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Treatments and overall survival in patients with Krukenberg tumor

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Abstract

Background

Krukenberg tumor (KT) is a rare secondary ovarian tumor, primarily localized at the gastrointestinal tract in most cases. KT is related to severe prognosis due to its aggressiveness, diagnostic difficulties and poor treatment efficacy. Several treatments have been used, such as cytoreductive surgery (CRS), adjuvant chemotherapy (CT) and/or hyperthermic intraperitoneal chemotherapy (HIPEC). To date, it is still unclear which treatment or combination of treatments is related to better survival.

Objective

To assess the most effective therapeutic protocol in terms of overall survival (OS).

Methods

A systematic review of the literature was performed by searching MEDLINE, Scopus, EMBASE, ClinicalTrial.gov, OVID, Web of Sciences, Cochrane Library, and Google Scholar for all studies assessing the association of treatments with OS in KTs. The effectiveness of each treatment protocol was evaluated by comparing the OS between patients treated with different treatment protocols.

Results

Twenty retrospective studies, with a total sample size of 1533 KTs, were included in the systematic review. Therapeutic protocols used were CRS in 18 studies, CT in 13 studies, HIPEC in 7 studies, neoadjuvant CT in 2 studies, and some combinations of these in 6 studies. Seven studies showed that CRS significantly improved OS compared to other treatments or association of treatments without it. 11 studies showed that CRS without residual (R0 CRS) had a significantly better OS than CRS with residual (R + CRS). Five studies showed that CT significantly improved OS, but other five showed it did not. Two studies showed that HIPEC in association with CRS improved OS, while another study showed that efficacy of HIPEC was comparable to CT. Two studies evaluated neoadjuvant CT, but results were conflicting.

Conclusion

CRS and in particular R0 CRS are the treatments showing the clearest results in improving OS in KT patients. Results about CT are conflicting. HIPEC appears effective both alone and in combination with CRS, and also related to fewer adverse effect than CT. The usefulness of neoadjuvant CT is still unclear. The association of R0 CRS with HIPEC seems to be the most effective and safe therapeutic protocol for KT patients.

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Funding

No financial support was received for this study.

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Authors and Affiliations

  1. General Surgery Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy

    Ruggero Lionetti, Marcello De Luca & Francesco Corcione

  2. Anatomic Pathology Unit, Department of Advanced Biomedical Sciences, School of Medicine, University of Naples Federico II, Via Sergio Pansini, 5, 80131, Naples, Italy

    Antonio Travaglino, Luigi Insabato & Massimo Mascolo

  3. Gynecology and Obstetrics Unit, Department of Neurosciences, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy

    Antonio Raffone, Gabriele Saccone & Fulvio Zullo

  4. Pathology Unit, Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy

    Maria D’armiento

Authors
  1. Ruggero Lionetti
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  2. Marcello De Luca
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  3. Antonio Travaglino
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  4. Antonio Raffone
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  5. Luigi Insabato
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  6. Gabriele Saccone
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  7. Massimo Mascolo
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  8. Maria D’armiento
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  9. Fulvio Zullo
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  10. Francesco Corcione
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Contributions

RL: study conception, electronic search, eligibility of the studies, inclusion criteria, risk of bias, data extraction and data analysis. MDL: electronic search, eligibility of the studies, inclusion criteria, risk of bias, data extraction and data analysis, and manuscript preparation. AT, AR: study conception, disagreement resolution, and manuscript preparation. GS: electronic search, eligibility of the studies, inclusion criteria, risk of bias, data extraction and data analysis. MM: methods supervision and manuscript preparation. LI: study design, methods supervision, and manuscript preparation. MDA: study design, manuscript preparation, and whole study supervision. FZ: study design, methods supervision, and whole study supervision. FC: study conception and whole study supervision.

Corresponding author

Correspondence to Antonio Travaglino.

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Lionetti, R., De Luca, M., Travaglino, A. et al. Treatments and overall survival in patients with Krukenberg tumor. Arch Gynecol Obstet 300, 15–23 (2019). https://doi.org/10.1007/s00404-019-05167-z

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  • DOI: https://doi.org/10.1007/s00404-019-05167-z

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