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

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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.

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Data Availability

No datasets were generated or analyzed during the current study.

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Funding

No funding was obtained for this study.

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Authors and Affiliations

  1. Department of Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX, 77701, USA

    Junaid Anwar, Ahmed Abdelhakeem & Muhammad Shariq Khan

  2. Department of Medicine, Lincoln Medical and Mental Health Center, Bronx, NY, 10451, USA

    Hafiz Muhammad Arslan

  3. Department of Medicine, TidalHealth Peninsula Regional, Salisbury, MD, 21801, USA

    Juwairiya Shuroog

  4. Department of Medicine, Fatima Jinnah Medical University, Lahore, Pakistan

    Zouina Sarfraz

  5. Department of Medicine, Ochsner Lafayette General Medical Center, Lafayette, LA, 70503, USA

    Ali Saeed

  6. Department of Medicine, Division of Hematology & Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, 15232, USA

    Anwaar Saeed

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  1. Junaid Anwar
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Contributions

All authors contributed to this manuscript equally. A.S. is the supervisor/guarantor.

Corresponding author

Correspondence to Anwaar Saeed.

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Conflict of Interest

Anwaar Saeed reports a leadership role with Autem therapeutics, Exelixis, KAHR Medical, and Bristol-Myers Squibb; consulting or advisory board role with AstraZeneca, Bristol-Myers Squibb, Merck, Exelixis, Pfizer, Xilio Therapeutics, Taiho, Amgen, Autem Therapeutics, KAHR Medical, and Daiichi Sankyo; institutional research funding from AstraZeneca, Bristol-Myers Squibb, Merck, Clovis, Exelixis, Actuate Therapeutics, Incyte Corporation, Daiichi Sankyo, Five Prime Therapeutics, Amgen, Innovent Biologics, Dragonfly Therapeutics, Oxford Biotherapeutics, Arcus Therapeutics, and KAHR Medical; and participation as a data safety monitoring board chair for Arcus Therapeutics. The remaining authors have no relevant financial interests to disclose.

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Anwar, J., Abdelhakeem, A., Khan, M.S. et al. Survival Outcomes in Stage IV Gastric Cancer Patients with Krukenberg Tumors: A Systematic Review and Meta Analysis. J Gastrointest Canc (2024). https://doi.org/10.1007/s12029-024-01068-w

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