Comparison of Surgery Plus Chemotherapy and Palliative Chemotherapy Alone for Advanced Gastric Cancer with Krukenberg Tumor
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Purpose This study was conducted to validate the survival benefit of metastasectomy pluschemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastriccancer and to identify prognostic factors for survival. Materials and MethodsClinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomyplus chemotherapy and arm B, chemotherapy alone. ResultsOverall survival (OS) was significantly increased in arm A relative to arm B for patients initiallydiagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and thosewith recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732;p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), andperitoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significantprognostic factors for survival. ConclusionMetastasectomy plus chemotherapy offers superior OS when compared to palliativechemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival appliesto all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology,and peritoneal carcinomatosis were prognostic factors for survival. Future prospectiverandomized trials are needed to confirm the optimal treatment strategy for Krukenbergtumors from gastric cancer.
Abstract
Purpose This study was conducted to validate the survival benefit of metastasectomy pluschemotherapy over chemotherapy alone for treatment of Krukenberg tumors from gastriccancer and to identify prognostic factors for survival. Materials and MethodsClinical data from 216 patients with Krukenberg tumors from gastric cancer were collected. Patients were divided into two arms according to treatment modality: arm A, metastasectomyplus chemotherapy and arm B, chemotherapy alone. ResultsOverall survival (OS) was significantly increased in arm A relative to arm B for patients initiallydiagnosed with stage IV gastric cancer (18.0 months vs. 8.0 months; p < 0.001) and thosewith recurrent Krukenberg tumors (19.0 months vs. 9.0 months; p=0.002), respectively. Metastasectomy (hazard ratio [HR], 0.458; 95% confidence interval [CI], 0.287 to 0.732;p=0.001), signet-ring cell pathology (HR, 1.583; 95% CI, 1.057 to 2.371; p=0.026), andperitoneal carcinomatosis (HR, 3.081; 95% CI, 1.610 to 5.895; p=0.001) were significantprognostic factors for survival. ConclusionMetastasectomy plus chemotherapy offers superior OS when compared to palliativechemotherapy alone in gastric cancer with Krukenberg tumor. Prolonged survival appliesto all patients, regardless of gastric cancer stage. Metastasectomy, signet-ring cell pathology,and peritoneal carcinomatosis were prognostic factors for survival. Future prospectiverandomized trials are needed to confirm the optimal treatment strategy for Krukenbergtumors from gastric cancer.
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