139例Krukenberg瘤的临床病理分析

目的:分析Krukenberg瘤患者的临床病理特点,寻找影响肿瘤发生和预后的相关因素。方法:回顾性分析139例确诊Krukenberg瘤的临床病理特点,重点考察年龄、原发瘤部位、临床表现、影像学、实验室检查、治疗及预后,进行多因素分析。结果:患者年龄13-73岁,中位数42岁;原发瘤为胃癌70例(50.36%),结肠癌28例(20.14%),直肠癌25例(17.99%),不明者16例(11.51%);116例有详细转移灶资料,双侧转移64例(55.17%),单侧转移52例(44.83%);53例有肿瘤标志物检验结果,CA125升高35例(66.04%),CEA升高25例(47.17%),CA199升高15例(28.30%),CA153升高4例(7.55%)。22例有完整生存资料,生存期0-55月,中位生存期11.5月。COX比例风险模型多因素分析显示年龄、治疗方案为影响预后的主要因素(似然比χ2=11.540,P<0.05),手术联合放疗能改善生存(P<0.05,β=-2.288),而原发瘤部位、大小、浸润深度、淋巴结数目、卵巢肿瘤偏侧性、体积、肿瘤分化程度、腹水等对预后的影响无统计学意义。结论:多数Krukenberg瘤在原发瘤手术2年内发生,主要预后因素是年龄和治疗方案,手术加放疗对改善生存有益。

Clinico-Pathological Studies on 139 Cases of Krukenberg Tumor

Objective:To analyze the clinico-pathological features of Krukenberg tumor, so as to elucidate key factors related to tumor formation and host survival. Methods: The clinico-pathological features of 139 cases of Krukenberg tumor were retrospectively studied, including age distribution, clinical presentations, imaging and lab results, and treatment modalities. Multivariate analyses on survival related factors were conducted. Results: The age of 138 patients with Krukenberg tumor ranged from 13 to 73 years with median age of 42. The primary tumor was gastric cancer in 70 (50.36%) cases, colon cancer in 28 (20.14%) cases, rectal cancer in 25 (17.99%) cases, and unknown primary origin in 16 (11.51%) cases. Tumors were bilateral in 64 (55.17%) cases and unilateral in 52 (44.83%), and 23 cases had uncertain laterality. Of 53 patients with tumor marker results, 35 (66.04%), 25 (47.17%), 15 (28.30%), and 4 (7.55%) cases respectively had increased CA125, CEA, CA199, and CA153, respectively. Survival time was 0-55 months with median 11.5 months in 22 cases with complete survival data. Multivariate analysis showed that survival was closely related to treatment modality and age (likelihood ratio χ2=11.540, P<0.05). COX proportional hazard analysis revealed that surgery plus radiotherapy could improve survival (P<0.05, β=-2.288). Tumor size, lymph node status and ascites were not significantly related to survival. Conclusion: Most Krukenberg tumors developed within two years after primary tumor operation, key prognostic factors are age and treatment modality, and surgery plus radiotherapy could provide survival benefit.