Lin Xiaolin, Han Ting, Zhuo Meng, Liu Tengfei, Liu Zebing, Xiang Dongxi, Li Hong, Xiao Xiuying
Department of Oncology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Pathology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
J Gastrointest Oncol. 2022 Jun;13(3):1022-1034. doi: 10.21037/jgo-22-464.
Krukenberg tumor (KT) of gastric origin has a poor prognosis. The present study of KTs are mainly case reports and clinical analysis with few samples. Therefore, it is urgent to explore the clinicopathologic characteristics of KTs through large sample studies. To improve the understanding of the clinical diagnosis and treatment of KT, this paper retrospectively analyzed 10 years of gastric cancer (GC) database data, including clinicopathological and prognostic features, aiming to provide a clinical reference for the diagnosis and treatment of the tumor.
The clinicopathological characteristics, treatments, and survival data were collected and analyzed from 130 patients with KTs of GC. Clinicopathological data included clinical manifestations, laboratory findings, imaging reports, pathology and immunohistochemistry (IHC) reports. We collected treatment regimens information on whether they had undergone surgery and chemotherapy and performed survival follow-up. Univariate and multivariate analysis were used to investigate the risk factors of KTs with gastric origin.
The median age of the patients was 41 years. A total of 63.1% of patients had synchronous ovarian metastasis, 70.8% had bilateral ovarian metastasis, 68.5% had peritoneum metastasis, and 98.5% had pathologically poorly differentiated adenocarcinoma. The positive rate of human epidermal growth factor receptor 2 (HER-2) was 1.8%. The follow-up rate was 90.8%, and the median overall survival (mOS) of ovarian metastasis was 13.0 months. Univariate analysis showed statistically significant prognostic factors including menstrual status, size of the gastric lesions and ovarian metastases, number of lymph node metastasis, interval to ovarian metastasis, resection of gastric lesions, peritoneal metastasis, oophorectomy, chemotherapy after ovarian metastases, two-drug regimen chemotherapy, albumin, serum cancer antigen 125 (CA-125) levels, platelet count, D-dimer, fibrinogen, and high pretreatment platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII). Fibrinogen [hazard ration (HR) =0.483; 95% confidence interval (CI): 0.300-0.777; P=0.003], size of ovarian metastasis (HR =1.808; 95% CI: 1.178-2.776; P=0.007), chemotherapy after ovarian metastasis (HR =0.195; 95% CI: 0.101-0.379; P=0.000), peritoneal metastasis (HR =2.742; 95% CI: 1.606-4.682; P=0.000) and oophorectomy (HR =1.720; 95% CI: 1.066-2.778; P=0.026) were independent prognostic factors.
GC patients with KTs have some unique clinical features. Hypercoagulable states, peritoneal metastasis, and untimely chemotherapy and oophorectomy might be a worse predictor for KTs derived from gastric origin.
胃源性库肯勃瘤（KT）预后较差。目前关于KT的研究主要是病例报告和临床分析，样本量较少。因此，迫切需要通过大样本研究来探索KT的临床病理特征。为提高对KT临床诊断和治疗的认识，本文回顾性分析了10年胃癌（GC）数据库数据，包括临床病理和预后特征，旨在为该肿瘤的诊断和治疗提供临床参考。
收集并分析130例GC源性KT患者的临床病理特征、治疗方法和生存数据。临床病理数据包括临床表现、实验室检查结果、影像学报告、病理及免疫组化（IHC）报告。我们收集了他们是否接受手术和化疗的治疗方案信息，并进行生存随访。采用单因素和多因素分析来研究胃源性KT的危险因素。
患者的中位年龄为41岁。共有63.1%的患者发生同步性卵巢转移，70.8%为双侧卵巢转移，68.5%有腹膜转移，98.5%为病理低分化腺癌。人表皮生长因子受体2（HER-2）阳性率为1.8%。随访率为90.8%，卵巢转移患者的中位总生存期（mOS）为13.0个月。单因素分析显示具有统计学意义的预后因素包括月经状态、胃部病变和卵巢转移灶大小、淋巴结转移数量、至卵巢转移的间隔时间、胃部病变切除情况、腹膜转移、卵巢切除术、卵巢转移后化疗、两药联合化疗、白蛋白、血清癌抗原125（CA-125）水平、血小板计数、D-二聚体、纤维蛋白原，以及治疗前高血小板与淋巴细胞比值（PLR）和全身免疫炎症指数（SII）。纤维蛋白原[风险比（HR）=0.483；95%置信区间（CI）：0.300-0.777；P=0.003]、卵巢转移灶大小（HR =1.808；95%CI：1.178-2.776；P=0.007）、卵巢转移后化疗（HR =0.195；95%CI：0.101-0
