Department of Medical Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
PLoS One. 2013 Jul 9;8(7):e68227. doi: 10.1371/journal.pone.0068227. Print 2013.
Krukenberg tumor originated from stomach in female patients is common in clinical practice, but it is still uncertain whether surgical resection of ovarian metastases could improve the outcome. Some studies suggested that a certain group of patients could benefit from the resection of ovarian metastases. However, conclusions were different between studies and there was no data to illustrate if certain molecular markers were associated with patients' survival. In this study, we analyzed the effects of resection of ovarian metastases, and investigated prognostic factors in 133 patients with ovarian metastases originated from stomach. Furthermore, we examined the expression of some cancer stem cells (CSCs) markers or related molecules in 64 ovarian metastases specimens and analyzed the correlation between these molecules and patients' survival. We found that the median overall survival (mOS) of all 133 patients was 16 months, and "gastrectomy" and "without ascites" were two independent prognostic factors associated with longer survival. The mOS of the patients with gastrectomy was longer than that of patients had not undergone gastrectomy (19 vs. 9 months, p = 0.048). Patients without ascites survived longer than those with ascites (mOS: 21 vs. 13 months, p = 0.008). We also found that Sox2, CD44 or CD133 positive expression in ovarian metastases were risk factors correlated with poor survival, and Sox2 expression was an independent prognostic indicator. These results suggested that ovarian metastasectomy might help to prolong the survivor of some patients with Krukenberg tumor originated from stomach. Patients without ascites, and with resected or resectable primary gastric cancer lesion could get benefit from and be potential candidate for surgical treatment. The expression of Sox2 might serve as a prognostic indicator for predicting patients' survival and be helpful for selecting patients in future.
临床上女性患者源于胃的库肯勃瘤很常见，但卵巢转移灶的手术切除是否能改善预后仍不确定。一些研究表明，某些特定的患者群体可能从卵巢转移灶的切除中获益。然而，不同研究之间的结论存在差异，也没有数据表明某些分子标志物与患者的生存相关。在这项研究中，我们分析了卵巢转移灶切除的效果，并对 133 例源于胃的卵巢转移患者的预后因素进行了研究。此外，我们还检测了 64 例卵巢转移标本中某些癌症干细胞 (CSCs) 标志物或相关分子的表达，并分析了这些分子与患者生存之间的相关性。我们发现，所有 133 例患者的中位总生存期 (mOS) 为 16 个月，“胃切除术”和“无腹水”是与生存时间延长相关的两个独立预后因素。行胃切除术患者的 mOS 长于未行胃切除术的患者 (19 个月比 9 个月，p = 0.048)。无腹水的患者比有腹水的患者生存时间更长 (mOS：21 个月比 13 个月，p = 0.008)。我们还发现，卵巢转移灶中 Sox2、CD44 或 CD133 的阳性表达是与不良预后相关的危险因素，Sox2 表达是独立的预后指标。这些结果表明，卵巢转移灶切除术可能有助于延长部分源于胃的库肯勃瘤患者的生存时间。无腹水、且原发胃肿瘤已切除或可切除的患者可从手术治疗中获益，并可能成为手术治疗的潜在候选者。Sox2 的表达可能是预测患者生存的预后指标，并有助于未来选择患者。
