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

Aurello, Paolo; Berardi, Giammauro; Antolino, Laura; Antonelli, Giulio; Rampini, Alessia; Moschetta, Giovanni; Ramacciato, Giovanni

doi:10.1159/000490956

Cited by 12 publications

(7 citation statements)

References 31 publications

(72 reference statements)

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“…This discrepancy was likely due to the use of palliative surgery in our study instead of cytoreductive resection of limited disease or oligometastatic disease with curative intent reported before (8,26). As to our patients with Krukenberg tumors from gastric cancer, we did not observe prolonged survival from palliative surgical resection of the Krukenberg tumors, different from previous reports (9,(28)(29)(30), likely due to small sample size in our study. To compare the median PFS between patients with colorectal and gastric cancers, those with colorectal cancer treated with surgical resection of their Krukenberg tumor had significantly longer PFS than their gastric cancer counterparts.…”

Section: Discussioncontrasting

confidence: 94%

The diagnosis and outcome of Krukenberg tumors

Xie¹,

Erickson

Sheedy

et al. 2021

J Gastrointest Oncol

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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%

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Section: Discussioncontrasting

confidence: 94%

The diagnosis and outcome of Krukenberg tumors

Xie¹,

Erickson

Sheedy

et al. 2021

J Gastrointest Oncol

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“…The prognosis of GC patients developing MOM is remarkably poor, with the median overall survival reportedly ranging from 11 to 21.7 months (5,7,11,18). To address this challenge, the early detection of ovarian reoccurrence is urgently needed to provide timely medical intervention (22,23). Unfortunately, this remains a major challenge, as most patients with ovarian reoccurrence are either asymptomatic or demonstrate non-specific symptoms such as lower abdominal discomfort, irregular bleeding, and weight loss (19).…”

Section: Discussionmentioning

confidence: 99%

Risk factors predicting the occurrence of metachronous ovarian metastasis of gastric cancer

Gao¹,

Weng²,

Qu³

et al. 2021

Ann Transl Med

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Background: Ovarian metastasis following radical gastrectomy, also known as metachronous ovarian metastasis (MOM), pose a significant threat to the long-term survival of female gastric cancer (GC) patients.However, a mechanism to identify and characterize operated patients at high risk of developing MOM remains unknown. This retrospective study aimed to identify risk factors for the occurrence of MOM based on the profiling of clinicopathological parameters and expression of sex hormone receptors (SHR) of operated GC patients with and without ovarian relapse. Methods:The clinicopathological data of 1,055 female GC patients from two medical centers who underwent surgery between January 2011 and December 2015 were reviewed. A total of 378 patients with and without the occurrence of MOM met the eligibility criteria, including the availability of medical records, adequacy of lymph node dissection, completeness of clinicopathological data, sufficient follow-up time, and no administration of neoadjuvant chemotherapy were selected for further analysis. Expressions of estrogen receptor alpha (ERα), estrogen receptor beta (ERβ), and progesterone receptor (PR) were detected by immunohistochemical staining on the surgical specimens of patients, and retrospective statistical analyses identified independent risk factors for the occurrence of MOM. A risk prediction model in the format of a polygenic hazard score (PHS) for the occurrence of MOM was established by introducing and modifying the previously validated polygenic risk score (PRS)/PHS.Results: A Cox regression-based multivariate analysis identified premenopausal with an HR of 3.15 (95% CI, 1.66-5.98), more advanced pathological T stage with an HR of 3.79 (95% CI, 2.14-6.69), more advanced pathological N stage with an HR of 1.85 (95% CI, 1.35-2.54), and negative expression of ERβ with an HR of 0.33 (95% CI, 0.15-0.7) as independent risk factors for the occurrence of MOM (P<0.01). Accordingly, a PHS for the occurrence of MOM was established, with 1-, 2-, and 3-year ovarian relapse rates for the highrisk group estimated at 17.8%, 33.7%, and 46.2%, respectively.Conclusions: Premenopausal status, depth of tumor invasion, number of positive lymph nodes, and negative expression of ERβ were independent factors for the occurrence of MOM. More frequent follow-up examinations are recommended to provide timely diagnosis and medical intervention.

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“…Все выявленные метастазы были радикально удалены. Для пациентов с отдаленными метастазами необходимо применять индивидуальный междисциплинарный подход с комбинированным системным и местным лечением, что может улучшить выживаемость [15,16]. Хирургическое лечение олигометастатического рака желудка может рассматриваться у больных с хорошим ответом на системную противоопухолевую терапию, с возможным достижением R0-резекции [17].…”

Section: результатыunclassified

Gastric Cancer Imaging: Computed Tomographic Pneumogastrography

Amelina

Shevkunov

Карачун

et al. 2021

Vestn. rentgenol. radiol.

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Objective: to reveal technical nuances for obtaining high-quality images using a computed tomography protocol with pneumogastrography and virtual gastroscopy, which contribute to the detection and assessment of the morphological type of gastric cancer and to the determination of its localization and invasion depth.Material and methods. The investigation enrolled 250 patients with both early (24.8%) and locally advanced (75.2%) gastric cancer treated in Petrov National Medical Research Center for Oncology from 2015 to 2018. Preoperative chemotherapy was performed in 142 (56.8%) patients and was not done in 108 (43.2%). All the patients underwent preoperative computed tomography with pneumogastrography and virtual gastroscopy. All the patients were radically operated on through subtotal or total gastric resection.Results. Computed tomography with pneumogastrography and virtual gastroscopy was used to detect gastric cancer in 98.4% of patients; the cases with early T1a and T1b invasion depth cancers were 23.2%. The tumor could not be significantly differentiated in 4 (1.6%) patients. This group consisted of: 3 (1.2%) and 1 (0.4%) patients with pT1a and pT1b invasion depth tumors, respectively. All non-visualized tumors had a superficial morphological type of growth (Type 0–II (3 cases with 0–IIa and 1 case with 0–IIb); their sizes were less than 2 cm. Three tumors were localized in the antral portion of the stomach; one was in its cardiac portion.Conclusion. Computed tomography with pneumogastrography and virtual gastroscopy is an effective technique to detect gastric cancer, including its early types of category T1, which makes it possible to assess its localization, morphological type, and invasion depth.

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

Cited by 12 publications

References 31 publications

The diagnosis and outcome of Krukenberg tumors

The diagnosis and outcome of Krukenberg tumors

Risk factors predicting the occurrence of metachronous ovarian metastasis of gastric cancer

Gastric Cancer Imaging: Computed Tomographic Pneumogastrography

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