Clinical characteristics and prognostic analysis of Krukenberg tumor

Abstract

Abstract. Krukenberg tumor is a rare metastastic tumor of the ovary, characterized by poor prognosis. In order to analyze the clinical characteristics and prognostic factors, we retrospectively investigated 128 patients who were diagnosed with Krukenberg tumor between January, 1990 and December, 2010. The median patient age was 48 years. The median overall survival (OS) of Krukenberg tumor for all patients was 16 months (95% CI: 15-19 months). The median OS among patients with Krukenberg tumors of gastric, colorectal, breast and other origins (including appendix, gallbladder, small intestine and unknown primary) was 11, 21.5, 31 and 19.5 months, respectively (P<0.0001). In the univariate analysis, synchronous metastasis, no chemotherapy, ovarian metastasis beyond the pelvis, ascites and no metastasectomy were identified as significant poor prognostic factors. The multivariate analysis suggested that synchronous metastasis (P=0.0080), pelvic invasion (P=0.0138), ascites (P<0.0001) and no metastasectomy (P=0.0060) were independent factors for predicting unfavorable OS. It was suggested that the prognosis of Krukenberg tumor is dismal and ovarian metastasectomy may prove beneficial. Adequate treatment planning is required for this group of patients. IntroductionKrukenberg tumor is a rare metastatic signet ring cell tumor of the ovary, accounting for 1-2% of all ovarian tumors. The stomach is the primary site in the majority of Krukenberg tumor cases, followed by carcinomas of the colon, appendix and breast, particularly invasive lobular carcinoma (1). The eponym was attributed to this tumor following the description of 5 cases by Friedrich Krukenberg (1871-1946) in 1896, who described it as being common among young women, presenting with ascites, an uneven knobby ovarian surface and lymphatic involvement (2). These tumors are characterised by uncertain pathogenesis, challenging etiological diagnosis and poorer prognosis compared with their primaries. Previously, any metastatic ovarian cancer was referred to as Krukenberg tumor; however, Novak and Gray (3) created new diagnostic criteria to eliminate any confusion. Accordingly, a mucin-secreting signet ring cell carcinoma in the dense fibroblastic stroma of the ovary is referred to as Krukenberg tumor. The diagnosis of Krukenberg tumor is currently based on the diagnostic criteria of the World Health Organization based on the pathological description by Serov and Scully (4). The presence of the following characteristics is required for diagnosis: Stromal involvement, mucin-producing neoplastic signet ring cells and ovarian stromal sarcomatoid proliferation.Krukenberg tumor is considered as a late-stage disease with poor prognosis and may account for 30-40% of metastatic cancers to the ovaries (5). The treatment approach to these metastatic ovarian tumors remains controversial. To date, treatment mainly consists of ovarian metastasectomy, chemotherapy or radiotherapy; however, the optimal treatment has not yet been established. As the biological behavior and clinical...

Impact of ovarian metastases on survival in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal malignancy originating from appendiceal and colorectal cancer

“…In patients with colorectal cancer without obvious metastatic spread, ovarian metastases are found in 3–28% of cases . Krukenberg tumours are associated with a poor prognosis, with mean overall survival (OS) in colorectal cancer of 16 months, depending on the aggressiveness of the tumour and the treatment employed . Increasingly, ovarian metastases are considered a manifestation of peritoneal dissemination .…”

Ovarian metastasis from non-gynecologic primary sites: a retrospective analysis of 177 cases and 13-year experience

“…Due to the variety of the tumor size, the depth of invasion, involvement, the surgical removal extent was various in which the minimal one was only unilateral salpingo-oophorectomy and the maximal one can include resection of multiple involved organs and local lymph nodes. Over the past decade, an amount of retrospective studies has proven that the residual lesion size at the completion of surgery is related to a survival benefit for patients with ovarian metastasis from non-gynecologic primary cancers [1,4,9,[25][26][27][28][29][30][31][32]. In our current study, there was a significant survival difference between patients with less than patients with 2 cm of largest residual lesion and more than or equal to 2 cm of largest residual lesion.…”

Bilateral Krukenberg Tumor with Undetermined Origin during Pregnancy

“…The Krukenberg tumor (KT) is a rare ovarian metastatic carcinoma, originated from different primary sites, with an incidence varying from 1 to 2%, affecting mainly women in perimenopause with a mean age of 48 years (27-65 years) [1,2]. In 63-80% of the cases KT are bilateral [3].…”

“…In 63-80% of the cases KT are bilateral [3]. Most frequently primary sites are gastric in 76% of the cases, followed by the bowel in 11%, breast in 4%, biliary tractin 3%, appendix in 3%, and the last 3% from pancreas, cervix, bladder and renal pelvis [2].…”