General Surgery Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy.
Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy.
Arch Gynecol Obstet. 2019 Jul;300(1):15-23. doi: 10.1007/s00404-019-05167-z. Epub 2019 May 1.
Krukenberg tumor (KT) is a rare secondary ovarian tumor, primarily localized at the gastrointestinal tract in most cases. KT is related to severe prognosis due to its aggressiveness, diagnostic difficulties and poor treatment efficacy. Several treatments have been used, such as cytoreductive surgery (CRS), adjuvant chemotherapy (CT) and/or hyperthermic intraperitoneal chemotherapy (HIPEC). To date, it is still unclear which treatment or combination of treatments is related to better survival.
To assess the most effective therapeutic protocol in terms of overall survival (OS).
A systematic review of the literature was performed by searching MEDLINE, Scopus, EMBASE, ClinicalTrial.gov, OVID, Web of Sciences, Cochrane Library, and Google Scholar for all studies assessing the association of treatments with OS in KTs. The effectiveness of each treatment protocol was evaluated by comparing the OS between patients treated with different treatment protocols.
Twenty retrospective studies, with a total sample size of 1533 KTs, were included in the systematic review. Therapeutic protocols used were CRS in 18 studies, CT in 13 studies, HIPEC in 7 studies, neoadjuvant CT in 2 studies, and some combinations of these in 6 studies. Seven studies showed that CRS significantly improved OS compared to other treatments or association of treatments without it. 11 studies showed that CRS without residual (R0 CRS) had a significantly better OS than CRS with residual (R + CRS). Five studies showed that CT significantly improved OS, but other five showed it did not. Two studies showed that HIPEC in association with CRS improved OS, while another study showed that efficacy of HIPEC was comparable to CT. Two studies evaluated neoadjuvant CT, but results were conflicting.
CRS and in particular R0 CRS are the treatments showing the clearest results in improving OS in KT patients. Results about CT are conflicting. HIPEC appears effective both alone and in combination with CRS, and also related to fewer adverse effect than CT. The usefulness of neoadjuvant CT is still unclear. The association of R0 CRS with HIPEC seems to be the most effective and safe therapeutic protocol for KT patients.
克鲁肯伯格瘤（KT）是一种罕见的卵巢继发性肿瘤，在大多数情况下主要位于胃肠道。由于其侵袭性、诊断困难和治疗效果不佳，KT 与严重的预后有关。已经使用了几种治疗方法，如细胞减灭术（CRS）、辅助化疗（CT）和/或腹腔热灌注化疗（HIPEC）。迄今为止，哪种治疗方法或联合治疗方法与更好的生存相关仍不清楚。
评估在总生存（OS）方面最有效的治疗方案。
通过检索 MEDLINE、Scopus、EMBASE、ClinicalTrial.gov、OVID、Web of Sciences、Cochrane 图书馆和 Google Scholar，对评估 KT 中治疗与 OS 相关性的所有研究进行了系统评价。通过比较不同治疗方案治疗的患者的 OS，评估每种治疗方案的有效性。
共纳入 20 项回顾性研究，共纳入 1533 例 KT 患者。系统评价中使用的治疗方案包括 18 项 CRS 研究、13 项 CT 研究、7 项 HIPEC 研究、2 项新辅助 CT 研究和 6 项联合治疗方案。7 项研究表明 CRS 与其他治疗方法或不联合 CRS 的治疗方法相比，显著提高了 OS。11 项研究表明，无残留（R0 CRS）的 CRS 比有残留（R+CRS）的 CRS 具有显著更好的 OS。5 项研究表明 CT 显著提高了 OS，但其他 5 项研究表明 CT 没有。2 项研究表明 HIPEC 联合 CRS 可提高 OS，而另一项研究表明 HIPEC 的疗效与 CT 相当。2 项研究评估了新辅助 CT，但结果相互矛盾。
CRS，特别是 R0 CRS，是改善 KT 患者 OS 的最有效治疗方法。关于 CT 的结果存在争议。HIPEC 单独使用和与 CRS 联合使用都有效，且与 CT 相比，不良反应更少。新辅助 CT 的有用性仍不清楚。R0 CRS 联合 HIPEC 似乎是 KT 患者最有效和安全的治疗方案。
