Cachexia index as a prognostic predictor after resection of pancreatic ductal adenocarcinoma

Abstract Aim This study was performed to investigate the relationship between the preoperative cachexia index (CXI) and long‐term outcomes in patients who have undergone radical resection of pancreatic ductal adenocarcinoma (PDAC). Methods In total, 144 patients who underwent pancreatic resection for treatment of PDAC were retrospectively analyzed. The relationship between the CXI and the patients' long‐term outcomes after PDAC resection was investigated. The CXI was calculated based on the preoperative skeletal muscle index, serum albumin level, and neutrophil‐to‐lymphocyte ratio. After propensity‐score matching, we compared clinicopathological features and outcomes. Results The multivariate analysis showed that lymph node metastasis (hazard ratio [HR], 1.93; 95% confidence interval [CI], 1.16–3.23; P = 0.0118), R1 resection (HR, 57.20; 95% CI, 9.39–348.30; P < 0.0001), and a low CXI (HR, 2.10; 95% CI, 1.27–3.46; P = 0.0038) were independent and significant predictors of disease‐free survival (DFS) after PDAC resection. Moreover, a low CXI (HR, 3.14; 95% CI, 1.71–5.75; P = 0.0002) was an independent and significant predictor of overall survival (OS) after PDAC resection. After propensity‐score matching, the low CXI group had a significantly worse prognosis than the high CXI group for both DFS and OS. Conclusion The CXI can be a useful prognostic factor for DFS and OS after pancreatic resection for treatment of PDAC

Liver metastasis composed of pure squamous cell carcinoma component from pancreatic pure ductal adenocarcinoma: a case report

Abstract Background Liver metastasis of pure squamous cell carcinoma (SCC) from pancreatic ductal adenocarcinoma has not been previously reported. Case presentation A 66-year-old man underwent a computed tomography scan 3 years after surgery for pancreatic head cancer, and the scan revealed a mass lesion in the right lobe of the liver. A liver tumor biopsy was performed, and SCC was diagnosed. Whole sections of the pancreatic head cancer were re-evaluated, but no areas of SCC-like differentiation were identified. Although the pathology differed between the pancreas and liver, metastasis of adenosquamous carcinoma was considered. Three courses of gemcitabine plus nab-paclitaxel were administered to treat the liver metastasis of pancreatic cancer, but no response was attained. Therefore, primary SCC of the liver was considered and hepatic resection was performed. The tumor had invaded the diaphragm, and S5/6 partial hepatic resection with right diaphragm resection was performed. Pathological examination showed pure SCC of the liver, which differed from the pancreatic cancer. KRAS mutations were evaluated in the pancreatic and liver tumor specimens, and Q61R mutation was identified in both specimens. This pure SCC of the liver was diagnosed as metastasis from pancreatic cancer not by histology but by genetic analysis. Conclusions This is the first reported case of pure SCC liver metastasis from pancreatic cancer without a squamous cell component in the primary tumor. Evaluation of KRAS mutations in both specimens was useful for diagnosis

Living Donor Liver Transplantation in an Elderly Recipient with Preserved Performance Status : A Case Report

Background : Living donor liver transplantation (LDLT) in an elderly recipient is controversial. Case presentation : We report a case of LDLT in a 74-year-old female who had decompensated liver cirrhosis and hepatocellular carcinoma (HCC). She was the oldest recipient who received LDLT in Japan ever. She was rejected for LDLT at a nearby hospital because of her age.We decided to perform LDLT because her general condition was good (the Eastern Cooperative Oncology Group (ECOG) performance status 2 ). The surgery was uncomplicated and the postoperative course was uneventful, and the patient was discharged 35 days after the surgery. Currently she is living at home, and she has maintained a good quality of life. Conclusions : We believe that a recipient in good general condition is capable of undergoing LDLT despite advanced age.【はじめに】高齢者に生体肝移植を行うべきかどうかについては，議論のあるところである．【症例】74 歳女性．検診で肝機能異常を指摘され，原発性胆汁性肝硬変と診断，経過観察されていた．その後肝予備能が低下し，他院にて生体肝移植が検討されたが，70 歳を超えていたため適応外とされた．当院では70 歳以上の肝移植症例の経験もあり，レシピエントの全身状態が良好であったこと（PS2），グラフト条件も満たしていたことから，生体肝移植可能と判断し，生体肝移植術（拡大左葉グラフト）施行．術後経過は概ね良好で，術後35 日目退院となった．現在も在宅・生存中であり，非常に良好なQOLを維持している．【考察】生体肝移植は，高齢レシピエントに対してもPS が保たれている場合は，安全に施行出来る可能性が高く，良好な術後成績を得られると考える