Ovarian metastases resection from extragenital primary sites: outcome and prognostic factor analysis of 147 patients

Li, Wenhua; Wang, Huaying; Wang, Jian; Lv, Fangfang; Zhu, Xiaoyan; Wang, Zhonghua

doi:10.1186/1471-2407-12-278

Cited by 31 publications

(34 citation statements)

References 23 publications

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“…These results were consistent with those of other studies (15,16). In Krukenberg tumor patients, ascites may be caused by tumor invasion of the peritoneum or malnutrition, and it is usually associated with dissemination to the abdominal or pelvic cavity.…”

Section: Univariate Analysis Multivariate Analysis ------------------supporting

confidence: 82%

Clinical characteristics and prognostic analysis of Krukenberg tumor

Zhao

et al. 2015

Molecular and Clinical Oncology

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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...

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Section: Univariate Analysis Multivariate Analysis ------------------supporting

confidence: 82%

Clinical characteristics and prognostic analysis of Krukenberg tumor

Zhao

et al. 2015

Molecular and Clinical Oncology

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“…By contrast, reports from Asia have emphasized that the stomach is the most common primary site (7)(8)(9), suggesting that the relative frequencies of various primary tumors are considered to simply reflect the prevalence of these tumors in the population at risk (2). However, gastric cancer has been reported to be the leading primary site in Krukenberg tumor, which is defined as a gastrointestinal cancer that has metastasized to the ovaries and contains a significant component of mucin-filled signetring cells typically lying within a cellular stroma derived from ovarian stroma (10,11), regardless of the region (3,8,9,(12)(13)(14)(15).…”

Section: Characteristicsmentioning

confidence: 99%

Metastatic gastric cancer to the female genital tract

Matsushita

Watanabe

Wakatsuki

2016

Molecular and Clinical Oncology

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Abstract. Metastases to the female genital tract from gastric cancer are rare, but they significantly worsen the prognosis of such patients. The potential routes for metastasis to the female genital tract from gastric cancer include hematogenous spread, lymphatic spread and surface implantation. The rate of lymphatic metastasis to the ovary from gastric cancer has been reported to be higher compared with that from colorectal cancer. Uterine or Fallopian tube metastases are usually secondary to ovarian metastases, which are typically identified prior to the detection of gastric cancer in half of all synchronous cases, with complaints of abdominal distention, pain, palpable mass, or abnormal uterine bleeding. The prognosis of patients with female genital tract metastases from gastric cancer is extremely poor, and is worse compared with that of other primary sites, such as the breast and colorectum. In the past, surgical intervention in such patients consisted mainly of palliative resection to relieve the symptoms associated with a sizeable pelvic mass. However, recent retrospective studies based on a relatively small number of patients have reported that surgical tumor debulking plus chemotherapy may improve the prognosis of patients with metastatic ovarian cancer originating from gastric cancer.

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“…This finding was consistent with previous reports. 6,9 Metastasectomy was considered to have a beneficial effect on survival in patients with MOT. In a series of 154 patients with MOT who had undergone metastasectomy, the median overall survival time was reported to be as high as 42 months.…”

Section: Discussionmentioning

confidence: 99%

“…However, it remains uncertain whether metastasectomy prolong survival in patients with MOTs. 5,6 The 5-year survival rate for patients with MOTs has been reported to be 10% to 36% in some studies. 7,8 The purpose of this study was to investigate the outcomes and prognostic effects of metastasectomy (removal of both ovarian and extraovarian metastasis) in patients with MOTs from extragenital primary sites.…”

mentioning

confidence: 99%