title: Feto-maternal outcomes of pregnancy complicated by Krukenberg tumor: a systematic review of literature.
abstract: Krukenberg tumor is a rare type of ovarian cancer with a poor prognosis, and little is known about its behavior during pregnancy.
  
  
  
  A systematic review was conducted to identify pregnancies complicated by Krukenberg tumor, correlated to oncologic and neonatal outcomes (n = 35).
  
  
  
  Mean age of cases was 30.4 years, and the most common origin of primary cancer was the stomach (68.6 %) followed by the colon (14.3 %). The two most common presenting symptoms were abdominal/pelvic pain (51.4 %) and nausea/vomiting (48.6 %). Two-thirds of tumors were bilateral (65.7 %) and the average size was 16.7 cm. Ascites (45.7 %), carcinomatosis (25.7 %) and non-ovarian distant metastases (14.3 %) were found at the time of surgery. Chemotherapy was administered in 20 cases, with fetal exposure in two of these. The ovarian tumor was identified prior to the primary cancer diagnosis in all 28 cases. The overall number of live births was 27 (81.8 %). The median survival was 6 months after Krukenberg tumor diagnosis. In univariate analysis, decreased overall survival was associated with dyspnea, ascites, carcinomatosis, non-radical surgery for the primary cancer, and residual disease at surgery (all, p < 0.05). On multivariate analysis, dyspnea and carcinomatosis remained independent prognostic factors for decreased overall survival after Krukenberg tumor diagnosis (2-year overall survival rates, dyspnea 0 vs. 56.6 %, adjusted-hazard ratio [HR] 9.74, 95 % confidence interval [CI] 2.04-46.2, p < 0.01; and carcinomatosis, 0 vs. 58.1 %, adjusted-HR 7.95, 95 % CI 1.76-36.0, p < 0.01).
  
  
  
  Our results showed that prognosis of Krukenberg tumor complicated pregnancies is extremely poor, however it may be improved if radical surgery is achievable.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Kodama
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
authors.forename: Aida
authors.initials: A
authors.lastname: Moeini
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Machida
authors.affiliation: Department of Obstetrics and Gynecology, University of Colorado, Denver, CO, USA.
authors.forename: Erin A
authors.initials: EA
authors.lastname: Blake
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA.
authors.forename: Brendan H
authors.initials: BH
authors.lastname: Grubbs
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Los Angeles County Medical Center, University of Southern California, 2020 Zonal Avenue, IRD520, Los Angeles, CA, 90033, USA. koji.matsuo@gmail.com.|Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA. koji.matsuo@gmail.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Matsuo
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007725:Krukenberg Tumor / Q000401:mortality* / Q000473:pathology; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality*; D011256:Pregnancy Outcome; D015996:Survival Rate
keywords: Krukenberg tumor; Ovarian cancer; Pregnancy; Review