Krukenberg瘤27例临床特点和预后分析

Clinical characters and survival analysis of twenty-seven cases with Krukenberg tumors

目的研究Krukenberg肿瘤的临床病理特点,分析影响其预后的因素,探讨改善预后的方法。方法回顾性分析我院从1996年1月至2008年8月收治的27例Krukenberg肿瘤患者的临床资料。结果 Krukenberg肿瘤中位发病年龄为34岁。15例检测消化肿瘤五项(CEA、AFP、CA125、CA19-9、鳞癌抗原),其中肿瘤标记物有阳性者8例(53.3%)。原发肿瘤来源于胃14例,结直肠癌11例,阑尾者1例,未确定原发灶者1例。16例(59.3%)为双侧卵巢转移,11例(40.7%)为单侧卵巢转移。25例有完整生存资料,生存期最长46个月,中位生存期11.7个月。单因素分析结果显示年龄以及治疗方案均为影响预后的主要因素(χ2=11.450,P<0.05),手术联合化疗能改善生存(P<0.05,β=-3.294),而原发肿瘤的直径、部位、浸润深度、淋巴转移以及卵巢转移瘤的肿瘤大小、部位、分化程度等因素并非影响生存的预后因素。结论 Krukenberg瘤多出现于原发病灶初次手术2年内,手术联合化疗为首选治疗方式,50岁以上的患者预后较佳。建议原发胃肠道恶性肿瘤术后,随访必须包括卵巢相关检查。

Objective To investigate the clinical characteristics and prognostic factors of Krukenberg tumors, in order to improve clinical survival. Methods Twenty-seven patients diagnosed with Krukenherg tumors from January 1996 to Auguest 2008 were investigated retrospectively. Results The median age at diagno- sis was 34 years old. Eight cases （53.3%） got positive result in tumor markers （ex. CEA, AFP, CA125, CA199, squamous cell carcinoma antigen） among 15 cases. The tumors number of gastric origin, colorectal origin, appendiceal origin, and other origins were 14, 11, 1 and 1, respectively. Tumors involved bilateral in 16 cases and unilateral in 11 cases. Among 25 patients with full follow-up data, the maximum survival time was 46 months and the median survival time was 11.7 months. Univariateanalysis showed that prognostic factors were treatment modality and age, likelihood ratio X^2=11.450, P〈0.05. Surgery plus chemotherapy could improve survival, P〈 0.05, β=-3.294. The diameter, origins, deep of tumor invasion, lymph node status of primary tumor as well as the tumor size, location, differentiation of ovary metastatic tumor were not the prognostic factors. Conclusions Krukenberg tumor usually occurred within 2 years after the primary tumor resection. Patients of GI tract tumors should be follow-up including ovary status. Surgery plus chemotherapy may be the first choice treatment, and cases over 50 years old have better survival.