以Krukenberg瘤为首发表现胃癌55例临床分析

目的比较Krukenberg瘤为首发表现的胃癌患者与原发卵巢上皮性癌患者的临床病理资料,探讨前者的临床病理特征。方法回顾性分析2005年9月至2013年9月郑州大学第一附属医院妇产科以Krukenberg瘤为首发表现的胃癌患者55例（Krukenberg瘤组）的临床资料,同期原发卵巢上皮癌患者55例（原发卵巢癌组）作为对照。结果 Krukenberg瘤组患者的平均年龄为（35.1±4.6）岁（20~56）岁,显著低于原发卵巢癌组的（57.2±6.8）岁（40~72）岁（P〈0.05）。Krukenberg瘤组合并腹水比例（34.5%,9/55）明显低于原发卵巢癌组（90.9%,50/55;P〈0.05）。Krukenberg瘤组血清CA125升高30例,平均CA125水平为（98.7±14.1）kU/L;原发卵巢癌组CA125升高55例,平均CA125水平为（473.9±123.9）kU/L;两组CA125水平比较,差异有统计学意义（P〈0.05）。Krukenberg瘤组术前术后诊断符合率（9.1%,5/55）明显低于原发卵巢癌组（100.0%,55/55;P〈0.05）。Krukenberg瘤组病理类型多为胃印戒细胞癌（49.1%,27/55）,原发卵巢癌组多为浆液性囊腺癌（74.5%,41/55）。Krukenberg瘤组患者6个月生存率为54.5%（30/55）,1年生存率为36.4%（20/55）,3年生存率为3.6%（2/55）;原发卵巢癌组分别是72.7%（40/55）、60.0%（33/55）和23.6%（13/55）。结论以Krukenberg瘤为首发表现的胃癌患者病理类型以胃印戒细胞癌为主,术前诊断率低,预后差,患者多为中青年妇女,合并腹水比例较低,血清CA125的测定及PET-CT检查对鉴别诊断有重要价值。

Clinical analysis of 55cases of gastric cancer whose first manifestation is Krukenberg tumor

Objective Compare the clinical data of patients those with Krukenberg tumor as the first manifestation and those with primary epithelial ovarian cancer,investigate the pathological features of the former.Methods We retrospectively reviewed 55 cases with Krukenberg tumor as the first manifestation of gastric cancer who were treated in the First Affiliated Hospital of Zhengzhou University from September 2005 to September 2013,and55 cases with primary epithelial ovarian cancer（ovarian cancer group）as a control.Results The average age of Krukenberg tumor group was significantly lower than that in ovarian cancer group （35.1±4.6）ys vs（57.2±6.8）ys,P〈0.05],ascites proportion（34.5%,19/55）in Krukenberg tumor group was significantly lower than that in ovarian cancer patients（90.9%,50/55;P〈0.05）.30 cases with increased serum CA125 with the average of（98.7±14.1）kU/L in Krukenberg tumor group,which was 55 cases （473.9±123.9）kU/L]in control group（P〈0.05）.The coincidence diagnostic rate（9.1%,5/55）of Krukenberg tumor group was significantly lower than that in ovarian cancer group（100.0%,55/55;P〈0.05）.In Krukenberg tumor group,most pathology type was signet ring cell carcinoma（49.1%,27/55）while in the control group,most was serous adenocarcinoma（74.5%,41/55）.The survival rate of Krukenberg tumor group was 6months 54.5%（30/55）,one year 36.4%（20/55）,three year 3.6%（2/55）;while it was within six months survival rate 72.7%（40/55）,one year 60.0%（33/55）,three year 23.6%（13/55）in ovarian cancer group.Conclusions Gastric cancer with Krukenberg tumor as the first manifestation has lower preoperative diagnosis rate and poor prognosis.The majority pathology typeis signet ring cell carcinoma.Most patients are young women.Determination of serum CA125 and PET-CT examination may help the diagnosis of ovarian metastases and primary ovarian cancer.