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Hayakawa N, Kikuchi E. Editorial comment to "The clinical impact of ureteroscopy for upper tract urothelial carcinoma: A multicenter study". Int J Urol 2024; 31:402-403. [PMID: 38284558 DOI: 10.1111/iju.15405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan
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2
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Tsukada H, Hayakawa N, Aida K, Wada S, Morimoto T, Doi M, Mimura H, Koike J, Kikuchi E. Small renal cell carcinoma accompanied by extensive inferior vena cava tumor thrombus diagnosed by percutaneous transvenous biopsy. IJU Case Rep 2024; 7:91-94. [PMID: 38440720 PMCID: PMC10909149 DOI: 10.1002/iju5.12662] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/13/2023] [Indexed: 03/06/2024] Open
Abstract
Introduction Up to 10% of patients with renal cell carcinoma present with tumor thrombus in the inferior vena cava. We report that a case of small renal cell carcinoma with tumor thrombus extending above the diaphragm for which transvenous biopsy was performed for diagnosis. Case presentation A 79-year-old man performed computed tomography to evaluate hepatic dysfunction, which revealed intravenous tumor extending above the diaphragm and a 15-mm-sized exophytic tumor in right kidney. Imaging suggested that the renal tumor was renal cell carcinoma. As this tumor was small and exophytic, confirmation of the intravenous tumor being tumor thrombus associated with renal cell carcinoma was difficult. We simultaneously performed transvenous biopsy on the intravenous tumor and percutaneous biopsy on the renal tumor for obtaining histologic diagnoses. The final diagnosis was small renal cell carcinoma accompanied by tumor thrombus above the diaphragm. Conclusion Transvenous biopsy may be useful for the definitive diagnosis of inferior vena cava-tumor thrombus in cases of small renal cell carcinoma.
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Affiliation(s)
- Hikaru Tsukada
- Department of UrologySt. Marianna University School of MedicineKawasakiJapan
| | - Nozomi Hayakawa
- Department of UrologySt. Marianna University School of MedicineKawasakiJapan
| | - Koichiro Aida
- Department of UrologySt. Marianna University School of MedicineKawasakiJapan
| | - Shinji Wada
- Department of Diagnostic and Interventional RadiologySt. Marianna University School of MedicineKawasakiJapan
| | - Tsuyoshi Morimoto
- Department of Diagnostic and Interventional RadiologySt. Marianna University School of MedicineKawasakiJapan
| | - Masatomo Doi
- Department of Diagnostic PathologySt. Marianna University School of MedicineKawasakiJapan
| | - Hidefumi Mimura
- Department of Diagnostic and Interventional RadiologySt. Marianna University School of MedicineKawasakiJapan
| | - Junki Koike
- Department of Diagnostic PathologySt. Marianna University School of MedicineKawasakiJapan
| | - Eiji Kikuchi
- Department of UrologySt. Marianna University School of MedicineKawasakiJapan
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3
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Kikuchi E, Hayakawa N. Editorial Comment to "Improving compliance with guidelines may lead to favorable clinical outcomes for patients with non-muscle-invasive bladder cancer: A retrospective multicenter study". Int J Urol 2023; 30:1163-1164. [PMID: 37759398 DOI: 10.1111/iju.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Affiliation(s)
- Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
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4
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Kikuchi E, Hayakawa N. Editorial Comment to "The poor antitumor effect of pembrolizumab in advanced upper urothelial carcinoma with renal parenchymal invasion". Int J Urol 2023; 30:786-787. [PMID: 37461821 DOI: 10.1111/iju.15257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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5
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Katayama S, Pradere B, Grossman NC, Potretzke AM, Boorjian SA, Ghoreifi A, Daneshmand S, Djaladat H, Sfakianos JP, Mari A, Khene ZE, D'Andrea D, Hayakawa N, Breda A, Fontana M, Fujita K, Antonelli A, van Doeveren T, Steinbach C, Mori K, Laukhtina E, Rouprêt M, Margulis V, Karakiewicz PI, Araki M, Compérat E, Nasu Y, Shariat SF. Biological and prognostic implications of biopsy upgrading for high-grade upper tract urothelial carcinoma at nephroureterectomy. Int J Urol 2023; 30:63-69. [PMID: 36349904 PMCID: PMC10098861 DOI: 10.1111/iju.15061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 09/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Technical limitations of ureteroscopic (URS) biopsy has been considered responsible for substantial upgrading rate in upper tract urothelial carcinoma (UTUC). However, the impact of tumor specific factors for upgrading remain uninvestigated. METHODS Patients who underwent URS biopsy were included between 2005 and 2020 at 13 institutions. We assessed the prognostic impact of upgrading (low-grade on URS biopsy) versus same grade (high-grade on URS biopsy) for high-grade UTUC tumors on radical nephroureterectomy (RNU) specimens. RESULTS This study included 371 patients, of whom 112 (30%) and 259 (70%) were biopsy-based low- and high-grade tumors, respectively. Median follow-up was 27.3 months. Patients with high-grade biopsy were more likely to harbor unfavorable pathologic features, such as lymphovascular invasion (p < 0.001) and positive lymph nodes (LNs; p < 0.001). On multivariable analyses adjusting for the established risk factors, high-grade biopsy was significantly associated with worse overall (hazard ratio [HR] 1.74; 95% confidence interval [CI], 1.10-2.75; p = 0.018), cancer-specific (HR 1.94; 95% CI, 1.07-3.52; p = 0.03), and recurrence-free survival (HR 1.80; 95% CI, 1.13-2.87; p = 0.013). In subgroup analyses of patients with pT2-T4 and/or positive LN, its significant association retained. Furthermore, high-grade biopsy in clinically non-muscle invasive disease significantly predicted upstaging to final pathologically advanced disease (≥pT2) compared to low-grade biopsy. CONCLUSIONS High tumor grade on URS biopsy is associated with features of biologically and clinically aggressive UTUC tumors. URS low-grade UTUC that becomes upgraded to high-grade might carry a better prognosis than high-grade UTUC on URS. Tumor specific factors are likely to be responsible for upgrading to high-grade on RNU.
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Affiliation(s)
- Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nico C Grossman
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Alireza Ghoreifi
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Sia Daneshmand
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - Hooman Djaladat
- Department of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, California, USA
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York, USA
| | - Andrea Mari
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Zine-Eddine Khene
- Department of Urology, Hospital Pontchaillou, CHU Rennes, Rennes, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Matteo Fontana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Kazutoshi Fujita
- Department of Urology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Alessandro Antonelli
- Urology Unit AUOI Verona, Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy
| | - Thomas van Doeveren
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Christina Steinbach
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Morgan Rouprêt
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Eva Compérat
- GRC 5 Predictive Onco-Uro, AP-HP, Urology, Pitie-Salpetriere Hospital, Sorbonne University, Paris, France.,Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan.,Department of Urology, Weill Cornell Medical College, New York City, New York, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
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Hayakawa N, Kikuchi E. A case of pseudoprogression in avelumab maintenance therapy for metastatic bladder cancer. IJU Case Rep 2022; 6:5-7. [PMID: 36605694 PMCID: PMC9807330 DOI: 10.1002/iju5.12510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/12/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction A unique phenomenon of immune therapy is pseudoprogression; however, a definite mechanism and predictive factors remain unclear. We herein report a case of pseudoprogression with avelumab maintenance therapy. Case presentation A 67-year-old male diagnosed with muscle-invasive bladder cancer with lung metastasis was treated with four cycles of gemcitabine and cisplatin chemotherapy immediately after cystectomy and ileal conduit urinary diversion. The response to cisplatin-based chemotherapy was a stable disease. Avelumab maintenance therapy was started after first-line chemotherapy but was interrupted due to his general fatigue after the third administration of avelumab. At that time, computed tomography (CT) revealed an increased size of lung metastases. Two months after the interruption, avelumab maintenance therapy was restarted. At the end of the seventh dose of avelumab administration, CT showed a dramatic reduction of lung metastatic tumors. Conclusion Pseudoprogression may also occur with avelumab maintenance therapy in metastatic bladder cancer.
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Affiliation(s)
- Nozomi Hayakawa
- Department of UrologySt Marianna University School of MedicineJapan
| | - Eiji Kikuchi
- Department of UrologySt Marianna University School of MedicineJapan
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7
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Hayakawa N, Kaneko G, Oyama M, Kikuchi E. 156P The association between response to enfortumab vedotin therapy and primary tumor location in Japanese urothelial carcinoma patients. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.10.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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8
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Yoza N, Nakazawa R, Nishi T, Tsukada H, Shirai D, Adachi H, Yamada R, Matsumura K, Iwata T, Usuba W, Aida K, Hayakawa N, Sasaki H, Kikuchi E. [Early Experience with MRI-Ultrasound Fusion-Guided Prostate Biopsy in Our Institution]. Hinyokika Kiyo 2022; 68:291-294. [PMID: 36199207 DOI: 10.14989/actauroljap_68_9_291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A total of 100 patients were retrospectively analyzed with magnetic resonance imaging-ultrasonography (MRI-US) fusion biopsy(KOELIS, TRINITY®) at our institution between October 2019 and May 2020. The median patient age was 71 years, median prostate specific antigen (PSA) level was 7.4 ng/ml, and median PSA-density was 0.183 mg/ml. Sixty-one of the patients were positive for cancer ; 14 of them were positive by targeted biopsy only, 9 were positive by systematic biopsy only, and 38 were positive by both. Clinically significant prostate cancer (CPSC ; Gleason Score ≥3+4 and % core ≥50%) was detected by target biopsies in 46 patients and by systematic biopsies in 33 patients. The positive core detection rate for CSPC was 32.5% for targeted biopsies and 7.0% for systematic biopsies(P<0.0001), with a significantly higher rate for targeted biopsies. These results indicate that in MRI-US fusion biopsy, targeted biopsy has a higher detection rate for cancer and a significantly higher detection rate for clinically significant prostate cancer compared with systematic biopsy.
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Affiliation(s)
- Naoto Yoza
- The Department of Urology, St Marianna University School of Medicine
| | - Ryuto Nakazawa
- The Department of Urology, St Marianna University School of Medicine
| | - Tomohiro Nishi
- The Department of Urology, St Marianna University School of Medicine
| | - Hikaru Tsukada
- The Department of Urology, St Marianna University School of Medicine
| | - Daisuke Shirai
- The Department of Urology, St Marianna University School of Medicine
| | - Hiroyuki Adachi
- The Department of Urology, St Marianna University School of Medicine
| | - Ryuji Yamada
- The Department of Urology, St Marianna University School of Medicine
| | - Kaori Matsumura
- The Department of Urology, St Marianna University School of Medicine
| | - Teppei Iwata
- The Department of Urology, St Marianna University School of Medicine
| | - Wataru Usuba
- The Department of Urology, St Marianna University School of Medicine
| | - Kouichirou Aida
- The Department of Urology, St Marianna University School of Medicine
| | - Nozomi Hayakawa
- The Department of Urology, St Marianna University School of Medicine
| | - Hideo Sasaki
- The Department of Urology, St Marianna University School of Medicine
| | - Eiji Kikuchi
- The Department of Urology, St Marianna University School of Medicine
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9
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Hayakawa N, Mizuno R, Shiraishi Y, Tanaka T, Matsumoto K, Kosaka T, Ohashi T, Kikuchi E, Shigematsu N, Oya M. PO-1818 Prospective study of tadalafil treatment in patients treated with prostate brachytherapy in Japan. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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Hayakawa N, Kikuchi E. Editorial Comment from Dr Hayakawa and Dr Kikuchi to Bladder cancer prospective cohort study on high‐risk non‐muscle invasive bladder cancer after photodynamic diagnosis‐assisted transurethral resection of the bladder tumor (BRIGHT study). Int J Urol 2022; 29:639-640. [DOI: 10.1111/iju.14888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology St. Marianna University School of Medicine Kanagawa Japan
| | - Eiji Kikuchi
- Department of Urology St. Marianna University School of Medicine Kanagawa Japan
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11
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Izawa N, Shiokawa H, Onuki R, Hamaji K, Morikawa K, Saji H, Ohashi H, Kasugai S, Hayakawa N, Ohara T, Sunakawa Y. The clinical utility of comprehensive measurement of autoimmune disease-related antibodies in patients with advanced solid tumors receiving immune checkpoint inhibitors: a retrospective study. ESMO Open 2022; 7:100415. [PMID: 35247869 PMCID: PMC9058890 DOI: 10.1016/j.esmoop.2022.100415] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/18/2021] [Accepted: 01/19/2022] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The comprehensive measurement of autoimmune disease-related antibodies (Abs) before immune checkpoint inhibitor (ICI) treatment may be useful for predicting the development of immune-related adverse events (irAEs); however, the clinical utility is not well known. MATERIALS AND METHODS We retrospectively analyzed patients with advanced solid tumors treated with ICI monotherapy or doublet combination therapy between July 2014 and December 2020 at single institute. Anti-nuclear antibody (ANA), anti-thyroglobulin (Tg) Ab, anti-thyroid peroxidase (TPO) Ab, anti-glutamic acid decarboxylase (GAD) Ab, anti-acetylcholine esterase receptor (AchR) Ab, and platelet-associated immunoglobulin G (PA-IgG) Ab were comprehensively measured for the screening before ICI therapy. RESULTS Of 275 registered patients (median age, 70 years; male, 64.4%; Eastern Cooperative Oncology Group performance status of 0 or 1, 88.7%; and prior regimen of 0-1/≥2, 88.7%/11.3%), 128 non-small-cell lung cancer, 35 gastric cancer, 33 head and neck cancer, 24 melanoma, 19 renal cell carcinoma, 13 urothelial carcinoma, 12 esophageal cancer, 5 malignant mesothelioma of pleura, 2 endometrial cancer, and 4 other cancer were included. The number of patients with positive ANA, Tg, TPO, PA-IgG, GAD, and AchR Abs was 52 (24.9%), 38 (14.5%), 11 (10.1%), 6 (3.5%), 5 (2.0%), and 1 (0.5%), respectively. There was no association between the development of any irAEs and Abs positivity, while thyroid dysfunction developed more frequently among patients with than without Tg Ab or TPO Ab (39.5% versus 12.5%, P < 0.01; 45.5% versus 14.3%, P = 0.02). CONCLUSIONS The clinical utility of comprehensive measurement of autoimmune disease-related Abs before introduction of ICI therapy was limited for predicting irAE. However, Tg and TPO Abs were risk factors as regards the development of ICI-induced thyroid dysfunction.
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Affiliation(s)
- N Izawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - H Shiokawa
- Department of Pharmacy, St. Marianna University Hospital, Kawasaki, Japan
| | - R Onuki
- Department of Pharmacy, St. Marianna University Hospital, Kawasaki, Japan
| | - K Hamaji
- Department of Pharmacy, St. Marianna University Hospital, Kawasaki, Japan
| | - K Morikawa
- Department of Internal Medicine, Division of Respiratory Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - H Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan
| | - H Ohashi
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - S Kasugai
- Department of Otorhinolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - N Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - T Ohara
- Department of Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Y Sunakawa
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan.
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12
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Hayakawa N, Kikuchi E. Editorial Comment to Incidence and location of perioperative deep vein thrombosis in patients with bladder cancer undergoing radical cystectomy. Int J Urol 2021; 29:264-265. [PMID: 34963201 DOI: 10.1111/iju.14777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
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13
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Hayakawa N, Kikuchi E. Editorial Comment to Effect of optimal neoadjuvant chemotherapy on oncological outcomes of locally advanced bladder cancer with laparoscopic radical cystectomy: A matched-pair analysis in a multicenter cohort. Int J Urol 2021; 28:664. [PMID: 33735941 DOI: 10.1111/iju.14557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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14
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Hayakawa N, Kikuchi E. Editorial Comment to Prognostic impact of non-urothelial carcinoma of the upper urinary tract: Analysis of hospital-based cancer registry data in Japan. Int J Urol 2020; 28:60-61. [PMID: 33167070 DOI: 10.1111/iju.14407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Eiji Kikuchi
- Department of Urology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
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15
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Takamatsu K, Mizuno R, Hayakawa N, Tanaka N, Kosaka T, Kikuchi E, Oya M. The change of serum C-reactive protein levels during molecular-targeted treatments could predict the response to anti-PD-1 treatment in metastatic renal cell carcinoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17085 Background: Immuno-oncology (IO) checkpoint inhibitors, such as programmed death-1/programmed death-ligand1 (PD-1/PD-L1) inhibitors have been standard of care in the metastatic renal cell carcinoma (mRCC) systemic treatment. However, predictive biomarkers for IO checkpoint inhibitors which is clinically usable have been still unclear. The aim of this study was to evaluate the clinical significance of the change of serum C-reactive protein (CRP) levels during molecular-targeted treatments (VEGFR-TKI and mTOR-I) prior to nivolumab as the predictive marker for the response of nivolumab in patients with refractory mRCC. Methods: A total of 73 mRCC patients (favorable 25(34%), Intermediate 38(52%) and poor 10(14%) risk group by IMDC criteria) treated with nivolumab were retrospectively reviewed. We evaluated the serum CRP levels before and after molecular-targeted treatments. The elevation of serum CRP during molecular-targeted therapies before nivolumab induction was defined as the CRP-elevation group. The clinical impact of CRP-elevation as well as other clinical and pathological prognostic factors on progression-free survival (PFS) and overall survival (OS) from nivolumab were assessed. Results: The median follow-up period after nivolumab initiation was 13.2 months (range 3.0-60.8). Forty-nine patients (67%) were categorized into the CRP-elevation group. A clear impact of the CRP-elevation on the response of nivolumab was observed: the median PFS of the CRP-elevation group was 11.9 months, and that of the CRP-non elevation was not-reached (p = 0.038). On multivariate analysis, the CRP-elevation before nivolumab was the independent prognostic factor to predict PFS in nivolumab treatment (HR: 2.68, 95% CI: 1.01-7.11, p = 0.047). CRP-elevation group had a tendency of shorter OS than CRP-non elevation group (p = 0.071). Conclusions: The change of serum CRP levels during molecular-targeted therapies could be the predictive factor for the efficacy of nivolumab in mRCC patients.
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Affiliation(s)
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University school of Medicine, Tokyo, Japan
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16
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Mizuno R, Takamatsu K, Tanaka N, Hayakawa N, Kosaka T, Kikuchi E, Oya M. Predictors of first line systemic therapy for metastatic renal cell carcinoma in IMDC favorable risk patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e17086 Background: With the induction of molecular targeted agents, which interfere with proteins that play critical roles in tumor growth and progression, and immune checkpoint inhibitors (ICI), the scenario of systemic treatment of metastatic renal cell carcinoma (mRCC) have dramatically been changed with improved survival. Prognostic risk assessment is essential for choosing the most appropriate first line treatment option, with selection based on International Metastatic RCC Database Consortium (IMDC) Risk Category. This study was designed to evaluate the actual efficacy of systemic therapy in the IMDC favorable risk group patients with mRCC. Methods: A total of 218 patients with mRCC who received systemic therapy were retrospectively reviewed (Institutional review board approval No 2013-0425). Among them, 55 (25%) patients were classified as favorable risk group based on the IMDC Risk Category. These mRCC patients in the favorable risk were divided into 2 groups by following factors; gender (male or female), age (≥70, or not), baseline serum CRP levels (≥0.6, and < 0.6 mg/dl), metastatic sites (exclusive lung, or lung and others), BMI (≥22, or < 22), respectively. The overall survival (OS) of patients in the favorable risk group were compared between the two cohorts. Results: The median PFS for first line treatment and OS of patients in favorable risk group were 31.6 (95% CI 19.9–33.7)) and 85.8 (56.8-NE) months, respectively. The median OS in patients with BMI≥22 and < 22 was 65.6 (95% CI 56.8–NE) and 56.8 (95% CI 30.8–NE) months, respectively (p = 0.0497). The median OS in patients with exclusive lung metastasis, and lung and other metastases were 115.1 (95% CI NE) and 65.6 (95% CI 43.9–NE) months, respectively (p = 0.0073). No significant difference was found in OS between male and female, age≥70 and < 70, and baseline serum CRP levels ≥0.6 mg/dl and < 0.6, respectively. Conclusions: The first line systemic treatment for mRCC patients in IMDC favorable risk group was feasible and effective in patients with BMI≥22 or exclusive lung metastasis.
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Affiliation(s)
- Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, St.Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Takeo Kosaka
- Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, St.Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University school of Medicine, Tokyo, Japan
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Kikuchi E, Hayakawa N, Fukumoto K, Shigeta K, Matsumoto K. Bacillus Calmette–Guérin‐unresponsive non‐muscle‐invasive bladder cancer: Its definition and future therapeutic strategies. Int J Urol 2019; 27:108-116. [DOI: 10.1111/iju.14153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/22/2019] [Indexed: 01/19/2023]
Affiliation(s)
- Eiji Kikuchi
- Department of Urology St. Marianna University School of Medicine Kanagawa Japan
| | - Nozomi Hayakawa
- Department of Urology Keio University School of Medicine Tokyo Japan
| | - Keishiro Fukumoto
- Department of Urology Keio University School of Medicine Tokyo Japan
| | - Keisuke Shigeta
- Department of Urology Keio University School of Medicine Tokyo Japan
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18
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Mizuno R, Takamatsu K, Hayakawa N, Kosaka T, Tanaka N, Oya M. Efficacy of systemic therapy for metastatic renal cell carcinoma in patients over 75 years of age. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16080 Background: In the last decade, approval of targeted agents and immune checkpoint inhibitors (ICI) have dramatically changed the scenario of systemic treatment of metastatic renal cell carcinoma (mRCC) with improved survival. Although elderly individuals represent a consistent proportion, clinical trials have not directly compared the efficacy and safety of targeted agents in the elderly population. Methods: A total of 195 patients were retrospectively reviewed. All patients received systemic therapy for mRCC at Keio University hospital in Japan (Institutional review board approval No 2013-0425). Patients were divided into two groups (≥75 or < 75 years) according to their age at the time of systemic therapy initiation. The disease control rate (DCR), progression-free survival (PFS), and overall survival (OS) were compared between the two cohorts. Results: The elderly cohort (≥75 years old) comprised of 42 patients (21.5%). The DCR for first line treatment in patients ≥75 years old and < 75 years old was 75.0 and 76.2 %, respectively (p = 0.8728). The median PFS for first line treatment in patients ≥75 years old and < 75 years old was 10.7 (95% CI 7.5–20.7) and 11.6 (95% CI 9.7–16.3) months, respectively (p = 0.6074). The median OS for systemic treatment in patients ≥75 years old and < 75 years old was 37.3 (95% CI 18.0–65.2) and 45.5 (95% CI 35.1–56.8) months, respectively (p = 0.0424). Conclusions: Systemic treatment for mRCC was feasible and effective in Japanese patients over 75 years of age.
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Affiliation(s)
- Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of Medicine, Tokyo, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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19
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Takamatsu K, Mizuno R, Hayakawa N, Kikuchi E, Kosaka T, Oya M. Prognostic value of serum C-reactive protein level prior to second-line treatment in intermediate risk metastatic renal cell carcinoma patients. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16065 Background: The later-line treatment of metastatic renal cell carcinoma (mRCC) has been drastically changing by the development of immune-oncology drugs and molecular targeted treatment in recent years. Although the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model is useful for second-line setting, this model has the problem that over 50% patients are classified as intermediate risk group. The aim of this study is to evaluate whether the serum C-reactive protein (CRP) levels prior to second-line treatment could divide intermediate risk group patients. Methods: We retrospectively reviewed 150 mRCC patients received second-line molecular targeted therapy. We assessed the prognostic impact of serum CRP levels prior to second-line treatment initiation to predict overall survival (OS) especially in intermediate risk group. Results: The median OS from second-line treatment of whole cohort and intermediate risk group were 24.6 (95%confidence interval, 95%CI:18.2-31.0) and 23.6 (95%CI:15.1-32.1) months. Thirty-three out of 82 (40%) intermediate risk patients demonstrated elevated baseline CRP levels. The median OS of elevated and non-elevated CRP group were 13.4 (95%CI:5.9-20.8) and 29.4 (95%CI:25.5-33.5) months, respectively (p = 0.001). The serum CRP elevation could predict prognosis in intermediate risk patients treated with second-line treatment (HR 2.5,95%CI:1.4-4.2, p = 0.001). Conclusions: The serum CRP levels at second-line treatment initiation could divide intermediate risk mRCC patients into two prognostic subgroups.
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Affiliation(s)
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of Medicine, Tokyo, Japan
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Hayakawa N, Kikuchi E, Ogihara K, Hattori S, Yoshimine S, Shirotake S, Okabe T, Yamashita R, Oya M. Is the occurrence of higher adverse effects associated with better oncological outcome in metastatic urothelial carcinoma patients treated with pembrolizumab? J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
405 Background: Pembrolizumab is an anti-programmed cell death protein-1 (anti-PD-1) monoclonal antibody and a recently approved and long-awaited drug for the treatment of metastatic urothelial carcinoma (UC). It is an immune checkpoint inhibitor, which has been shown to trigger new autoimmune disorders. We investigated the association of occurrence of adverse effects (AE) with clinical outcome in Japanese UC treated with pembrolizumab. Methods: We identified 50 cases treated with pembrolizumab for chemo-resistant UC between December 2017 and August 2018 at our 5 institutions. Pembrolizumab-induced AE were reported by using Common Terminology Criteria for Adverse Events (CTCAE) v 4.0. We evaluated the association between pembrolizumab-induced AE and response rate as well as patient survival. Results: The median age of the patients was 73 years (range, 46-89 years). The male/female ratio was 36/14. The primary tumor location was the pelvis in 10, ureter in 10, and bladder in 30. The median course of pembrolizumab was 4 (1-11). In the 50 patients, 36 AEs were observed, 11 of which were classified as CTCAE grade 2/3 . These patients were defined as the high AE groups. No grade 4 AE was encountered. In the high AE groups the most common AE was adrenal dysfunction (n = 4). Patients with no or CTCAE grade 1 were defined as the no/low AE groups. In the 45 cases who had measurable lesions, at the point of maximum effect the sum of the target lesion longest diameter (SLD) was decreased in 17 cases (37.8%) compared to baseline. SLD decreased in 7 (70%) patients in the high AE groups, which was significantly lower than those in the no/low AE groups (10, 28.6%, p = 0.027). The disease control rate defined by RECST ver. 4.0 at best response in the high AE groups was 81.8%, which was significantly higher than that in the no/low AE groups (46.2%, p = 0.046). The 6-month progression-free survival rate and the 6-month cancer-specific survival rate for the high AE groups was not different from that for the no/low AE groups. Conclusions: In patients with metastatic UC, the occurrence of CTCAE grade 2/3 might be associated with a better clinical response to pembrolizumab treatment.
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Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Koichirou Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | | | - Suguru Shirotake
- Saitama Medical University International medical center, Saitama, Japan
| | - Takashi Okabe
- Saitama Medical University International Medical Center, Saitama, Japan
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Kikuchi E, Hayakawa N, Ogihara K, Omura M, Mizuno R, Oya M. The timing from perioperative chemotherapy and disease recurrence could have clinical impact on survival in bladder cancer patients treated with salvage chemotherapy. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
444 Background: Our aim was to clarify whether the duration between perioperative chemotherapy and disease recurrence could affect therapeutic efficacy of salvage chemotherapy in bladder cancer patients treated with radical cystectomy. Methods: We retrospectively identified 201 patients treated with radical cystectomy and perioperative chemotherapy of neoadjuvant chemotherapy (NAC) and/or adjuvant chemotherapy (AC) for bladder cancer at our 7 institutions between 2003 and 2015. Of them 56 patients received salvage chemotherapy for disease recurrence and were included in the present analysis. We classified these patients according to the time from perioperative chemotherapy received to disease recurrence ( < 12 months, 12-24 months, and 24 < months) and compared their clinical characteristics and survival outcomes. Results: Overall, 33, 14, and 9 patients developed disease recurrence in < 12 months, 12-24 months, and < 24 months, respectively after perioperative chemotherapy. Patients in the 12-24 months group had a higher smoking rate compared to those in the other two groups, and were higher rate of female in comparison to the < 24 months group. Twenty-four (42.8%) patients received NAC alone, 23 (41.1%) received AC alone, and 9 (16.1%) received both NAC and AC. Twenty-two (66.7%), 9 (64%), and 4 (44.4%) patients received NAC in the < 12 months group, the 12-24 months group, and the < 24 months group, respectively. Furthermore, 19 (57.6%), 7 (50%), and 6 (66.7%) patients received AC in the < 12 months group, the 12-24 months group, and the < 24 months group, respectively. The 5 year overall survival in the < 12 months group was 26.6%, which was significantly lower than those in the 12-24 months group (51.1%, p < 0.001) and in the 24 months group (46.9%, p = 0.014). Multivariate Cox regression analysis revealed that disease recurrence after perioperative chemotherapy within 12 months was the only independent prognostic indicator for overall death (p = 0.032). Conclusions: Bladder cancer patients with disease recurrence within 12 months from their perioperative chemotherapy have a worse overall survival after salvage chemotherapy.
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Affiliation(s)
- Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Koichirou Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Minami Omura
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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22
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Akita H, Kikuchi E, Hayakawa N, Mikami S, Sugiura H, Oya M, Jinzaki M. Performance of diffusion-weighted MRI post-CT urography for the diagnosis of upper tract urothelial carcinoma: Comparison with selective urine cytology sampling. Clin Imaging 2018; 52:208-215. [DOI: 10.1016/j.clinimag.2018.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 07/13/2018] [Accepted: 08/14/2018] [Indexed: 01/03/2023]
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Sugiura H, Akita H, Kikuchi E, Mikami S, Hayakawa N, Narita K, Jinzaki M. Ureteral pseudodiverticulosis accompanied by urothelial carcinoma diagnosed by CT urography: a case report and review of the literature. BJR Case Rep 2018; 4:20170111. [PMID: 30363136 PMCID: PMC6159122 DOI: 10.1259/bjrcr.20170111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 12/14/2017] [Accepted: 01/03/2018] [Indexed: 11/24/2022] Open
Abstract
Ureteral pseudodiverticulosis is a relatively rare condition and has been diagnosed by retrograde urography and excretory urography. Ureteral pseudodiverticulosis is also suspected to be a potential risk factor for the development of urothelial carcinoma. We report the case of a male in his 70 s who was suspected to have right ureteral pseudodiverticulosis accompanied by multifocal urothelial carcinoma based on CT urography findings. After surgery, the pathological findings confirmed the presence of ureteral pseudodiverticulosis and multifocal urothelial carcinoma in his right ureter and bladder. To the best our knowledge, this is the first reported case of ureteral pseudodiverticulosis with concurrent urothelial carcinoma detected by CT urography. Since CT urography has replaced excretory urography as the first-line imaging test for investigating patients with high risk for upper tract urothelial carcinoma, it is important to recognize the characteristic findings of ureteral pseudodiverticulosis on CT urography.
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Affiliation(s)
- Hiroaki Sugiura
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | | | - Keiichi Narita
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Hayakawa N, Kikuchi E, Shigeta K, Mizuno R, Oya M. 452 Relationship between radiation doses and development of erectile dysfunction in patients treated with permanent prostate brachytherapy for localized prostate cancer. J Sex Med 2018. [DOI: 10.1016/j.jsxm.2018.04.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shimizu T, Ishida H, Hayakawa N, Shibahara R, Tanabe K. Clinical and Pathological Analyses of Cases of Acute Vascular Rejection After Kidney Transplantation. Transplant Proc 2018; 49:2251-2255. [PMID: 29198655 DOI: 10.1016/j.transproceed.2017.09.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We performed a clinical and pathological analysis of cases of acute vascular rejection (AVR), characterized by intimal arteritis and transmural arteritis (Banff v score) after kidney transplantation, in an attempt to clarify the mechanisms underlying the development and prognostic significance of AVR. METHODS AVR (Banff score: v >0) was diagnosed in 31 renal allograft biopsy specimens (BS) obtained from 31 renal transplant patients receiving follow-up care at the Department of Urology, Tokyo Women's Medical University, between January 2010 and April 2016. RESULTS AVR was diagnosed at a median of 124.6 days after transplantation. Among the 31 BS showing evidence of AVR, AVR was mild (v1 in Banff's classification) in 25 cases, moderate (v2) in 6, and severe (v3) in none. We classified the 31 BS with evidence of AVR by their overall histopathological features as follows: isolated v lesions were observed in 6 BS, acute antibody-mediated rejection (AAMR) in 7, acute T-cell-mediated rejection (ATCMR) in 12, and both ATCR and AAMR in 6. Loss of the renal allograft occurred during the observation period in 3 patients, and, of the remaining cases with functioning grafts, deterioration of renal allograft function after biopsy occurred in only 2 patients. CONCLUSIONS The results of our study suggest that ATCMR contributes to AVR in 40% to 60% of cases, AAMR in 20% to 40% of cases, and isolated v lesions in 20% of cases. The prognosis of the patient with the graft that had AVR was relatively good under the present immunosuppression protocol and current anti-rejection therapies.
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Affiliation(s)
- T Shimizu
- Department of Transplant Surgery, Toda Chuo General Hospital, Saitama, Japan; Department of Urology, Toda Chuo General Hospital, Saitama, Japan; Department of Urology, Tokyo Women's Medical University, Tokyo, Japan.
| | - H Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - N Hayakawa
- Department of Urology, Edogawa Hospital, Tokyo, Japan
| | - R Shibahara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - K Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
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26
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Takamatsu K, Mizuno R, Hayakawa N, Kosaka T, Kikuchi E, Mikami S, Oya M. The clinical impact of serum C-reactive protein levels in metastatic renal-cell carcinoma patients treated by second-line molecular targeted therapies. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Mizuno R, Mikami S, Takamatsu K, Hayakawa N, Kosaka T, Kikuchi E, Oya M. Constitutive activation of mTOR pathways in renal cell carcinoma arising in dialyzed patients. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | | | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Keio University School of Medicine, Tokyo, Japan
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Hayakawa N, Kikuchi E, Mizuno R, Oya M, Takamatsu K. Does neoadjuvant chemotherapy affect postoperative complication rates in elderly patients treated with radical cystectomy for bladder cancer? J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Hayakawa N, Kikuchi E, Takamatsu K, Mizuno R, Oya M. Association between expression of programmed cell death-1 and smoking status in patients with upper tract urothelial carcinoma treated by radical nephroureterectomy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.e16592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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30
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Fukumoto K, Kikuchi E, Mikami S, Hayakawa N, Matsumoto K, Niwa N, Oya M. Clinical Role of Programmed Cell Death-1 Expression in Patients with Non-muscle-invasive Bladder Cancer Recurring After Initial Bacillus Calmette-Guérin Therapy. Ann Surg Oncol 2018; 25:2484-2491. [PMID: 29717423 DOI: 10.1245/s10434-018-6498-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The programmed cell death-1 (PD-1) pathway has been suggested to play an important role in tumor immune escape. We evaluated changes in PD-1 expression before and after Bacillus Calmette-Guérin (BCG) therapy and its prognostic significance in non-muscle-invasive bladder cancer (NMIBC) patients. METHODS We examined 78 paired tissue samples of NMIBC in tumors just before BCG therapy and BCG-relapsing tumors, defined as recurrence after achieving disease-free status by initial BCG instillations for 6 months. We counted PD-1-positive cells, and PD-1 expression was defined as high when the number of PD-1-positive cells was more than 18 under ×200 magnification. RESULTS The median number of PD-1-positive cells in tumors just before BCG therapy was 3.5, significantly lower than that in BCG-relapsing tumors (17.0, p < 0.001). High PD-1 expression was observed in 20 tumors just before BCG therapy (25.6%) and 36 BCG-relapsing tumors (46.2%). Fifty-two cases (66.6%) showed an increase in the number of PD-1-positive cells in BCG-relapsing tumors. High PD-1 expression in BCG-relapsing tumors was independently associated with subsequent tumor recurrence (p = 0.011) and stage progression (p = 0.033). The 5-year recurrence-free and progression-free survival rates were 40.7 and 74.1% in patients with high PD-1 expression in BCG-relapsing tumors, significantly lower than those in their counterparts (72.9 and 94.1%, respectively). CONCLUSIONS PD-1 was induced by BCG therapy, and its expression in BCG-relapsing tumors may be an important indicator for predicting worse clinical outcomes in NMIBC patients treated with BCG therapy.
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Affiliation(s)
- Keishiro Fukumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - Shuji Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | | | - Naoya Niwa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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31
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Hayakawa N, Kikuchi E, Mikami S, Fukumoto K, Oya M. The Role of PD-1 Positivity in the Tumour Nest on Clinical Outcome in Upper Tract Urothelial Carcinoma Patients Treated with Radical Nephroureterectomy. Clin Oncol (R Coll Radiol) 2017; 30:e1-e8. [PMID: 29153625 DOI: 10.1016/j.clon.2017.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/26/2017] [Accepted: 10/12/2017] [Indexed: 11/15/2022]
Abstract
AIMS The role of PD-1 (programmed cell death 1) expression on the clinical outcome of upper tract urothelial carcinoma has not yet been elucidated in detail. MATERIALS AND METHODS PD-1 expression was immunohistochemically examined in 181 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy. A part of PD-1 protein expression in the tumour periphery and tumour nest was evaluated separately. The PD-1-positive cells were counted in the area showing the highest density of PD-1 expression at a magnification of 400×. RESULTS PD-1 staining in the tumour nest was low in 137 (75.7%) and high in 44 (24.3%) patients. PD-1 staining in the tumour periphery was low in 78 (43.1%) and high in 103 (56.9%) patients. The 5 year progression-free survival rates in patients with the high PD-1 expression in the tumour nest and in the tumour periphery were 54.6% and 67.7%, respectively, which were significantly lower than those in their counterparts (79.4%, P < 0.001; 80.0%, P = 0.04). The 5 year cancer-specific survival rates in patients with the high PD-1 expression in the tumour nest and the tumour periphery were 69.1% and 75.7%, respectively, which were significantly lower than those in their counterparts (84.7%, P = 0.007; 87.8%, P = 0.01). A multivariate Cox regression analysis identified the high PD-1 expression in the tumour nest (hazard ratio 3.07, P < 0.001; hazard ratio 2.44, P = 0.011) and positive lymphovascular invasion (hazard ratio 4.86, P < 0.001; hazard ratio 4.03, P < 0.001) as independent predictors of disease progression and of cancer death, respectively. CONCLUSIONS PD-1 positivity in the tumour nest could be a strong predictor for a worse clinical outcome and may be a useful indicator for selecting appropriate candidates for adjuvant therapy such as chemotherapy in upper tract urothelial carcinoma patients treated with radical nephroureterectomy.
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Affiliation(s)
- N Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - E Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.
| | - S Mikami
- Department of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - K Fukumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - M Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Hayakawa N, Kikuchi E, Mizuno R, Oya M. Prognostic rule of programmed cell death protein 1 expression in resectable upper tract urothelial carcinoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e16090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16090 Background: Programmed cell death protein (PD-1) expressed on active T cells are related to immune tolerance. A close association between PD-1 expression and poor prognosis has been reported in several cancers, however, in upper tract urothelial carcinoma (UTUC) the rule of PD-1 expression on clinical outcome have not been investigated. Methods: The protein expression of PD-1 was evaluated by immunohistochemistry and the relationship with clinicopathological features was investigated in surgical specimens obtained from 155 patients who had been surgically treated for UTUC without previous history of bladder cancer. At a magnification of 400x, PD-1 protein expression was estimated and the positive cells was graded as weak and strong. The protein expression of PD-1 was evaluated in the most invasive part of the cancer with tumor periphery and inside separately. Results: The PD-1 expression was weak in 67 (43.2%) and strong in 88 (56.8%) in tumor periphery. On the other hands, the staining was weak in 117 (75.5%) and strong in 38(24.5%) in tumor insides. Regarding to pathological features, high grade (p = 0.026) and pT2≤ (p = 0.008) related to strong PD-1 expression in tumor inside, and high grade (p = 0.002), pT2≤ (p < 0.001) and positive LVI (p = 0.008) were associated with strong PD-1 expression in tumor periphery. The 5-year caner-specific survival (CSS) in patients with strong PD-1 staining in tumor periphery was 79.4%, which was significantly lower than those in their counterparts (86.0%, p = 0.044). The 5-year CSS in patients with strong PD-1 staining in tumor inside was 73.3%, which was significantly lower than those in their counterparts (85.1%, p < 0.021). Multivariate Cox regression analysis demonstrated that positive LVI (HR; 3.92, p < 0.001) and strong PD-1 expression in tumor inside (HR; 2.30, p < 0.036) were independent predictors for CSS. Conclusions: PD-1 expression, especially in tumor inside, may be a novel indicator for identifying a worse prognosis in UTUC patients with radical nephroureterectomy. Targeting therapy against PD-1 might be a promising therapeutic modality for UTUC, especially aggressive UTUC.
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Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Kikuchi E, Niwa N, Hayakawa N, Mizuno R, Oya M. The clinical role of purified protein derivative skin test reaction in patients with non-muscle invasive bladder cancer treated with bacillus-Calmette Guerin. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.4545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4545 Background: We investigated the association between purified protein derivative (PPD) skin test reaction prior to BCG therapy and clinical outcomes, both oncological outcomes and occurrence of side effects, in BCG-naïve non-muscle invasive bladder cancer (NMIBC) patients. Methods: A total of 288 NMIBC patients who received PPD skin test prior to BCG therapy were included. The PPD skin test reaction was categorized into three groups: positive, slightly positive, and negative. The presence of an induration was positive. If an induration was absent, an erythema 10 mm or more and less than 10 mm corresponds to slightly positive and negative, respectively. Results: Sixty-six (22.9%), 149 (51.7%), and 73 (25.3%) patients had positive, slightly positive, and negative PPD skin test results, respectively. The 5-year recurrence-free survival rate of patients with a positive PPD skin test was 89.4±4.1%, which was significantly higher than that of patients with slightly positive (65.5±4.2%, p = 0.001) and negative (56.4±6.6%, p < 0.001) results. Multivariate Cox regression analysis demonstrated that a positive PPD skin test was independently associated with tumor recurrence (Hazard ratio of 0.213, p < 0.001) but not with stage progression. The occurrence rate of major side effects in patients with a positive BCG skin test (33.3%) was significantly higher than that in patients with slightly positive (26.8%) and negative PPD skin tests (13.7%). The incidence rate of fever persisting beyond 2 days or fever of ≥38°C in patients with a positive PPD skin test (18.2%) was significantly higher than that in patients with slightly positive (8.7%) and negative PPD skin tests (4.1%). Conclusions: NMIBC patients with a positive PPD skin test and who were treated with BCG therapy had a significantly lower tumor recurrence rate and higher incidence of major side effects such as fever persisting beyond 2 days or fever of ≥38°C. Our findings suggest that PPD skin test prior to BCG therapy can predict clinical outcomes following BCG therapy and provide useful information regarding who would experience a strong therapeutic effect for BCG therapy and BCG-related major side effects.
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Affiliation(s)
- Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Naoya Niwa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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TAKAMATSU KIMIHARU, Kikuchi E, Ogihara K, Hayakawa N, Matsumoto K, Mizuno R, Miyajima A, Oyama M, Oya M. MP15-03 WHO COULD BE ELIMINATED FOR RANDOM BIOPSIES AFTER BCG THERAPY IN PATIENTS WITH BLADDER CARCINOMA IN SITU? J Urol 2017. [DOI: 10.1016/j.juro.2017.02.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hayakawa N, Sato Y, Nagasaka A, Mano Y, Nagasaka T, Nakai A, Iwase K, Yoshida S. High levels of DNA polymerase β mRNA corresponding with the high activity in Graves' thyroid tissue. J Endocrinol Invest 2017; 40:385-389. [PMID: 27848228 DOI: 10.1007/s40618-016-0571-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/18/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION High DNA polymerase β activity has been observed in the thyroid tissue of patients with Graves' disease (Nagasaka et al. in Metabolism 37:1051-1054, 1988). This fact aroused our interest in whether the alteration of DNA polymerase β activity depends on DNA polymerase β (DNA poly β) mRNA levels, which may be modulated by thyroid-stimulating hormone (TSH) or thyroid-stimulating substances, i.e. TSH receptor antibody (TRAb). RESULT Addition of TSH or TRAb to primary cultures of Graves' disease thyroid cells for 4 h led to no increase in DNA poly β mRNA levels. In contrast, thyroid hormone synthesizing enzyme, peroxidase, mRNA levels increased fivefold after coculture with TSH and TRAb, even though DNA poly β activity and mRNA levels are already significantly higher in Graves' disease thyroid tissues, compared with normal thyroid tissue. DISCUSSION These results indicate that DNA poly β expression in Graves' disease thyroid cells may be maximally activated or plateau in response to thyroid-stimulating immunoglobulins, or that the activation of to poly β expression may occur via pathways other than the G protein and cyclic AMP system.
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Affiliation(s)
- N Hayakawa
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Y Sato
- Faculty of Agriculture, Nagoya University, Nagoya, 466-8550, Japan
| | - A Nagasaka
- Department of Internal Medicine, Fujita Health University School of Medicine, Toyoake, Aichi, 470-1192, Japan
| | - Y Mano
- Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
| | - T Nagasaka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, 113-8655, Japan
| | - A Nakai
- Nakai Clinic, Chita, Aichi, 478-0041, Japan
| | - K Iwase
- Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - S Yoshida
- Laboratory of Cancer Cell Biology, Research Institute for Disease Mechanism and Control , Nagoya University School of Medicne, Nagoya University, Nagoya, 466-8550, Japan
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Shigeta K, Kikuchi E, Fukumoto K, Hayakawa N, Kosaka T, Miyajima A, Oya M. MP71-13 EFFICACY OF CHEMOTHERAPY ADMINISTRATION IN ELDERLY PATIENTS WITH METASTATIC UPPER TRACT UROTHELIAL CARCINOMA AFTER RADICAL NEPHROURETERECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fukumoto K, Kikuchi E, Mikami S, Hayakawa N, Miyajima A, Oya M. MP98-01 PROGRAMMED CELL DEATH-1 EXPRESSION IN BCG RELAPSING TUMORS IS SIGNIFICANTLY ASSOCIATED WITH STAGE PROGRESSION IN NON-MUSCLE INVASIVE BLADDER CANCER PATIENTS. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Shimizu T, Toma H, Hayakawa N, Shibahara R, Ishiyama R, Hayashida A, Fujimori D, Tsunoyama K, Ikezawa E, Kitajima S, Iida S, Ishida H, Tanabe K, Honda K, Koike J. Clinical and pathological analyses of interstitial fibrosis and tubular atrophy cases after kidney transplantation. Nephrology (Carlton) 2017; 21 Suppl 1:26-30. [PMID: 26972969 DOI: 10.1111/nep.12766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2016] [Indexed: 11/26/2022]
Abstract
AIM We carried out a clinicopathological analysis of cases presenting with interstitial fibrosis and tubular atrophy (IF/TA) after renal transplantation in an attempt to clarify the mechanisms underlying the development and prognostic significance of IF/TA. METHODS IF/TA was diagnosed in 35 renal allograft biopsy specimens (BS) obtained from 35 renal transplant recipients under follow up at the Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, between January 2014 and March 2015. RESULTS IF/TA was diagnosed at a median of 39.9 months after the transplantation. Among the 35 patients with IF/TA, 19 (54%) had a history of acute rejection. Among the 35 BS showing evidence of IF/TA, the IF/TA was grade I in 25, grade II in 9, and grade III in 1. Arteriosclerosis of the middle-sized arteries was observed in 30 BS (86%). We then classified the 35 BS showing evidence of IF/TA according to their overall histopathological features, as follows; IF/TA alone (6 BS; 17%), IF/TA + medullary ray injury (12 BS; 34%), and IF/TA + rejection (12 BS; 34%). Loss of the renal allograft occurred during the observation period in one of the patients (3%). Of the remaining patients with functioning grafts, deterioration of the renal allograft function after the biopsies occurred in 15 patients (43%). CONCLUSIONS The results of our study suggests that rejection contributes to IF/TA in 30-40% of cases, medullary ray injury in 30-40% of cases, and nonspecific injury in 20% of cases. IF/TA contributes significantly to deterioration of renal allograft function.
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Affiliation(s)
- Tomokazu Shimizu
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Hiroshi Toma
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Nozomi Hayakawa
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Rumi Shibahara
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryou Ishiyama
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Akihiro Hayashida
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Daiji Fujimori
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Kuniko Tsunoyama
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Eri Ikezawa
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Shoji Kitajima
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shoichi Iida
- Department of Transplant Surgery, Kidney Center, Toda Chuo General Hospital, Saitama, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuho Honda
- Department of Anatomy, Showa University, Tokyo, Japan
| | - Junki Koike
- Department of Pathology, Kawasaki Municipal Tama Hospital, Kanagawa, Japan
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Ide H, Kikuchi E, Hagiwara M, Hayakawa N, Hongo H, Miyajima A, Oya M. Urinary pH Levels are Strongly Associated with Bladder Recurrence After Nephroureterectomy in Upper Tract Urothelial Carcinoma Patients with a Smoking History. Ann Surg Oncol 2016; 23:1029-1038. [PMID: 27613550 DOI: 10.1245/s10434-016-5555-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Aromatic amines, well-known bladder carcinogens, derived from cigarette smoke are activated by acidic urine. We herein determined whether urinary pH levels are associated with bladder recurrence in upper tract urothelial carcinoma patients with a positive smoking history. METHODS A total of 256 upper tract urothelial carcinoma patients who were surgically treated at our institution between 1990 and 2013 were included. Urinary pH levels were defined as the median of at least two consecutive measurements within 1 month of surgery. RESULTS Ninety-six patients (37.5 %) had pH <5.5 and 160 (62.5 %) had pH ≥5.5, and urinary pH levels were identified as one of the significant predictors for bladder recurrence in univariate but not multivariate Cox regression analysis in overall. In patients with a positive smoking history among those without a history of bladder tumor (N = 110), the 5-year bladder recurrence-free survival rate was 52.5 % in patients with pH ≥5.5, which was significantly higher than that in those with pH <5.5 (25.9 %, p = 0.032). In the multivariate analysis, urinary pH <5.5 (p = 0.022, HR; 1.86) was independently associated with bladder recurrence. No significant difference for bladder recurrence was observed between these two groups in patients with no smoking history among them. CONCLUSIONS Urinary pH <5.5 is associated with an increased risk of bladder recurrence in upper tract urothelial carcinoma patients with a positive smoking history among those without a history of bladder tumor. Modifications to pH for urine alkalization may prevent bladder recurrence.
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Affiliation(s)
- Hiroki Ide
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
| | - Masayuki Hagiwara
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Hiroshi Hongo
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
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Matsumoto K, Hayakawa N, Mizuno R, Kikuchi E, Miyajima A, Oya M. MP03-03 METASTATIC RENAL CELL CARCINOMA TO THE BLADDER: SYSTEMATIC REVIEW OF 113 REPORTED CASES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hayakawa N, Kikuchi E, Mikami S, Matsumoto K, Fukumoto K, Kosaka T, Mizuno R, Miyajima A, Oya M. MP27-02 PROGNOSTIC ROLE OF PROGRAMMED CELL DEATH PROTEIN 1 EXPRESSION IN SURGICALLY TREATED PATIENTS WITH UPPER TRACT UROTHELIAL CARCINOMA. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Matsumoto K, Kikuchi E, Yanai Y, Hayakawa N, Ito Y, Maeda T, Nagata H, Miyajima A, Oya M. MP13-17 CHARACTERIZING INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER: IMPLICATIONS FOR THE DEFINITION OF INTERMEDIATE RISK AND TREATMENT STRATEGY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Niwa N, Matsumoto K, Tanaka N, Hayakawa N, Ito Y, Maeda T, Akatsuka S, Masuda T, Nakamura S, Oya M. PD11-12 COMPARISON OF OUTCOMES BETWEEN ULTRASONOGRAPHY AND CYSTOSCOPY IN THE SURVEILLANCE OF PATIENTS WITH LOW- OR INTERMEDIATE-RISK NON-MUSCLE INVASIVE BLADDER CANCER. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kikuchi E, Hagiwara M, Hayakawa N, Mizuno R, Kosaka T, Mikami S, Miyajima A, Saya H, Oya M. Variant isoforms of CD44 expression as predictive markers for mortality in surgically treated patients with locally advanced upper tract urothelial carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
388 Background: The variant isoforms of CD44 (CD44v), which are some of the new cell surface markers for cancer stem cells, have been associated with tumor growth, treatment resistance, and cancer death in several cancers. We investigated the role of CD44v8-10, which is a CD44v, on the clinical outcome of patients with advanced upper tract urothelial cancer (UTUC). Methods: The protein expression of CD44v8-10 was immunohistochemically evaluated using CD44v9 antibody, which detects immunogen of CD44v8-10, and investigated the association with clinical characteristics and outcome in surgical specimens obtained from 110 patients who had been treated with radical nephroureterectomy for ≥pT2 UTUC. The mean percentage of positive cancer cells stained with CD44v9 antibody in each tumor was estimated. Results: The median percentage of CD44v9 positivity was 5.50±7.74%. Patients were subsequently stratified into a CD44v9-positive group (n = 82) and a CD44v9-negative group (n = 28) based on a cut-off level of 5%. During the mean follow-up of 4.8 years, disease recurrence was observed in 49 patients (59.8%) in the CD44v9-positive group and in 8 patients (28.6%) in the CD44v9-negative group. The 5-year recurrence-free survival rates were 47.6% in the CD44v9-positive group and 66.6% in the CD44v9-negative group (p= 0.038). Multivariate analysis showed that tumor grade G3 (p= 0.005, HR = 3.77), the presence of lymphovascular invasion (p= 0.041, HR = 1.84), and CD44v8-10 expression (p= 0.028, HR = 2.33) were independent risk factors for disease recurrence. In this series, 37 patients in the CD44v9-positive group (45.1%) and 5 (17.9%) in the CD44v9-negative group died of the disease. The 5-year cancer-specific survival rates were 57.8% in the CD44v9-positive group and 80.4% in the CD44v9-negative group (p= 0.032). The CD44v9 expression (p= 0.040, HR = 2.67) in addition to tumor grade G3 (p= 0.003, HR = 8.35) were independently associated with cancer death. Conclusions: The expression ofCD44v8-10 may be a new biomarker of malignant potential in locally advanced UTUC and could provide additional prognostic information in patients with UTUC.
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Affiliation(s)
- Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Masayuki Hagiwara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Hideyuki Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Mizuno R, Miyajima A, Hayakawa N, Kikuchi E, Mikami S, Jinzaki M, Oya M. Impact of precise quantitative assessment of visceral obesity on outcomes of patients with metastatic renal cell carcinoma treated with systemic therapy. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
597 Background: With its excellent resolution of adipose tissue, CT presents precise quantitative assessment of visceral obesity. We assessed the impact of visceral obesity on progression free and overall survival in patients treated with systemic therapy for metastatic renal cell carcinoma. Methods: This retrospective cohort study included 114 patients treated with systemic therapy for metastatic renal cell carcinoma between 2007 and 2015 at Keio university hospital in Japan. The visceral fat area was measured at the level of umbilicus using CT. A visceral fat area ≥100cm2 was used as the definition of visceral obesity. Progression free and overall survival was compared according to visceral obesity. Results: In the whole cohort, the median progression free survival in first line treatment was 12.0 month. The median overall survival was 42.5 month. According to Memorial Sloan-Kettering Cancer Center classification, 31 patients were favorable risk, 61 were intermediate risk, and 22 were poor risk; median overall survival for these groups were 76.9, 40.8, and 23.7 months, respectively (P<0.0001). Visceral obesity correlated with improved progression free (P=0.0095) and overall survival (P=0.0002). On multivariate analysis, visceral obesity (HR 0.64, P=0.0393) and Memorial Sloan-Kettering Cancer Center classification (P=0.0037) were independent indices to predict progression free survival in first line treatment. In addition, visceral obesity (HR 0.42, P=0.0016) and Memorial Sloan-Kettering Cancer Center classification (P=0.0006) independently predicted overall survival. Conclusions: The precision of CT imaging for measuring visceral fat tissue provides useful clinical venue to predict prognosis for metastatic renal cell carcinoma. Visceral obesity may be a useful and independent indicator for a better prognosis in patients treated with systemic therapy for metastatic renal cell carcinoma.
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Affiliation(s)
- Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University Hospital, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Hayakawa N, Kikuchi E, Mizuno R, Fukumoto K, Kosaka T, Mikami S, Miyajima A, Oya M. Prognostic role of programmed cell death protein 1 expression in surgically treated patients with upper tract urothelial carcinoma. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
402 Background: Programmed cell death protein (PD-1) expressed on active T cells, and its ligand PD-L1 expressed on the surface of cancer cells, complementarily down-regulate T cell activation and are related to immune tolerance. A close association between PD-1 expression and poor prognosis has been reported in several cancers, however, in upper tract urothelial carcinoma (UTUC) the role of PD-1 expression on clinical outcome has not been investigated. Methods: The protein expression of PD-1 was evaluated by immunohistochemistry and the relationship with clinicopathological features was investigated in surgical specimens obtained from 100 patients who had been surgically treated for UTUC. At a magnification of 200x, PD-1 protein expression was estimated and the positive cells were graded as no (negative), moderate (1-10 cells), and strong ( > 10 cells). Results: Twenty-four patients (24.0%) had strong PD-1 staining, 32 patients (32.0%) had moderate PD-1 staining, and 44 patients (44.0%) had no PD-1 staining. PD-1 staining was associated with pathological T stage (p = 0.023), tumor grade (p = 0.005), and lymphovascular invasion (p = 0.033). Lymphovascular invasion (p < 0.001) and PD-1 staining (p = 0.02) were independent factors for predicting disease metastasis. The 5-year matastatic free survival rate in patients with strong PD-1 staining was 57.3 %, which was significantly lower than that with no PD-1 staining (87.3%, p=0.001) and that with moderate PD-1 staining (74.3%, p = 0.05). In a sub-group analysis of patients with ≥pT2 (N = 59), a significant difference in disease metastasis was observed between patients with strong PD-1 staining and no PD-1 staining (p = 0.018), but was not observed between strong and moderate PD-1 staining (p = 0.146). Conclusions: PD-1 expression may be a useful indicator for a worse prognosis in UTUC patients who undergo radical nephroureterectomy. Targeting therapy against PD-1 might be a promising therapeutic modality for UTUC.
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Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Keishiro Fukumoto
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Shuji Mikami
- Division of Diagnostic Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Akira Miyajima
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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Niwa N, Matsumoto K, Hayakawa N, Ito Y, Maeda T, Akatsuka S, Masuda T, Nakamura S, Tanaka N. Comparison of outcomes between ultrasonography and cystoscopy in the surveillance of patients with initially diagnosed TaG1-2 bladder cancers: A matched-pair analysis. Urol Oncol 2015; 33:386.e15-21. [DOI: 10.1016/j.urolonc.2015.04.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/29/2015] [Accepted: 04/29/2015] [Indexed: 12/01/2022]
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Matsumoto K, Gondo T, Hayakawa N, Maeda T, Ninomiya A, Nakamura S. The role of single instillation chemotherapy in patients who receive subsequent bacillus Calmette-Guérin: A retrospective single centre study, and systematic review of the literature. Can Urol Assoc J 2015; 9:E411-6. [PMID: 26279708 DOI: 10.5489/cuaj.2818] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This retrospective study was undertaken to evaluate the combined effect of immediate intravesical chemotherapy and subsequent bacillus Calmette-Guérin (BCG) therapy. METHODS The study population consisted of 207 intermediate- or high-risk patients with non-muscle invasive bladder cancer who underwent an induction course of BCG between 1993 and 2007. We introduced single immediate instillation of 50 mg epirubicin for all cases in 2004, and thus earlier cases could be considered as historical controls. The primary endpoint was recurrence-free survival (RFS). For cumulative analysis, we systematically reviewed studies indexed in databases. Including ours, the records of 856 patients from a total of 7 studies, including ours, were finally analyzed. RESULTS In our cohort, the 5-year RFS in patients who received the combination therapy was 66.2%, compared to 55.2% in the BCG alone group (p = 0.149). Multivariate analysis on tumour recurrence showed that patients with the combination therapy had a hazard ratio (HR) of 0.74 (p = 0.189). A subsequent literature review revealed that RFS rates in the combination groups were higher than those in the corresponding BCG alone groups in 4/7 studies (p = 0.02-0.15), and lower in 1 study (p = 0.51). We identified 5 studies which examined a HR for combination therapy, and performed a cumulative analysis. Adding a single chemo-instillation prior to BCG resulted in a significant reduction in tumour recurrence (summary HR 0.69, p = 0.010). CONCLUSIONS Our analysis suggested that the combination of single chemo-instillation with subsequent BCG therapy exhibited an additive effect against potential tumour recurrence.
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Affiliation(s)
- Kazuhiro Matsumoto
- Tokyo Saiseikai Central Hospital, Department of Urology, Minato-ku, Tokyo, Japan
| | - Tatsuo Gondo
- Tokyo Saiseikai Central Hospital, Department of Urology, Minato-ku, Tokyo, Japan
| | - Nozomi Hayakawa
- Tokyo Saiseikai Central Hospital, Department of Urology, Minato-ku, Tokyo, Japan
| | - Takahiro Maeda
- Tokyo Saiseikai Central Hospital, Department of Urology, Minato-ku, Tokyo, Japan
| | - Akiharu Ninomiya
- Tokyo Saiseikai Central Hospital, Department of Urology, Minato-ku, Tokyo, Japan
| | - So Nakamura
- Tokyo Saiseikai Central Hospital, Department of Urology, Minato-ku, Tokyo, Japan
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Hayakawa N, Kikuno N, Ishihara H, Ryoji O, Tanabe K. Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience. Springerplus 2015; 4:401. [PMID: 26261759 PMCID: PMC4529429 DOI: 10.1186/s40064-015-1200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 07/29/2015] [Indexed: 11/29/2022]
Abstract
Purpose Decision making regarding the urethra before and after radical cystectomy due to urothelial carcinoma has always been controversial. To determine whether anterior urethra sparing cystoprostatectomy for bladder cancer is an oncologically-safe procedure, we evaluated the long-term oncologic clinical outcome. Patients and methods A total of 51 male patients with cTa-4N0-2M0 bladder cancer were treated with anterior urethra sparing cystoprostatectomy and simultaneous urinary diversion between 2000 and 2013, and underwent follow up for 4 months or more. We assessed differences in the perioperative outcomes, oncologic outcomes and recurrence rates according to the urinary diversion. Results The median patient age and follow-up period were 66 years and 35 months, respectively. The 5- and 10-year recurrence free survival (RFS) rates in ileal conduit (IC) group vs. orthotopic neobladder reconstruction (NB) group were 45.0 and 20.3% vs. 39.3 and 19.6%, respectively. Likewise, the 5- and 10-year disease specific survival (DSS) were 52.7 and 32.1% vs. 39.3 and 29.5%, respectively. Multivariate analysis revealed two independent prognostic factors for RFS and DSS, including age at surgery and lymph node status. Local recurrence in the remnant anterior urethra occurred in only 1 patient (2.0%) at 57 months after surgery. Conclusions Our long-term data show that anterior urethra sparing cystoprostatectomy is an oncologically-safe procedure regardless of the type of urinary diversion in a subset of carefully selected patients with bladder cancer without evidence of urothelial carcinoma in the urethra/bladder neck and urethral surgical margin. Electronic supplementary material The online version of this article (doi:10.1186/s40064-015-1200-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nozomi Hayakawa
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Nobuyuki Kikuno
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Hiroki Ishihara
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Osamu Ryoji
- Department of Urology, Saiseikai Kawaguchi General Hospital, Nishikawaguchi, Kawaguchi, Saitama Japan ; Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Shinjyuku-ku, Tokyo, Japan
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Tanaka N, Kikuchi E, Kanao K, Matsumoto K, Shirotake S, Miyazaki Y, Kobayashi H, Kaneko G, Hagiwara M, Ide H, Obata J, Hoshino K, Hayakawa N, Kosaka T, Hara S, Nakagawa K, Jinzaki M, Oya M. Impact of Combined Use of Blood-based Inflammatory Markers on Patients with Upper Tract Urothelial Carcinoma Following Radical Nephroureterectomy: Proposal of a Cumulative Marker Score as a Novel Predictive Tool for Prognosis. Eur Urol Focus 2015; 1:54-63. [DOI: 10.1016/j.euf.2015.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/26/2014] [Accepted: 02/04/2015] [Indexed: 12/22/2022]
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