Metastatic factors for Krukenberg tumor: a clinical study on 102 cases

Abstract

To investigate factors associated with gastrointestinal (GI) carcinomas metastasizing to ovaries to form Krukenberg tumor. Among the 102 cases of Krukenberg tumor due to GI cancers, there were 41 cases synchronously diagnosed, 43 cases with primary tumor identified first and 18 cases with ovarian tumor identified first. Metastatic factors of 43 cases of metachronous Krukenberg tumor were analyzed with univariate and multivariate methods. Of the 43 patients, the median age at diagnosis of Krukenberg tumor was 42 years (range, 21-72). Stomach is the most common primary site (58.1%), followed by colon (25.6%) and rectum (16.3%). Most of the patient was in premenopausal state (81.4%) and had bilateral ovaries involved (67.4%). The overall median metastasis-free time in T3 group (17.0 months) was significantly longer than that in T4 group (10.0 months) (P=0.003). Univariate analysis identified tumor invasion depth and ascites as significant factors for metastasis. Multivariate analysis confirmed that invasion depth was the only significant metastatic factor (Relative Risk: 3.2, P=0.004). Primary carcinomas T stage is the most important predictor of Krukenberg tumor from GI cancer.

An Up-to-Date Understanding of the “Krukenberg Tumor” Mechanism

“…So attention should always be paid regarding transcoelomic metastasis to ovaries from advanced GI carcinomas. The study result of Li Qiu et al showed the 1-year and 2-year metastasis-free survival rates were 48.5% and 18.2% in T3 group, compared with 14.3% and 0 in T4 group (P = 0.031) [10].…”

“…There is a major chance of cancer cells invading the ovaries when the serosal layer or tissue beyond is invaded by GI cancer in female patients. Based on the cases of advanced T stage of primary GI cancer, the tumor cells could easily be scattered into the peritoneal cavity forming a metastasis to ovaries [7] [10]. So attention should always be paid regarding transcoelomic metastasis to ovaries from advanced GI carcinomas.…”

“…The route of metastasis of tumors originating from the gastrointestinal tract is still in the hypothetical stage. Although the mechanism of Krukenberg tumor formation remains inconclusive [10], the current understanding suggests three major possible pathways of metastasis: lymphatic, hematogenous, and transcoelomic metastasis. Lymphatic and hematogenous metastasis meaning the cancer cells metastasis via the lymphatic channels and blood vessels respectively, where as transcoelomic metastasis is when the free-floating cancer cells spread intra abdominally.…”

“…However, due to the detection of original tumor at advanced stage majority of the cases may involve mixed metastatic pathways. Lymphatic and hematogenous spread, especially lymphatic spread is widely believed to play the possible role in cancer metastasis from primary gastrointestinal site to the ovaries [10].…”

Transcoelomic spread and ovarian seeding during ovulation: A possible pathogenesis of Krukenberg tumor

“…Lymphatic and hematogenous spread, especially lymphatic spread is widely believed to play the possible role in cancer metastasis from the primary gastrointestinal site to the ovaries. But here, we would like to discuss the role of transcoelomic spread and rupture in the ovary (wound) during ovulation providing favorable seeding site as a major route of metastasis [9].…”