ABSTRACT
OBJECTIVES: The total psoas area index (TPI) is an emerging alternative to the total skeletal muscle area index as a prognostic factor but has never been evaluated in metastatic pancreatic cancer (mPC). METHODS: Areas were manually recorded, as previously described. Sex-specific cutoffs were identified by optimum stratification of TPI using log-rank χ2 statistic associated with mortality to define sarcopenic psoas. Progression-free survival (PFS) and overall survival (OS) were the primary objectives. Two period groups were used as internal validation. RESULTS: During the period study, 79 patients were treated for mPC. The TPI was correlated with PFS (hazards ratio, 0.81; P = 0.02) and OS (hazards ratio, 0.7; P < 0.001). Optimum thresholds defining sarcopenic psoas were less than 5.73 cm2/m2 in men and less than 4.37 cm2/m2 in women. Patients with sarcopenic psoas (62.0%) had shorter median PFS (2.9 months) compared with the others (6.6 months, adjusted P log-rank = 0.01), independently to the intensity of chemotherapy, weight loss, and performance status greater than 1. Similarly, OS was independently shorter in patients with sarcopenic psoas (7.6 months) versus the others (22.2 months, adjusted P < 0.001). These results were confirmed in the 2 period groups. CONCLUSIONS: A low TPI is a stronger independent prognostic factor in mPC.
Subject(s)
Liver Neoplasms/secondary , Pancreas/pathology , Pancreatic Neoplasms/pathology , Psoas Muscles/pathology , Sarcopenia/diagnosis , Aged , C-Reactive Protein/metabolism , CA-19-9 Antigen/metabolism , Female , Humans , Kaplan-Meier Estimate , Liver Neoplasms/metabolism , Male , Middle Aged , Multivariate Analysis , Pancreas/drug effects , Pancreas/metabolism , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/metabolism , Prognosis , Sarcopenia/diagnostic imaging , Tomography, X-Ray Computed/methodsSubject(s)
Cholangitis/surgery , Drainage/methods , Endoscopy, Digestive System/methods , Endosonography/methods , Palliative Care/methods , Stents , Surgery, Computer-Assisted/methods , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Aged , Anastomosis, Surgical/methods , Cholangiography , Cholangitis/diagnosis , Cholangitis/etiology , Female , Humans , Pancreatic Neoplasms/complications , Pancreatic Neoplasms/diagnosisSubject(s)
Cell Differentiation/physiology , Endometriosis/pathology , Fallopian Tube Diseases/pathology , Mediastinal Cyst/pathology , Endometriosis/diagnosis , Endometriosis/surgery , Fallopian Tube Diseases/diagnosis , Female , Humans , Mediastinal Cyst/diagnosis , Middle Aged , Treatment OutcomeABSTRACT
We report the case of a 76-year-old patient presenting with an anterior mediastinal heterogeneous mass. Surgical biopsy revealed a solid and cystic lesion filled with hair. Pathological examination showed an atypical papillary epithelial lining without other germ cell tumor or immature teratoma associated. The final diagnosis was a mature teratoma of the mediastinum with somatic-type malignancy (carcinomatous transformation). After 8-month follow-up, subcutaneous and lymph node metastatic lesions of the carcinomatous component were identified. Subtyping of the malignant component within germ cell tumors is an important challenge for therapeutic options and prognosis.