prognostic marker in metastatic ovarian tumors.

METHODS

Immunohistochemistry was used to assess LAPTM4B expression in metastatic ovarian tumors from 102 patients. Subsequently, univariate and multivariate survival analyses with Cox regression were performed to determine the association between LAPTM4B expression and prognosis. To identify any differences in prognosis between the 2 groups of patients with differing primary malignancies, the log-rank test was used.

RESULTS

The median overall and progression-free survival rates of patients with tumors of gastrointestinal tract origin were 0.97 and 0.51 years, respectively, and both were statistically significantly lower than those of patients with tumors of breast origin (P < 0.0001), which were 2.68 and 1.96 years, accordingly. Of 102 patients, 77 were classified as having a high expression of LAPTM4B, and LAPTM4B expression had a significant association with the prognosis of metastatic ovarian tumors (P < 0.01); no statistically significant interaction between LAPTM4B expression and primary malignancies was detected (P > 0.1). On the other hand, medians of overall survival and progression-free survival of patients with tumors of gastrointestinal tract origin were significantly lower than those of patients with tumors of breast origin (P < 0.0001).

CONCLUSIONS

Patients with metastatic ovarian tumors of breast origin had significantly better prognosis than those with the disease from gastrointestinal tract primary malignancies. LAPTM4B overexpression might be an independent prognostic marker of metastatic ovarian tumors.

Clinical characteristics of metastatic tumors to the ovaries

Approximately 5-30% of the ovarian cancers are metastatic malignancies. The prevalence of metastatic ovarian tumors varies with the incidence rates and spread patterns of primary malignancies. We evaluated the prevalence, pre- and postoperative characteristics of metastatic ovarian cancer in Korean women. We reviewed the records for 821 ovarian malignancies with pathological consultation from 1996-2006 and recorded patient demographical, radiological, histopathological, and survival data. The study included 112 cases of histologically confirmed metastatic ovarian cancer. Metastatic ovarian cancer accounted for 13.6% of all ovarian malignancy, primarily arising from the gastrointestinal tract. The preoperative detection rate with imaging was 75%, and none of the radiological or serological features were useful for differential diagnosis. In multivariate analysis for prognostic variables, the only significant factor was the primary tumor site (p=0.004). Furthermore, extensive resection increased survival for some patients. The differential diagnosis of metastatic ovarian cancer can be problematic, so multiple diagnostic approaches are necessary. The extent of cytoreductive surgery for this type of tumor must be decided on a case-by-case basis.

Surgical treatment for patients with different origins of Krukenberg tumors: outcomes and prognostic factors

AIMS

We sought to investigate survival impacts of metastasectomy in women with Krukenberg tumors of the ovary and survival benefits in different origins (gastric cancer, colorectal cancer, or others).

METHODS

All patients diagnosed with Krukenberg tumors of the ovary who underwent surgical treatment at a single institution between 1997 and 2003 were retrospectively evaluated. Survival analyses and comparisons were performed using Kaplan-Meier method and log-rank test.

RESULTS

A total of 54 patients with Krukenberg tumors of the ovary were identified. The estimated 5-year survival was 12.1%. The median survival in patients with microscopic residual disease after metastasectomy was 29.6 months, compared to 10 months in those with visible residual disease (P<0.01). The median survival among patients with Krukenberg tumors of gastric origin, colon and rectum origin, and other origins were 13 months, 29.6 months, and 48.2 months, respectively (P=0.03). There was a significant difference in survival between patients with metastatic disease confined to the ovaries and those with extensive metastases, with an estimated median survival of 30.7 months and 10 months, respectively (P=0.02). Multivariate analysis suggested that the origin of ovarian metastatic carcinoma (P<0.01), residual disease after metastasectomy (P<0.01), and KPS (Karnofsky performance status) (P=0.03) were independent prognostic factors of survival.

CONCLUSIONS

Patients with Krukenberg tumors from colorectal cancer experience a better prognosis than those from gastric cancer and benefit more from metastasectomy. And metastasectomy significantly lengthens overall survival in patients with primary colorectal or breast cancer, higher KPS score, and those with optimal metastasectomy.

Comparison of secondary and primary ovarian malignancies reveals differences in their pre- and perioperative characteristics

OBJECTIVE

Preoperative differentiation of primary and metastatic ovarian tumors is difficult. Young age of the patient, bilateralism and reduced multilocularity are cited characteristics of secondary ovarian malignancies. We sought to identity pre- and perioperative factors which may aid in differentiating metastatic ovarian tumors from primary ovarian malignancies.

PATIENTS AND METHODS

We performed a retrospective analysis of demographic parameters, preoperative serum tumor marker levels and ultrasonographic as well as operative findings in 38 patients with secondary ovarian malignancies and 76 control patients with primary epithelial ovarian cancer. All patients were treated at our institute from 1996 to 2003.

RESULTS

The proportion of secondary ovarian tumors, of all ovarian malignancies, was 5.2%. The most common sites of origin were the gastrointestinal tract (42%), breast (29%) and peritoneum (16%). Fifty-eight percent of the patients with a secondary ovarian tumor had a history of previous malignancy; 42% of the primary malignancies were detected only following diagnosis of ovarian metastasis. The two patient groups (primary or secondary ovarian malignancy) could not be distinguished by age, parity, menopausal status or history of hysterectomy. Of the serum markers, the preoperative level of serum CA 125 was not different between the two groups. Both serum tumor-associated trypsin inhibitor (TATI) (7.2 +/- 9.6 vs. 4.7 +/- 9.4 mug/l [mean +/- SD]) and carsinoembryonic antigen (CEA) levels (19.7 +/- 30.8 vs. 6.7 +/- 120.0 mug/l) were higher in the group with secondary malignancies (P < 0.02). The metastatic ovarian tumors, as measured preoperatively by ultrasonography (US), were smaller (64 mm, 62-89 mm [median, 95% Cl]) than the primary tumors (105 mm, 104-134 mm) (P < 0.0005). The same was true for tumor sizes measured at surgery (P < 0.05). Furthermore, the secondary tumors were more often solid (50 vs. 10%) (P < 0.005), and more seldom cystic-solid (17 vs. 55%) (P < 0.001). Presence of ascites was more common among patients with primary ovarian malignancies in both preoperative US (P < 0.01) and at operation (P < 0.0001). Bilateralism, presence of adhesions, and carcinosis did not differ between the two groups.

CONCLUSIONS

When evaluating a patient with an ovarian tumor, a history of malignancy strongly suggests a metastatic nature. Size less than 9 cm, solid structure, absence of ascites and elevated serum CEA and TATI levels were typical features associated with secondary ovarian malignancies.