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转移灶切除术可改善有克鲁肯伯根氏瘤的胃癌患者的生存率:182 例患者的回顾性分析
Authors Ma F, Li Y, Li W, Kang W, Liu H, Ma S, Xie Y, Zhong Y, Xu Q, Wang B, Xue L, Tian Y
Received 18 August 2019
Accepted for publication 21 November 2019
Published 18 December 2019 Volume 2019:11 Pages 10573—10580
DOI https://doi.org/10.2147/CMAR.S227684
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Sanjeev Srivastava
Purpose: There is no consensus regarding whether metastasectomy in gastric cancer patients with Krukenberg tumors (KTs) is associated with survival benefits. The aim of this study was to evaluate the treatment of KTs of gastric origin in a large series of patients and to identify prognostic factors affecting survival.
Patients and Methods: All patients who were diagnosed with gastric cancer and ovarian metastases in a single medical center between January 2006 and December 2016 were identified and included. The patients were divided into two groups according to treatment modality: a metastasectomy group and a nonmetastasectomy group. Clinicopathological features and overall survival (OS) were compared between the groups.
Results: In total, 182 patients were identified; 94 patients presented with synchronous KTs, and 88 developed metachronous KTs during follow-up. OS was significantly longer in the metastasectomy group than in the nonmetastasectomy group among those with synchronous (14.0 months vs 8.0 months; p = 0.001) and metachronous (14 months vs 8 months; p = 0.018) KTs. Multivariate analysis indicated that metastasectomy (hazard ratio [HR] 0.537; 95% confidence interval [CI] 0.344–0.839; p = 0.006), ascites (HR 1.523; 95% CI 1.058–2.193; p = 0.024), linitis plastica (HR 1.995; 95% CI 1.115–3.571; p = 0.020), and systemic chemotherapy (HR 0.456; 95% CI 0.280–0.742; p = 0.002) were independent predictors of OS.
Conclusion: Metastasectomy combined with systemic chemotherapy should be performed in gastric cancer patients with synchronous or metachronous KTs. Metastasectomy, systemic therapy, linitis plastica, and ascites are prognostic factors for OS. Further prospective randomized studies are needed.
Keywords: gastric cancer, ovarian metastasis, Krukenberg tumor, ovarian metastasectomy, survival benefit