Metastasectomy Improves the Survival of Gastric Cancer Patients with Krukenberg Tumors: A Retrospective Analysis of 182 patients

Figures & data

Table 1 Clinical Characteristics of 94 Patients with Synchronous Krukenberg Tumors

Variable	Metastasectomy n=57 (%)	Nonmetastasectomy n=37 (%)	p value
Age			0.598
≥45	17 (29.8)	13 (35.1)
<45	40 (70.2)	24 (64.9)
Year of diagnosis			0.262
2006–2008	14 (24.6)	5 (13.5)
2009–2012	22 (38.6)	20 (54.1)
2013–2016	21 (36.8)	12 (32.4)
Menstrual status			0.095
Premenopausal	39 (68.4)	31 (83.8)
Postmenopausal	18 (31.6)	6 (16.2)
Tumor location
Upper 1/3	6 (10.5)	4 (10.8)	1.000
Middle 1/3	19 (33.3)	12 (32.4)
Lower 1/3	22 (38.6)	14 (37.8)
Whole stomach	10 (17.5)	7 (18.9)
Linitis plastica			1.000
Yes	6 (10.5)	4 (10.8)
No	51 (89.5)	33 (89.2)
Signet-ring cells			0.773
Yes	31 (54.4)	19 (51.4)
No	26 (45.6)	18 (48.6)
Laterality			0.185
Bilateral	48 (84.2)	27 (73.0)
Unilateral	9 (15.8)	10 (27.0)
Tumor size (cm)	8.7±4.5	6.2±3.0	0.031
Pathologic differentiation			0.943
Differentiated	8 (14.0)	5 (13.5)
Undifferentiated	49 (86.0)	32 (86.5)
Other types of metastasis	37 (64.9)	31 (83.8)	0.046
Peritoneum	37 (64.9)	28 (75.7)	0.270
Liver	0	3
Supraclavicular lymph nodes	0	6
Bone	1	2
Lung	2	2
Other	0	2
Ascites			0.089
Yes	30 (52.6)	26 (70.3)
No	27 (47.4)	11 (29.7)
Gastrectomy			<0.001
Yes	28 (49.1)	0 (0)
No	29 (50.9)	37 (100)
Distal gastrectomy	17	-
Proximal gastrectomy	3	-
Total gastrectomy	8	-
Systemic chemotherapy			0.020
Yes	49 (86.0)	37 (100)
No	8 (14.0)	0 (0)

Table 2 Clinical Characteristics of 88 Patients with Metachronous Krukenberg Tumors

Variable	Metastasectomy n=71 (%)	Nonmetastasectomy n=17 (%)	p value
Age			0.618
≥45	34 (47.9)	7 (41.2)
<45	37 (52.1)	10 (58.8)
Year of diagnosis			0.552
2006–2008	21 (29.6)	3 (17.6)
2009–2012	26 (36.6)	6 (35.3)
2013–2016	24 (33.8)	8 (47.1)
Menstrual status			0.507
Premenopausal	44 (62.0)	12 (70.6)
Postmenopausal	27 (38.0)	5 (29.4)
Tumor location			0.394
Upper 1/3	12 (16.9)	1 (5.9)
Middle 1/3	12 (16.9)	1 (5.9)
Lower 1/3	42 (59.2)	14 (82.3)
Whole stomach	5 (7.0)	1 (5.9)
Linitis plastica			0.616
Yes	5 (7.0)	2 (11.8)
No	66 (93.0)	15 (88.2)
Signet-ring cells			0.493
Yes	23 (32.4)	7 (41.2)
No	48 (67.6)	10 (58.8)
Laterality			1.000
Bilateral	53 (74.6)	13 (76.5)
Unilateral	18 (25.4)	4 (23.5)
Tumor size	8.9±4.8	7.3±4.2	0.322
Pathologic differentiation			0.066
Differentiated	5 (7.0)	4 (23.5)
Undifferentiated	66 (93.0)	13 (76.5)
Other types of metastasis	33 (46.5)	11 (64.7)	0.233
Peritoneum	33 (46.5)	6 (35.3)	0.404
Liver	1	1
Supraclavicular lymph node	0	1
Bone	2	0
Lung	1	0
Other	1	4
Ascites			0.951
Yes	34 (47.9)	8 (47.1)
No	37 (52.1)	9 (52.9)
Procedure of gastrectomy			0.357
Distal gastrectomy	49 (69.0)	9 (53.0)
Proximal gastrectomy	5 (7.0)	1 (5.9)
Total gastrectomy	17 (24.0)	7 (41.1)
Systemic chemotherapy			0.231
Yes	48 (67.6)	14 (82.4)
No	23 (32.4)	3 (17.6)

Figure 1 Kaplan–Meier analysis of overall survival in patients with synchronous Krukenberg tumors who did or did not undergo metastasectomy.

Figure 2 Kaplan–Meier analysis of overall survival in patients with metachronous Krukenberg tumors who did or did not undergo metastasectomy.

Figure 3 Kaplan–Meier analysis of overall survival in patients who underwent metastasectomy according to the residual disease state. The residual disease state of each patient was documented as the presence or absence of gross residual disease, which was classified as negative resection margins (R0), microscopic tumor infiltration (R1), and macroscopic residual tumor (R2).

Table 3 Univariate and Multivariate Analyses of Overall Survival in 182 Patients

Variable	Univariate		Multivariate
Hazard Ratio	p value	Hazard Ratio	p value
Age (>45)	0.871 (0.618–1.227)	0.428	–	–
Menstrual status	1.071 (0.748–1.534)	0.708	–	–
Size of Krukenberg tumor (>10 cm)	0.726 (0.493–1.068)	0.104	–	–
Bilateral ovarian metastases	1.064 (0.707–1.601)	0.765	–	–
Gastrectomy	0.568 (0.403–0.801)	0.001	0.695 (0.391–1.233)	0.213
Metastasectomy	0.466 (0.319–0.681)	0.000	0.537 (0.344–0.839)	0.006
Synchronous disease	1.402 (0.997–1.971)	0.052	1.030 (0.604–1.758)	0.913
Linitis plastica	1.839 (1.049–3.222)	0.033	1.995 (1.115–3.571)	0.020
Ascites	1.778 (1.262–2.506)	0.001	1.523 (1.058–2.193)	0.024
Peritoneal carcinomatosis	1.423 (1.011–2.003)	0.043	1.012 (0.703–1.481)	0.914
Other types of metastasis	1.785 (1.078–2.956)	0.024	1.289 (0.744–2.233)	0.365
Systemic chemotherapy	0.641 (0.412–0.996)	0.048	0.456 (0.281–0.742)	0.002