Cancer Res Treat.  2015 Oct;47(4):697-705. 10.4143/crt.2013.175.

Comparison of Surgery Plus Chemotherapy and Palliative Chemotherapy Alone for Advanced Gastric Cancer with Krukenberg Tumor

• Cho JH
• Lim JY
• Choi AR
• Choi SM
• Kim JW
• Choi SH
• Cho JY

• KMID: 2403388
• DOI: http://doi.org/10.4143/crt.2013.175

Abstract

PURPOSE
This study was conducted to validate the survival benefit of metastasectomy plus chemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastric cancer and to identify prognostic factors for survival.
MATERIALS AND METHODS
Clinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy and arm B, chemotherapy alone.
RESULTS
Overall survival (OS) was significantly increased in arm A relative to arm B for patients initially diagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and those with recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732; p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), and peritoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significant prognostic factors for survival.
CONCLUSION
Metastasectomy plus chemotherapy offers superior OS when compared to palliative chemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival applies to all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology, and peritoneal carcinomatosis were prognostic factors for survival. Future prospective randomized trials are needed to confirm the optimal treatment strategy for Krukenberg tumors from gastric cancer.

Keyword

Krukenberg tumor; Metastasectomy; Prognosis; Stomach neoplasms

MeSH Terms

Arm
Carcinoma
Drug Therapy*
Humans
Krukenberg Tumor*
Metastasectomy
Pathology
Prognosis
Prospective Studies
Stomach Neoplasms*

Figure

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  Fig. 1. Kaplan-Meier overall survival based on treatment arm in initial stage IV gastric cancer. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy; arm B, chemotherapy alone.

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  Fig. 2. Kaplan-Meier overall survival based on treatment arm with recurred Krukenberg tumor. Patients were divided into two arms according to treatment modality: arm A, metastasectomy plus chemotherapy; arm B, chemotherapy alone.

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  Fig. 3. Kaplan-Meier overall survival based on curative resection of Krukenberg tumor in stomach cancer. The residual disease state of each patient was documented as the presence or absence of gross residual disease, which was classified as negative resection margins (R0), microscopic tumor infiltration (R1), and macroscopic residual tumor (R2).

Reference

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