Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX, 77701, USA.
Department of Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, 10451, USA.
J Gastrointest Cancer. 2024 Sep;55(3):1004-1025. doi: 10.1007/s12029-024-01068-w. Epub 2024 May 15.
Stage IV gastric cancer patients with Krukenberg tumors typically exhibit poor survival outcomes, often less than 2 years. The management of this tumor subgroup remains non-standardized, and the impact of oophorectomy on survival remains uncertain. In this study, we systematically analyzed survival outcomes among gastric cancer patients with ovarian metastases who underwent standard chemotherapy, surgical resection of ovarian metastases, or combined chemotherapy and surgery.
We conducted a systematic review and meta-analysis of randomized controlled trials and observational studies retrieved from MEDLINE (PubMed), Embase, and the Cochrane Library until January 25, 2024, applying the Boolean logic. Participants included individuals with pathologically and radiologically confirmed ovarian metastasis or clinically symptomatic cases with imaging evidence. Statistical analyses were performed using R (v.4.3.2., Vienna). The study was registered with PROSPERO (ID-CRD42023488373).
A total of 1502 patients from 17 retrospective studies were pooled for analysis of overall survival (OS) outcomes. The OS in the standard chemotherapy cohort, as determined by the random effects model, was 6.708 months (95% CI 3.867 to 9.548; P<0.0001), with non-significant heterogeneity (I = 5.5%). In the surgical resection cohort, OS was 12.786 months (95% CI 6.9 to 18.671; P<0.0001), with low heterogeneity (I = 0%). In the combined chemotherapy and surgical resection cohort, OS was 16.228 months (95% CI 12.254 to 20.202), with insignificant heterogeneity (I = 0%).
This meta-analysis offers key insights into survival outcomes associated with different therapeutic modalities in gastric cancer with Krukenberg metastases. It provides valuable evidence for clinical decision-making and future research directions. While the combined approach of chemotherapy and surgery demonstrates the highest effect size for OS, careful consideration of patient-centric approaches is essential in the oncological care landscape.
患有 Krukenberg 肿瘤的 IV 期胃癌患者的生存结局通常较差，通常不到 2 年。对于这个肿瘤亚组的治疗仍然没有标准化，卵巢切除术对生存的影响也不确定。在这项研究中，我们系统地分析了接受标准化疗、卵巢转移灶切除术或化疗联合手术的胃癌伴卵巢转移患者的生存结局。
我们对从 MEDLINE（PubMed）、Embase 和 Cochrane Library 检索到的随机对照试验和观察性研究进行了系统回顾和荟萃分析，检索时间截至 2024 年 1 月 25 日，应用布尔逻辑。参与者包括经病理和影像学证实有卵巢转移或有影像学证据的临床症状性病例。统计分析使用 R（v.4.3.2.，维也纳）进行。该研究在 PROSPERO 注册（ID-CRD42023488373）。
共有来自 17 项回顾性研究的 1502 名患者被纳入总生存（OS）结局的分析。随机效应模型确定的标准化疗组 OS 为 6.708 个月（95%CI 3.867 至 9.548；P<0.0001），异质性不显著（I=5.5%）。在卵巢切除术组，OS 为 12.786 个月（95%CI 6.9 至 18.671；P<0.0001），异质性低（I=0%）。在化疗联合手术组，OS 为 16.228 个月（95%CI 12.254 至 20.202），异质性不显著（I=0%）。
本荟萃分析为 Krukenberg 转移的胃癌患者不同治疗方式相关的生存结局提供了关键见解。它为临床决策和未来的研究方向提供了有价值的证据。虽然化疗联合手术的联合方法对 OS 的效果最大，但在肿瘤学护理领域，需要仔细考虑以患者为中心的方法。
