胃癌卵巢转移姑息手术及化疗的相关临床研究

ComparisonofSurgeryPlusChemotherapyand

PalliativeChemotherapyAloneforAdvancedGastricCancerwithKrukenbergTumorCancerResTreat.2015;47(4):697-705（IF

3.23）汇报者：陈开波2018-9-18BackgroundTheincidenceofovarianmetastasisorKrukenbergKrukenbergtumorisassociatedwithpoorprognosisingastriccancerSystemicchemotherapyistheoptimaltreatmentstrategyforrecurrentormetastaticgastriccancer,ithasnotprovidedsignificantsurvivalbenefitsControversiesregardingthebesttreatmentstrategyforKrukenbergtumoringastriccancerhavecausedconfusionMaterialsandMethodsMarch2004andFebruary2012atYonseiUniversityMedicalCenter216withKrukenbergtumoramong9,217femalegastriccancerpatients125stageIVgastriccancer91withrecurrentKrukenbergtumorSynchronously84Metachronously41ArmA141chemotherapyandmetastasectomyArmB176chemotherapyaloneArmA258chemotherapyandmetastasectomyArmB233chemotherapyaloneOSanalysisResultsResultsResultsThemedianOSofpatientswithinitialstageIVgastriccancerwas12.0months(95%CI,9.7to14.3months).ThemedianOSofarmA1andarmB1was18.0months(95%CI,15.2to20.8months)and8.0months(95%CI,6.6to9.4months),respectively.(p<0.001)ThemedianOSofpatientswithrecurrentKrukenbergtumorswas15.0months(95%CI,12.7to17.3months).ThemedianOStimeofarmA2andarmB2was19.0months(95%CI,14.4to23.6months)and9.0months(95%CI,6.2to11.8months),respectively.(p=0.002)ResultsThemedianOSwas30.0months(95%CI,24.0to36.0)intheR0resectiongroupand15.0months(95%CI,13.6to16.4)intheR1,R2resectiongroupResultsMetastasectomy,signet-ringcell,andpresenceofperitonealwereindependentpredictorsofOS.ResultsChemotherapyregimensdidnotdiffersignificantlybetweenarmsAandB(p=0.535).ConclusionsMetastasectomypluschemotherapyofferssuperiorOSwhencomparedtopalliativechemotherapyaloneingastriccancerwithKrukenbergtumor.Prolongedsurvivalappliestoallpatients,regardlessofgastriccancerstage.Metastasectomy,signet-ringcellpathology,Peritonealcarcinomatosiswereprognosticfactorsforsurvival.DiscussionInmostofourcases,Krukenbergtumorwasdiagnosedduringlaterstagesofgastriccancerprogression.Therefore,atthetimeofKrukenbergtumordiagnosis,patientshavealreadyreceivedstandardfirst-linechemotherapyforadvancedormetastaticgastriccancer.SerumCEA,CA19-9,andCA-125levelwerenotusefulpredictors.Identifygenesanddevelopapracticalbiomarkerinfuturestudies.LaparoscopicexaminationhasshownbetteraccuracyindetectingperitonealcarcinomatosisKrukenbergTumors(KTs)metastaticrouteLympathicroutehypothesis:cancercellsmetastasizetoperi-gastricnodes,formingcarcinomatousembolithatblockthelymphaticupwardflow.Then,theyreachthepara-aorticandpelviclymphnodesalongwiththelymphaticreflux.Aspelvicorganswitharichnetworkoflymphaticvessels,ovarieswouldbepreferentiallyreachedbythecancercells.Peritonealspread:ThistheoryissupportedbythefrequentassociationbetweenKTs,freeperitonealcancercellsandperitonealcarcinomatosis.hematogenousdiffusion:KTsareprevalentinpremenopausalwomen,whichhaveagreatervascularityoftheovaries.thepresenceofhilarmetastasesandlymphovascularinvasioncorroboratethepossibilityofhematogenousdiffusioninadditiontoalymphaticone.theoccurrenceofKTsasaconsequenceofbreastcancerfavorsanhematogenousmorethanalymphaticorperitonealrouteofdiffusion.recentinvestigationsoncirculatingtumorcells(CTCs),whichmaybepresentevenwhenthetumorsa