Effects of metastasectomy and other factors on survival of patients with ovarian metastases from gastric cancer: a systematic review and meta-analysis |
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| Authors: | Chao Zhang Wenbin Hou Jinyu Huang Songcheng Yin Pengliang Wang Zhe Zhang Yuen Tan Huimian Xu |
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| Institution: | 1. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, China
Key Laboratory of Gastric Cancer Molecular Pathology of Liaoning Province, 155 Nanjing North Street, Heping District, Shenyang, China;2. Department of Surgical Oncology, First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, China |
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| Abstract: | Ovarian metastasis from gastric cancer (Krukenberg tumor KT]) has no consensus treatment and the role of surgical treatment is still controversial. Identifying prognostic factors for KT could help guide the management of this tumor. We used a meta-analysis to evaluate the prognostic value of metastasectomy and other factors in patients with KT to develop a treatment plan. We searched literature in PubMed, Cochrane library and EMBASE. We analyzed hazard ratios (HR) and 95% confidence intervals (CI) with respect to overall survival (OS). The meta-analysis included 12 cohort studies with 1,031 patients associated with longer OS following metastasectomy (HR = 0.41; 95% CI = 0.32–0.53; P < 0.001), R0 resection (HR = 0.37; 95% CI = 0.26–0.53; P < 0.001), metachronous ovarian metastasis (HR = 0.74; 95% CI = 0.58–0.93; P = 0.012), size of KT (<5 cm) (HR = 0.74; 95% CI = 0.58–0.95; P = 0.019), ECOG PS (Eastern Cooperative Oncology Group performance status) 0 to 1 (HR = 0.48; 95% CI = 0.29–0.80; P = 0.004), tumor confined to ovary (HR = 0.40; 95% CI = 0.16–0.99; P = 0.047), and tumor confined to pelvic cavity (HR = 0.36; 95% CI = 0.14–0.92; P = 0.033). Shorter OS was associated with peritoneal carcinomatosis (HR = 2.00; 95% CI = 1.25–3.21; P = 0.004), ascites (HR = 1.66; 95% CI = 1.19–2.31; P = 0.003) and positive CEA (HR = 1.41; 95% CI = 1.10–1.82; P = 0.007). Gastrectomy led to a slight improvement in OS, but without statistical significance (HR = 0.69; 95% CI = 0.47–1.02; P = 0.061). No significant difference in OS was observed in patients with signet-ring cells (HR = 1.17; 95% CI = 0.91–1.51; P = 0.226), bilateral ovarian metastasis (HR = 0.87; 95% CI = 0.70–1.08; P = 0.212), age ≥ 50 years (HR = 0.93; 95% CI = 0.71–1.22; P = 0.619), positive CA19-9 (HR = 1.01; 95% CI = 0.75–1.35; P = 0.960), and positive CA-125 (HR = 0.98; 95% CI = 0.73–1.33; P = 0.915). Various factors affect OS in patients with KT. |
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| Keywords: | Gastric cancer Krukenberg tumor Meta-analysis Metastasectomy Prognosis |
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