Survival Outcomes in Stage IV Gastric Cancer Patients with Krukenberg Tumors: A Systematic Review and Meta Analysis

Junaid Anwar; Ahmed Abdelhakeem; Muhammad Shariq Khan; Hafiz Muhammad Arslan; Juwairiya Shuroog; Zouina Sarfraz; Ali Saeed; Anwaar Saeed

doi:10.1007/s12029-024-01068-w

Survival Outcomes in Stage IV Gastric Cancer Patients with Krukenberg Tumors: A Systematic Review and Meta Analysis

J Gastrointest Cancer. 2024 May 15. doi: 10.1007/s12029-024-01068-w. Online ahead of print.

Authors

Junaid Anwar¹, Ahmed Abdelhakeem¹, Muhammad Shariq Khan¹, Hafiz Muhammad Arslan², Juwairiya Shuroog³, Zouina Sarfraz⁴, Ali Saeed⁵, Anwaar Saeed⁶

Affiliations

¹ Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX, 77701, USA.
² Department of Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, 10451, USA.
³ Department of Medicine, TidalHealth Peninsula Regional, Salisbury, MD, 21801, USA.
⁴ Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan.
⁵ Department of Medicine, Ochsner Lafayette General Medical Center, Lafayette, LA, 70503, USA.
⁶ Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA. saeeda3@upmc.edu.

PMID: 38748352
DOI: 10.1007/s12029-024-01068-w

Abstract

Background: 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.

Methods: 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).

Results: 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 (I² = 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 (I² = 0%). In the combined chemotherapy and surgical resection cohort, OS was 16.228 months (95% CI 12.254 to 20.202), with insignificant heterogeneity (I² = 0%).

Conclusion: 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.

Keywords: Chemotherapy; Gastric cancer; Metastasectomy; Ovarian metastasis; Overall survival; Surgery.

Publication types

Review