Prognostic Factors Analysis Of Krukenberg Tumors From Gastric Cancer

Objective:The aim of this study was to determine the prognostic factors of Krukenberg tumors from gastric cancer, thereby helping to establish a therapeutic plan for these patients, finally to improve the survival time of these patients.Patients and Methods:156patients with Krukenberg tumors from gastric cancer that contains51synchronous Krukenberg tumors and105metachromous Krukenberg tumors were treated at Fudan University Shanghai Cancer Center between2001and2011.148patients underwent operation, of which135received chemotherapy after operation and13not.8patients without operation all received chemotherapy. Survival analyses and comparisons were performed using Kaplan-Meier method and log-rank test.Results:The median age of156patients was44years (range,23-77). The majority of patients was in the premenopausal state (63.5%) and had bilateral ovarian involvement (74.4%). The median survival time of all the patients was14.0months (range,3.5～66.5months), and the estimated1-year,3-year and5-year survival rate was60.1%,4.7%and1.6%, respectively. From univariate analysis, the median survival time of the operational group was14.0months, in comparison with9.5months for those patients without operation (P=0.043). In the operational group of synchronous Krukenberg tumors, the median survival time was significantly longer for patients with gastrectomy and metastasectomy than those only with metastasectomy (14.0months VS8.5months, P=0.014); the median survival time according to the extent of disease was15.0months for patients with disease confined to the pelvic cavity, and8.0months for patients with both pelvis and abdomen metastasis, P<0.001; the median survival time was also significantly longer for patients without gross residual disease after operation than that of patients with gross residual disease(24.0months VS8.0months,P<0.001). In the operational group of metachromous Krukenbeg tumors, the median survival time according to the extent of disease was15.5months for patients with disease confined to the pelvic cavity,11.0months for patients with both pelvis and abdomen metastasis,3.0months for patients with disease spread outside pelvis and abdomen,P<0.001; the median survival time was significantly longer for patients without gross residual disease after operation than that of patients with gross residual disease after operation(17.0months VS10.0months, P<0.001). Multivariate analysis identified patitents without gross residual disease after operation and the extent of disease confined were independently favorable prognostic factors of Krukenberg tumors from gastric cancer.Conlusions:The study suggests that operation without residual disease and the extent of disease confined to the pelvic cavity were associated with a better survival time for patients with Krukenberg tumors from gastric cancer. Both gastrectomy with metasatsectomy and without gross residual disease in synchronous krukenberg tumors and a metastasectomy without gross residual disease in metachromous krukenberg tumors maybe associated with an improved survival time.