Survival outcomes in patients with stage IV gastric cancer with Krukenberg tumors: A systematic review and meta-analysis.

person Junaid Anwar Baptist Hospitals of Southeast Texas, Beaumont, TX info_outline Junaid Anwar, Ahmed Abdelhakeem, Muhammad Shariq Khan, Hafiz Muhammad Arslan, Zouina Sarfraz, Anwaar Saeed

Authors person Junaid Anwar Baptist Hospitals of Southeast Texas, Beaumont, TX info_outline Junaid Anwar, Ahmed Abdelhakeem, Muhammad Shariq Khan, Hafiz Muhammad Arslan, Zouina Sarfraz, Anwaar Saeed Organizations Baptist Hospitals of Southeast Texas, Beaumont, TX, Lincoln Medical and Mental Health Center, Bronx, NY, Fatima Jinnah Medical University, Lahore, Pakistan, Department of Medical Oncology, University of Pittsburgh, Pittsburgh, PA Abstract Disclosures Research Funding No funding sources reported Background: Stage IV gastric cancer patients with Krukenberg tumors tend to have poor survival outcomes, usually less than 2 years. The management of such tumor groups remains unstandardized, and whether oophorectomy improves survival is unknown. In this study, we systematically analyze the survival outcomes in gastric cancer patients with ovarian metastases who received either standard chemotherapy, surgical resection of ovarian metastases, or combined chemotherapy and surgery. Methods: We synthesized randomized controlled trials and observational studies, which were retrieved by systematically searching MEDLINE (PubMed), Embase, and the Cochrane Library through January 25, 2024, using the Boolean logic. Participants included individuals with pathologically and radiologically confirmed ovarian metastasis or clinically symptomatic cases with imaging evidence. Statistical analyses were conducted using R (v.4.3.2., Vienna) (PROSPERO ID-CRD42023488373). Results: A total of 1502 patients from 17 retrospective studies were pooled for differential overall survival (OS) outcomes ( Table ). The OS in the standard chemotherapy cohort using the random effects model was 6.708 months (95% CI: 3.867 to 9.548). Heterogeneity was non-significant (P = 0.3854) with I2 of 5.5%. In the surgical resection cohort, OS was 12.786 months (95% CI: 6.9 to 18.671). I2 was 0%, and heterogeneity was low (P = 0.6013). In the combined chemotherapy and surgical resection cohort, OS was 16.228 months (95% CI: 12.254 to 20.202). I2 was 0%, and heterogeneity was insignificant (P = 0.9632). Conclusions: This meta-analysis provides novel insights into survival outcomes associated with distinct therapeutic modalities in gastric cancer with krukenberg metastases, contributing 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, judicious consideration of patient-centric approaches is imperative in the oncological care landscape. Meta-Analytical Parameters Chemotherapy Only Surgery Only Chemotherapy and Surgery Number of Studies (k) 7 7 13 Total Sample Size (N) 250 308 648 Effect Size (Random Effects Model) 6.7076 (95%-CI: [3.8674; 9.5478]) 12.7857 (95%-CI: [6.9006; 18.6707]) 16.2278 (95%-CI: [12.2536; 20.2021]) z-value (Random Effects Model) 4.63 4.26 8 p-value (Random Effects Model) < 0.0001 < 0.0001 < 0.0001 Heterogeneity (τ2) 0.8887 0 0 Heterogeneity (H) 1.03 (95%-CI: [1.00; 1.90]) 1.00 (95%-CI: [1.00; 1.61]) 1.00 (95%-CI: [1.00; 1.00]) Heterogeneity (I2) 5.5% (95%-CI: [0.0%; 72.4%]) 0.0% (95%-CI: [0.0%; 61.6%]) 0.0% (95%-CI: [0.0%; 0.0%]) Residual I-squared (Rb) 6.0% (95%-CI: [0.0%; 100.0%]) 0.0% (95%-CI: [0.0%; 100.0%]) 0.0% (95%-CI: [0.0%; 100.0%]) Test of Heterogeneity (Q, d.f., p-value) 6.35, 6, 0.3854 4.56, 6, 0.6013 4.84, 12, 0.9632