Establishment and validation of a nomogram to predict the risk of ovarian metastasis in gastric cancer: Based on a large cohort

Abstract

BACKGROUND Ovarian metastasis is a special type of distant metastasis unique to female patients with gastric cancer. The pathogenesis of ovarian metastasis is incompletely understood, and the treatment options are controversial. Few studies have predicted the risk of ovarian metastasis. It is not clear which type of gastric cancer is more likely to metastasize to the ovary. A prediction model based on risk factors is needed to improve the rate of detection and diagnosis. AIM To analyze risk factors of ovarian metastasis in female patients with gastric cancer and establish a nomogram to predict the probability of occurrence based on different clinicopathological features. METHODS A retrospective cohort of 1696 female patients with gastric cancer between January 2006 and December 2017 were included in a single center, and patients with distant metastasis other than ovary and peritoneum metastasis were excluded. Potential risk factors for ovarian metastasis were analyzed using univariate and multivariable logistic regression. Independent risk factors were chosen to construct a nomogram which received internal validation. RESULTS Ovarian metastasis occurred in 83 of 1696 female patients. Univariate analysis showed that age, Lauren type, whether the primary lesion contained signet-ring cells, vascular tumor emboli, T stage, N stage, the expression of estrogen receptor, the expression of progesterone receptor, serum carbohydrate antigen 125 and the neutrophil-to-lymphocyte ratio were risk factors for ovarian metastasis of gastric cancer (all P < 0.05). Multivariate analysis showed that age ≤ 50 years, Lauren typing of non-intestinal, gastric cancer lesions containing signet-ring cell components, N stage > N2, positive expression of estrogen receptor, serum carbohydrate antigen 125 > 35 U/mL, and a neutrophil-to-lymphocyte ratio > 2.16 were independent risk factors (all P < 0.05). The independent risk factors were constructed into a nomogram model using R language software. The consistency index after continuous correction was 0.840 [95% confidence interval: (0.774-0.906)]. After the internal self-sampling (Bootstrap) test, the calibration curve of the model was obtained with an average absolute error of 0.007. The receiver operating characteristic curve of the obtained model was drawn. The area under the curve was 0.867, the maximal Youden index was 0.613, the corresponding sensitivity was 0.794, and the specificity was 0.819. CONCLUSION The nomogram model performed well in the prediction of ovarian metastasis. Attention should be paid to the possibility of ovarian metastasis in high-risk populations during re-examination, to ensure early detection and treatment.

Krukenberg tumour in a patient with secondary infertility – case report

“…Due to the detected ultrasound pathology, she was thoroughly screened for tumour markers, which were found to be normal. A 12-year study in a cohort of 1,696 women showed elevated CA-125 levels in patients with Krukenberg tumours, which decreased after its eradication (5) . Similarly, Aziz et al reported an increase in CA-125 and CA-19-9 in Krukenberg tumours (21) .…”

“…Metastatic ovarian tumours often pose a diagnostic challenge. In order to distinguish Krukenberg tumours from primary ovarian carcinomas, many diagnostic models have been developed that take into account clinical, biochemical and radiological features to accurately define these two types of cancer (5,19,20) . It is estimated that the primary source of Krukenberg tumour is unknown in approximately 15% of women (1) .…”

“…Cancers metastasising to the ovary may arise from various organs, including the breast, stomach, colon, and appendix. However, these tumours mostly arise from gastrointestinal malignancies (about 70% of cases), gastric cancer in particular (5)(6)(7) . A metastatic ovarian malignancy originating from gastric cancer was first described by a German gynaecologist and pathologist Friedrich Krukenberg in 1896; hence the name "Krukenberg tumour" (8) .…”

“…CK7 and CK20), tumour markers and homeobox proteins (e.g. CDX2) (1)(2)(3)5,15,16) . Krukenberg tumour is associated with poor prognosis; survival is approximately 1 year and seems to depend on the location of the primary tumour, the size of the ovarian tumour, and the management (ovariectomy vs. non-ovariectomy).…”

Assessing synchronous ovarian metastasis in gastric cancer patients using a clinical-radiomics nomogram based on baseline abdominal contrast-enhanced CT: a two-center study

“…Gao et alreported premenopausal status, tumor invasion depth, number of positive lymph nodes, and no ERβ expression as factors independently predicting metachronous ovarian metastasis [ 17 ]. Li et alconstructed a nomogram including age, N stage, Lauren type, signet-ring cell component, estrogen receptor expression, neutrophil/lymphocyte ratio, and serum CA125 for predicting ovarian metastasis in GC, with an area under the curve (AUC) for the model of 0.819 [ 18 ]. However, both synchronous and metachronous ovarian metastases were involved in this study, which may not mimic the real-world setting.…”