33 Krukenberg Tumor from Gastric Cancer Treated patients’ tumor metastasized to the intraperitoneal peritoneum and thus the complete resection of the metastasized ovarian lesions was difficult and only palliative resection was performed, and this resulted in the presence of macroscopic residual cancer cells. After the second surgery, more than 4 cycles chemotherapy was per- formed for 15 patents (68.2%). Eight patients (36.4%) were treated with the combination of Taxane and platinum and 7 patients (31.8%) were treated with 5-FU monotherapy. The average postsurgical survival time of all the patients was 1 ８.8 months (range: 2.0~59.０ months, including the 2 surviving patients), the 3-year survival rate was 15.8%, the survival period of the 16 patients (R0) for whom tumor resection could be performed without leaving residual tumors was on average 23.7 months, and it was significantly higher than the 6.0 months average survival time of the 8 patients (R2) for whom only palliative resection was per- formed because of the invasion to the adjacent pelvis, etc. (P=0.0003) (Fig. 1). However, the age of the patient at the time of the diagnosis of tumors, the menopausal status, the AJCC TMN disease stage of the primary tumor, the grade of differentiation of the tumor cells, the interval from the first surgery to tumor development, the tumor size and the status of chemotherapy were not associated with the survival rate (Table 1). Among all 22 patients, 9 patients were tested for two tumor mark- ers, serum CEA and CA-125, which may be of help to make an early diagnosis of Krukenberg tumor. Of the 9 patients, the CA-125 level was shown to be higher than normal (normal: lower than 35 U/ml) in 8 patients out of the 9 patients (88.9%), and the average value was 45.5 ±25.3 U/ml. The CEA was elevated in 1 patient (11.1%) to 16.2 ng/ ml, which was slightly high, and the rest of the patients were within the normal range (normal: lower than 10 ng/ml). Discussion The metastasis mechanism of Krukenberg tumor is particular, for example, it has been reported to develop even after the radical resection of early gastric cancer,(6) and so we studied the clini- cal characteristics, including the metastasis patterns. It has been reported that Krukenberg tumor is rare and its prognosis is poor, Table 1. Factors associated with survival after the development of Krukenberg Tumor from gastric cancers treated by resection Variables No. (%) P-value* Age at the time of ovarian relapse <50 years (premenopause) ≥50 years (postmenopause) AJCC TMN stage of primary gastric lesion EGC IIa Ib II IIIa IIIb IV Histology of primary lesion Well differentiated Mod. differentiated Poorly differentiated Interval to ovarian relapse <1 year 1~2 years >2 years Size of ovarian tumor <5 cm 5~10 cm >10 cm Chemotherapy regimen Taxane+Platinum 5 FU None Gross residual disease after treatment Absence Presence Total 13 (59.1) 9 (40.9) 1 (4.5) 2 (9.1) 4 (18.2) 6 (27.3) 4 (18.2) 2 (9.1) 1 (4.5) 8 (36.4) 10 (45.4) 4 (18.2) 8 (36.4) 7 (31.8) 7 (31.8) 1 (4.5) 9 (40.9) 12 (54.5) 8 (36.4) 7 (31.8) 7 (31.8) 14 (63.6) 8 (36.4) 22 (100) NS NS NS NS NS NS 0.0003 Fig. 1. Overall survival curves for the patients with Krukenberg tumor from gastric cancer. The patients without gross residual disease sur- vived longer than the patients with gross residual disease (P=0.0003). NS = not significant; AJCC = American Joint Commitee on Cancer; TMN = tumor node metastasis; EGC = early gastric cancer; FU = fluorouracil. *P>0.05.