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Harada S, Abe T, Furumido J, Takahashi K, Hori K, Abe N, Kon M, Murai S, Miyata H, Kikuchi H, Matsumoto R, Osawa T, Shinohara N. A prospective study of surgeons' workloads and associated factors in real-world practice. Sci Rep 2024; 14:9741. [PMID: 38679610 PMCID: PMC11056359 DOI: 10.1038/s41598-024-59596-1] [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] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/12/2024] [Indexed: 05/01/2024] Open
Abstract
New technologies such as laparoscopic and robotic surgery are spreading, and there is a demand for physicians to keep up with novel methods. In contrast to the recent focus on healthcare professional burnout, the mental and physical costs during surgery are not well-understood. We aimed to quantify surgeons' workloads in daily urological surgical practice and clarify potential background factors associated with such workloads. Urologists in Hokkaido, Japan, were invited to this study. Between December 2020 and December 2021, participants repeatedly reported workloads, which were assessed using the National Aeronautics and Space Administration-Task Load Index (NASA-TLX), after each surgery in conjunction with participants' names, patients' backgrounds, their roles (independent operator, operator under supervision, instructor, and 1st or 2nd assistant), and surgical outcomes, via SurveyMonkey®. Because of the heterogeneity among individuals, a linear mixed-effects model was utilized to analyze factors associated with NASA-TLX, calculating the parameter estimates (PE) of regression coefficients for each factor and their 95% confidence interval (CI). Sixty-five urologists (5 women) joined the study, and 2169 data were collected within 7 days after surgeries. A linear mixed-effects model revealed that female surgeons (PE + 15.56, 95% CI 2.36-28.77), urgent/emergency surgery (PE + 6.65, 95% CI 4.59-8.70), intraoperative complications (PE + 9.26, 95% CI 6.76-11.76), and near-miss incidents (PE + 3.81, 95% CI 2.27-5.36) were associated with higher workloads. Regarding the surgeons' role, operator under supervision (PE + 12.46, 95% CI 9.86-15.06) showed the highest workloads. Surgeons' workloads decreased as the number of previous cases of the same procedure increased. Surgeons' workloads were associated with various factors. Given that the highest workloads were for operators under supervision, instructors should be aware of trainees' high workloads and devise appropriate instructional interventions.
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Affiliation(s)
- Shigeru Harada
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
- Department of Urology, Asahikawa Kousei Hospital, Asahikawa, Japan
| | - Keita Takahashi
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kanta Hori
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Noriyuki Abe
- Department of Urology, Asahikawa Medical University, Asahikawa, Japan
| | - Masafumi Kon
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
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Ouchi M, Kitta T, Chiba H, Higuchi M, Abe-Takahashi Y, Togo M, Kusakabe N, Murai S, Kikuchi H, Matsumoto R, Osawa T, Abe T, Shinohara N. Physiotherapy for continence and muscle function in prostatectomy: a randomised controlled trial. BJU Int 2024. [PMID: 38658057 DOI: 10.1111/bju.16369] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To assess the effectiveness of pre- and postoperative supervised pelvic floor muscle training (PFMT) on the recovery of continence and pelvic floor muscle (PFM) function after robot-assisted laparoscopic radical prostatectomy (RARP). PATIENTS AND METHODS We carried out a single-blind randomised controlled trial involving 54 male patients scheduled to undergo RARP. The intervention group started supervised PFMT 2 months before RARP and continued for 12 months after surgery with a physiotherapist. The control group was given verbal instructions, a brochure about PFMT, and lifestyle advice. The primary outcome was 24-h pad weight (g) at 3 months after RARP. The secondary outcomes were continence status (assessed by pad use), PFM function, and the Expanded Prostate Cancer Index Composite (EPIC) score. RESULTS Patients who participated in supervised PFMT showed significantly improved postoperative urinary incontinence (UI) compared with the control group (5.0 [0.0-908.0] g vs 21.0 [0.0-750.0] g; effect size: 0.34, P = 0.022) at 3 months after RARP based on 24-h pad weight. A significant improvement was seen in the intervention compared with the control group (65.2% continence [no pad use] vs 31.6% continence, respectively) at 12 months after surgery (effect size: 0.34, P = 0.030). Peak pressure during a maximum voluntary contraction was higher in the intervention group immediately after catheter removal and at 6 months, and a longer duration of sustained contraction was found in the intervention group compared with the control group. We were unable to demonstrate a difference between groups in EPIC scores. CONCLUSION Supervised PFMT can improve postoperative UI and PFM function after RARP. Further studies are needed to confirm whether intra-anal pressure reflects PFM function and affects continence status in UI in men who have undergone RARP.
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Affiliation(s)
- Mifuka Ouchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Hiroki Chiba
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Madoka Higuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yui Abe-Takahashi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Mio Togo
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Naohisa Kusakabe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Murakami T, Minami K, Harabayashi T, Maruyama S, Takada N, Kashiwagi A, Miyata H, Sato Y, Matsumoto R, Kikuchi H, Abe T, Ito YM, Murai S, Shinohara N, Harada H, Osawa T. Cross-sectional and longitudinal analyses of urinary extracellular vesicle mRNA markers in urothelial bladder cancer patients. Sci Rep 2024; 14:6801. [PMID: 38514751 PMCID: PMC10957914 DOI: 10.1038/s41598-024-55251-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/21/2024] [Indexed: 03/23/2024] Open
Abstract
We designed this multi-center prospective study with the following objectives: (1) the cross-sectional validation of extracellular vesicles (EV) mRNA markers to detect urothelial bladder cancer (UBC) before transurethral resection of bladder cancer (TURBT), and (2) the longitudinal validation of EV mRNA markers to monitor non-muscle invasive bladder cancer (NMIBC) recurrence after TURBT. EV mRNA markers evaluated in this study were KRT17, GPRC5A, and SLC2A1 in addition to two additional markers from literatures, MDK and CXCR2, and measured by quantitative RT-PCR with normalization by a reference gene (ALDOB). Diagnostic performances of EV mRNA markers were compared to conventional markers. Regarding the first objective, we confirmed that EV mRNA biomarkers in urine were higher in UBC patients, particularly those with higher stage/grade tumors, than in those without UBC (n = 278 in total) and the diagnostic performance of EV mRNA MDK and KRT17 outperformed conventional biomarkers with AUC 0.760 and 0.730, respectively. Concerning the second objective, we prospectively analyzed the time courses of EV mRNA markers while NMIBC patients (n = 189) (median follow-up 19 months). The expression of EV mRNA KRT17 was significantly high in patients with recurrence, while it gradually decreased over time in those without recurrence (p < 0.01).
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Affiliation(s)
- Taku Murakami
- Research & Development, Showa Denko Materials (America), Inc., Irvine, CA, USA
| | - Keita Minami
- Departments of Kidney Transplant Surgery and Urology, Sapporo City General Hospital, Sapporo, Japan
| | | | - Satoru Maruyama
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Yasuyuki Sato
- Department of Urology, Sapporo Keiyukai Hospital, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Yoichi M Ito
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroshi Harada
- Departments of Kidney Transplant Surgery and Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, N15 W7 Kita-ku, Sapporo, 060-8638, Japan.
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Hori K, Abe T, Abe N, Abe J, Okada K, Takahashi K, Harada S, Furumido J, Murai S, Kon M, Hashimoto K, Masumori N, Kakizaki H, Shinohara N. Gap analysis between trainees' subjective competencies and the competencies expected by instructors in urology: A need assessment survey in Japan. Int J Urol 2024. [PMID: 38366737 DOI: 10.1111/iju.15430] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/07/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE According to the rapid progress in surgical techniques, a growing number of procedures should be learned during postgraduate training periods. This study aimed to clarify the current situation regarding urological surgical training and identify the perception gap between trainees' competency and the competency expected by instructors in Japan. METHODS Regarding the 40 urological surgical procedures selected via the Delphi method, we collected data on previous caseloads, current subjective autonomy, and confidence for future skill acquisition from trainees (<15 post-graduate years [PGY]), and the competencies when trainees became attending doctors expected by instructors (>15 PGY), according to a 5-point Likert scale. In total, 174 urologists in Hokkaido Prefecture, Japan were enrolled in this study. RESULTS The response rate was 96% (165/174). In a large proportion of the procedures, caseloads grew with accumulation of years of clinical practice. However, trainees had limited caseloads of robotic and reconstructive surgeries even after 15 PGY. Trainees showed low subjective competencies at present and low confidence for future skill acquisition in several procedures, such as open cystectomy, ureteroureterostomy, and ureterocystostomy, while instructors expected trainees to be able to perform these procedures independently when they became attending doctors. CONCLUSION Trainees showed low subjective competencies and low confidence for future skill acquisition in several open and reconstructive procedures, while instructors considered that these procedures should be independently performable by attending doctors. We believe that knowledge of these perception gaps is helpful to develop a practical training program.
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Affiliation(s)
- Kanta Hori
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Noriyuki Abe
- Department of Urology, Asahikawa Medical University, Asahikawa, Japan
| | - Junya Abe
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Kazufumi Okada
- Promotion Unit, Data Science Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Takahashi
- Promotion Unit, Data Science Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Shigeru Harada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masafumi Kon
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kohei Hashimoto
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Naoya Masumori
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Hidehiro Kakizaki
- Department of Urology, Asahikawa Medical University, Asahikawa, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Minami K, Osawa T, Kojima T, Hara T, Eto M, Takeuchi A, Nakai Y, Ueda K, Ozawa M, Uemura M, Ohba K, Tamura K, Shindo T, Nakagomi H, Takahashi A, Anai S, Yokomizo A, Morizane S, Kimura T, Shimazui T, Miyauchi Y, Mitsuzuka K, Hara H, Yoshimura K, Shiina H, Ito YM, Murai S, Nishiyama H, Shinohara N, Kitamura H. Efficacy and safety of axitinib for metastatic renal cell carcinoma: Real-world data on patients with renal impairment. Urol Oncol 2023; 41:458.e9-458.e19. [PMID: 37798145 DOI: 10.1016/j.urolonc.2023.08.008] [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] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Limited information is currently available on the efficacy and safety of axitinib for metastatic renal cell carcinoma (mRCC) patients with renal impairment. Therefore, the present study investigated the efficacy and toxicity of axitinib in patients with chronic kidney disease. METHODS Post-hoc analyses were performed on a Japanese multicenter cohort study of 477 mRCC patients who received axitinib followed by 1 or 2 regimens of systemic antiangiogenic therapy between January 2012 and December 2016. Differences in clinical characteristics and the efficacy and safety of axitinib were assessed based on pretreatment renal function. RESULTS Patients were categorized into the following 5 renal function groups according to baseline renal function: estimated glomerular filtration rate (eGFR) ≥60 ml/min (n = 133), 45 ml/min ≤eGFR <60 ml/min (n = 153), 30 ml/min ≤eGFR< 45 ml/min (n = 130), eGFR <30 ml/min (n = 45), and dialysis (n = 16). Median progression-free survival (PFS) (95% confidence interval [CI]) in the 5 groups was 11 (8-16), 14 (11-19), 14 (10-19), 12 (8-24), and 6 (3-NR) months, respectively (p = 0.781). After adjustments for treatment-related confounders, the renal function group was not a significant prognostic factor for PFS. Objective response rates in the 5 groups were 22%, 23%, 23%, 18%, 20%, and 38%, respectively (p = 0.468). Regarding adverse events of all grades, hypertension (p = 0.0006) and renal and urinary disorders (p < 0.0001) were more frequently observed in the eGFR <30 ml/min group than in the other groups. CONCLUSIONS Since renal function at the initiation of treatment with axitinib does not adversely affect the efficacy of VEGF-TKI therapy, clinicians do not need to avoid its administration to mRCC patients with impaired renal function in consideration of the risk of progression to end-stage renal disease.
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Affiliation(s)
- Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
| | | | - Tomohiko Hara
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University Hospital, Kurume, Japan
| | - Michinobu Ozawa
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Hospital, Suita, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, Nagasaki, Japan
| | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | - Hiroshi Nakagomi
- Department of Urology, University of Yamanashi Hospital, Chuo, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | | | - Takahiro Kimura
- Department of Urology, The Jikei University, School of Medicine, Tokyo, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan
| | | | | | - Hiroaki Hara
- Department of Urology, Shinshu University Hospital, Matsumoto, Japan
| | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | | | - Youichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Toyama University Hospital, Toyama, Japan
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Abe T, Yamada S, Kikuchi H, Sazawa A, Katano H, Suzuki H, Takeuchi I, Minami K, Morita K, Tsuchiya K, Takada N, Maru S, Sato S, Yamashita T, Mochizuki T, Akino T, Sasaki Y, Shinno Y, Murahashi N, Kawazu T, Furumido J, Miyata H, Matsumoto R, Osawa T, Murai S, Shinohara N. Impact of postoperative complications on long-term survival in bladder cancer patients. Jpn J Clin Oncol 2023; 53:966-976. [PMID: 37461191 PMCID: PMC10550200 DOI: 10.1093/jjco/hyad079] [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] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/29/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE To determine the impact of postoperative complications on long-term survival outcomes in patients with bladder cancer undergoing radical cystectomy. METHODS This retrospective multi-institutional study included 766 bladder cancer patients who underwent radical cystectomy between 2011 and 2017. Patient characteristics, perioperative outcomes, all complications within 90 days after surgery and survival outcomes were collected. Each complication was graded based on the Clavien-Dindo system, and grouped using a standardized grouping method. The Comprehensive Complication Index, which incorporates all complications into a single formula weighted by their severity, was utilized. Overall survival and recurrence-free survival (local, distant or urothelial recurrences) were stratified by Comprehensive Complication Index (high: ≥26.2; low: <26.2). A multivariate model was utilized to identify independent prognostic factors. RESULTS The incidence of any and major complications (≥Clavien-Dindo grade III) was 70 and 24%, respectively. In terms of Comprehensive Complication Index, 34% (261/766) of the patients had ≥26.2. Patients with Comprehensive Complication Index ≥ 26.2 had shorter overall survival (4-year, 59.5 vs. 69.8%, respectively, log-rank test, P = 0.0037) and recurrence free survival (51.9 vs. 60.1%, respectively, P = 0.0234), than those with Comprehensive Complication Index < 26.2. The Cox multivariate model identified the age, performance status, pT-stage, pN-stage and higher CCI (overall survival: HR = 1.35, P = 0.0174, recurrence-free survival: HR = 1.26, P = 0.0443) as independent predictors of both overall survivial and recurrence-free survival. CONCLUSIONS Postoperative complications assessed by Comprehensive Complication Index had adverse effects on long-term survival outcomes. Physicians should be aware that major postoperative complications can adversely affect long-term disease control.
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Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Shuhei Yamada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Department of Urology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Ataru Sazawa
- Department of Urology, Obihiro Kousei Hospital, Obihiro, Japan
| | - Hidenori Katano
- Department of Urology, Iwamizawa Municipal General Hospital, Iwamizawa, Japan
| | - Hidetaka Suzuki
- Department of Urology, Hakodate Central Hospital, Hakodate, Japan
| | - Ichiro Takeuchi
- Department of Urology, Tomakomai City Hospital, Tomakomai, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | | | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Shintaro Maru
- Department of Urology, Jinyukai Hospital, Sapporo, Japan
| | - Soshu Sato
- Department of Urology, Ebetsu City Hospital, Ebetsu, Japan
| | | | - Tango Mochizuki
- Department of Urology, Abashiri Kousei Hospital, Abashiri, Japan
| | | | | | | | - Norihiro Murahashi
- Department of Urology, Asahikawa Kousei Hospital, Asahikawa, Japan
- Department of Urology, JCHO Sapporo Hokushin Hospital, Sapporo, Japan
| | - Takafumi Kawazu
- Department of Urology, Hokkaido Urology Memorial Hospital, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Department of Urology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Iwahara N, Hotta K, Iwami D, Tanabe T, Tanaka Y, Ito YM, Otsuka T, Murai S, Takada Y, Higuchi H, Sasaki H, Hirose T, Harada H, Shinohara N. Analysis of T-cell alloantigen response via a direct pathway in kidney transplant recipients with donor-specific antibodies. Front Immunol 2023; 14:1164794. [PMID: 37207202 PMCID: PMC10189043 DOI: 10.3389/fimmu.2023.1164794] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/21/2023] Open
Abstract
Donor-specific antibodies (DSAs) are the main cause of graft loss over time. The direct pathway of alloantigen recognition is important in the pathogenesis of acute rejection. Recent studies have suggested that the direct pathway also contributes to the pathogenesis of chronic injury. Nevertheless, there are no reports on T-cell alloantigen response via the direct pathway in kidney recipients with DSAs. We analyzed the T-cell alloantigen response via the direct pathway in kidney recipients with DSAs (DSA+) or without DSAs (DSA-). A mixed lymphocyte reaction assay was implemented to assess the direct pathway response. DSA+ patients showed significantly higher CD8+ and CD4+ T cell responses to donor cells than DSA- patients. Furthermore, proliferating CD4+ T cells showed a marked increase in Th1 and Th17 responses in DSA+ patients than in DSA- patients. In a comparison between anti-donor and third-party responses, the anti-donor CD8+ and CD4+ T cell response was significantly lower than the anti-third-party response. In contrast, the donor-specific hyporesponsiveness was absent in DSA+ patients. Our study demonstrated that DSA+ recipients have a greater potential for developing immune responses against the donor tissues via the direct alloantigen recognition pathway. These data contribute to an understanding of DSAs pathogenicity during kidney transplantation.
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Affiliation(s)
- Naoya Iwahara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
- *Correspondence: Kiyohiko Hotta,
| | - Daiki Iwami
- Division of Renal Surgery and Transplantation, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Yuka Tanaka
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M. Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takuya Otsuka
- Department of surgical pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Yusuke Takada
- Departments of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Haruka Higuchi
- Departments of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Hajime Sasaki
- Departments of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Harada
- Departments of Kidney Transplant Surgery, Sapporo City General Hospital, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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8
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Ebina K, Abe T, Hotta K, Higuchi M, Furumido J, Iwahara N, Kon M, Miyaji K, Shibuya S, Lingbo Y, Komizunai S, Kurashima Y, Kikuchi H, Matsumoto R, Osawa T, Murai S, Tsujita T, Sase K, Chen X, Konno A, Shinohara N. Automatic assessment of laparoscopic surgical skill competence based on motion metrics. PLoS One 2022; 17:e0277105. [PMID: 36322585 PMCID: PMC9629630 DOI: 10.1371/journal.pone.0277105] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to characterize the motion features of surgical devices associated with laparoscopic surgical competency and build an automatic skill-credential system in porcine cadaver organ simulation training. Participants performed tissue dissection around the aorta, dividing vascular pedicles after applying Hem-o-lok (tissue dissection task) and parenchymal closure of the kidney (suturing task). Movements of surgical devices were tracked by a motion capture (Mocap) system, and Mocap-metrics were compared according to the level of surgical experience (experts: ≥50 laparoscopic surgeries, intermediates: 10-49, novices: 0-9), using the Kruskal-Wallis test and principal component analysis (PCA). Three machine-learning algorithms: support vector machine (SVM), PCA-SVM, and gradient boosting decision tree (GBDT), were utilized for discrimination of the surgical experience level. The accuracy of each model was evaluated by nested and repeated k-fold cross-validation. A total of 32 experts, 18 intermediates, and 20 novices participated in the present study. PCA revealed that efficiency-related metrics (e.g., path length) significantly contributed to PC 1 in both tasks. Regarding PC 2, speed-related metrics (e.g., velocity, acceleration, jerk) of right-hand devices largely contributed to the tissue dissection task, while those of left-hand devices did in the suturing task. Regarding the three-group discrimination, in the tissue dissection task, the GBDT method was superior to the other methods (median accuracy: 68.6%). In the suturing task, SVM and PCA-SVM methods were superior to the GBDT method (57.4 and 58.4%, respectively). Regarding the two-group discrimination (experts vs. intermediates/novices), the GBDT method resulted in a median accuracy of 72.9% in the tissue dissection task, and, in the suturing task, the PCA-SVM method resulted in a median accuracy of 69.2%. Overall, the mocap-based credential system using machine-learning classifiers provides a correct judgment rate of around 70% (two-group discrimination). Together with motion analysis and wet-lab training, simulation training could be a practical method for objectively assessing the surgical competence of trainees.
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Affiliation(s)
- Koki Ebina
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Madoka Higuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoya Iwahara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Masafumi Kon
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kou Miyaji
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Sayaka Shibuya
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Yan Lingbo
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Shunsuke Komizunai
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Yo Kurashima
- Hokkaido University Clinical Simulation Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Teppei Tsujita
- Department of Mechanical Engineering, National Defense Academy of Japan, Yokosuka, Japan
| | - Kazuya Sase
- Department of Mechanical Engineering and Intelligent Systems, Tohoku Gakuin University, Tagajo, Japan
| | - Xiaoshuai Chen
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, Japan
| | - Atsushi Konno
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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9
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Yamada R, Morikawa K, Hotta K, Iwami D, Tanabe T, Murai S, Shinohara N, Yoshida S, Hosoda S, Kubo A, Tokuchi Y, Kitagataya T, Kimura M, Yamamoto K, Nakai M, Sho T, Suda G, Natsuizaka M, Ogawa K, Sakamoto N. Incidence of post-transplant hepatitis B virus reactivation with the use of kidneys from donors with resolved hepatitis B virus infection. J Viral Hepat 2022; 29:976-985. [PMID: 36031873 DOI: 10.1111/jvh.13740] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/11/2022] [Accepted: 07/19/2022] [Indexed: 12/09/2022]
Abstract
Donors with resolved hepatitis B virus (HBV) infection may be a solution for the organ shortage for kidney transplantation (KT). The purpose of this study was to clarify the current state of HBV markers after KT from donors with resolved HBV infection to HBV naïve recipients and the rate of HBV reactivation in recipients with resolved HBV infection. Furthermore, we investigated HBV covalently closed circular DNA (cccDNA) in transplanted organs from donors with resolved HBV infection and the capability of HBV replication in kidney cell lines. We retrospectively analysed the HBV status of 340 consecutive donors and recipients who underwent KT in a single centre. We prospectively measured cccDNA by real-time polymerase chain reaction in kidney biopsy specimens of 32 donors with resolved HBV infection. HBV reactivation was found in three recipients with resolved HBV infection (4.8%, 3/63) after KT. We analysed 45 cases of transplantation from donors with resolved HBV infection to HBV-naive recipients. One case (2.2%, 1/45) became seropositive for hepatitis B core antibody (anti-HBc) and in another case (2.2%, 1/45), HBV-DNA was detected qualitatively in an HBV naive recipient with a donor with resolved HBV infection. In the latter case, cccDNA was measured in the donor kidney during KT. HBV replication was observed in kidney cell lines with HBV plasmid transfection. In conclusion, the risk of reactivation in anti-HBc-positive donors is relatively low. However, post-transplant HBV monitoring should be conducted in all at-risk cases.
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Affiliation(s)
- Ren Yamada
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Kenichi Morikawa
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Renal and Genitourinary Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Daiki Iwami
- Department of Renal and Genitourinary Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan.,Surgical Branch, Institute of Kidney Diseases, Jichi Medical University Hospital, Shimotsuke, Japan
| | - Tatsu Tanabe
- Department of Renal and Genitourinary Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Sonoe Yoshida
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Shunichi Hosoda
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Akinori Kubo
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Yoshimasa Tokuchi
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Takashi Kitagataya
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Megumi Kimura
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Koji Yamamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Masato Nakai
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Takuya Sho
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Goki Suda
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Mitsuteru Natsuizaka
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Koji Ogawa
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Japan
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10
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Kikuchi H, Osawa T, Abe T, Matsumoto R, Maruyama S, Murai S, Shinohara N. Quality improvement in managing patients with non-muscle-invasive bladder cancer by introducing a surgical checklist for transurethral resection of bladder tumor. PLoS One 2022; 17:e0276816. [PMID: 36301957 PMCID: PMC9612454 DOI: 10.1371/journal.pone.0276816] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The quality of transurethral resection of bladder tumor (TURBT) markedly varies among surgeons and may have a considerable impact on treatment outcomes. The importance of a surgical checklist for TURBT has been suggested in order to standardize the procedure and improve surgical and oncological outcomes. In the present study, we verified the usefulness of a checklist for managing patients with non-muscle-invasive bladder cancer (NMIBC). METHODS This retrospective study included 201 NMIBC patients diagnosed with Ta, T1, or Tis between October 2011 and February 2021. After September 2016, TURBT was performed with a checklist. We analyzed the intravesical recurrence-free survival (RFS) rate and the presence or absence of the detrusor muscle in resected specimens before and after the introduction of the checklist. Survival rates were compared using the Log-rank test. A multivariate analysis with Cox proportional hazards modeling was performed to verify risk factors for intravesical recurrence. RESULTS Ninety-nine patients who underwent TURBT with the checklist (checklist group) were compared with 102 patients who underwent TURBT without the checklist (non-checklist group). When the analysis was narrowed down to 9 critical items, we observed a mean number of 9 documented items per operative report (98.0% completion) after implementation of the checklist. Two-year intravesical RFS rates in the checklist and non-checklist groups were 76.7 and 69.5%, respectively (p = 0.1059). The Cox proportional multivariate analysis showed that the rate of intravesical recurrence was slightly lower in the checklist group (hazard ratio 0.7376, 95% CI 0.4064-1.3388, P = 0.3170). CONCLUSION The introduction of a checklist is recommended for the standardization of TURBT and increasing the quality of operative reporting, and it may also improve oncological outcomes.
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Affiliation(s)
- Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoru Maruyama
- Department of Urology, National Hospital Organisation Hokkaido Cancer Center, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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11
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Hirata Y, Higuchi M, Osawa T, Hinotsu S, Harabayashi T, Mochizuki T, Enami N, Nounaka O, Shinno Y, Kikuchi H, Matsumoto R, Abe T, Murai S, Shinohara N. Late recurrence in patients with non-muscle-invasive bladder cancer after 5-year cancer-free periods. Int J Urol 2022; 29:1140-1146. [PMID: 35598096 DOI: 10.1111/iju.14936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/04/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES There is no consensus about the follow-up schedule after 5-year cancer-free periods. In this study, we aimed to elucidate the risk factors for the recurrence in patients with non-muscle-invasive bladder cancer who remained cancer free for more than 5 years. METHODS Data from six Japanese institutions were retrospectively reviewed. Among the patients with non-muscle-invasive bladder cancer who were treated with transurethral resection of bladder tumor between 1990 and 2013, those who had no recurrence for more than 5 years were included in this study. The Kaplan-Meier method and Cox hazards model were used to estimate recurrence-free survival and to determine the pathologic and clinical factors affecting late recurrence. RESULTS In total, 434 patients were enrolled in this study. Of these patients, 55 patients (12.7%) experienced late recurrence. The median follow-up time was 8.9 years (interquartile range 6.9-11.3 years). Prior history of bladder cancer before the most recent transurethral resection was a significant predictor for late recurrence (hazard ratio 1.99 [95% confidence interval 1.13-3.47], P = 0.019), although other clinical factors including tumor grade, pathologic stage, tumor multiplicity, and current risk classification systems were not associated with late recurrence. CONCLUSIONS Late recurrence after a long tumor-free period is not rare and it was not predicted by current risk classification systems. Only prior history of bladder cancer was a significant predictor for late recurrence in this study.
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Affiliation(s)
- Yurie Hirata
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Shiro Hinotsu
- Department of Biostatistics, Sapporo Medical University, Sapporo, Japan
| | | | - Tango Mochizuki
- Department of Urology, Asahikawa City Hospital, Asahikawa, Japan
| | - Nobuyasu Enami
- Department of Urology, Nikko Memorial Hospital, Muroran, Japan
| | - Osamu Nounaka
- Department of Urology, Chitose City Hospital, Chitose, Japan
| | | | - Hiroshi Kikuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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12
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Ebina K, Abe T, Hotta K, Higuchi M, Furumido J, Iwahara N, Kon M, Miyaji K, Shibuya S, Lingbo Y, Komizunai S, Kurashima Y, Kikuchi H, Matsumoto R, Osawa T, Murai S, Tsujita T, Sase K, Chen X, Konno A, Shinohara N. Objective evaluation of laparoscopic surgical skills in wet lab training based on motion analysis and machine learning. Langenbecks Arch Surg 2022; 407:2123-2132. [PMID: 35394212 PMCID: PMC9399206 DOI: 10.1007/s00423-022-02505-9] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/28/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Our aim was to build a skill assessment system, providing objective feedback to trainees based on the motion metrics of laparoscopic surgical instruments. METHODS Participants performed tissue dissection around the aorta (tissue dissection task) and renal parenchymal closure (parenchymal-suturing task), using swine organs in a box trainer under a motion capture (Mocap) system. Two experts assessed the recorded movies, according to the formula of global operative assessment of laparoscopic skills (GOALS: score range, 5-25), and the mean scores were utilized as objective variables in the regression analyses. The correlations between mean GOALS scores and Mocap metrics were evaluated, and potential Mocap metrics with a Spearman's rank correlation coefficient value exceeding 0.4 were selected for each GOALS item estimation. Four regression algorithms, support vector regression (SVR), principal component analysis (PCA)-SVR, ridge regression, and partial least squares regression, were utilized for automatic GOALS estimation. Model validation was conducted by nested and repeated k-fold cross validation, and the mean absolute error (MAE) was calculated to evaluate the accuracy of each regression model. RESULTS Forty-five urologic, 9 gastroenterological, and 3 gynecologic surgeons, 4 junior residents, and 9 medical students participated in the training. In both tasks, a positive correlation was observed between the speed-related parameters (e.g., velocity, velocity range, acceleration, jerk) and mean GOALS scores, with a negative correlation between the efficiency-related parameters (e.g., task time, path length, number of opening/closing operations) and mean GOALS scores. Among the 4 algorithms, SVR showed the highest accuracy in the tissue dissection task ([Formula: see text]), and PCA-SVR in the parenchymal-suturing task ([Formula: see text]), based on 100 iterations of the validation process of automatic GOALS estimation. CONCLUSION We developed a machine learning-based GOALS scoring system in wet lab training, with an error of approximately 1-2 points for the total score, and motion metrics that were explainable to trainees. Our future challenges are the further improvement of onsite GOALS feedback, exploring the educational benefit of our model and building an efficient training program.
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Affiliation(s)
- Koki Ebina
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Madoka Higuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Naoya Iwahara
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Masafumi Kon
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Kou Miyaji
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Sayaka Shibuya
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Yan Lingbo
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Shunsuke Komizunai
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Yo Kurashima
- Hokkaido University Clinical Simulation Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
| | - Teppei Tsujita
- Department of Mechanical Engineering, National Defense Academy of Japan, Yokosuka, 239-8686, Japan
| | - Kazuya Sase
- Department of Mechanical Engineering and Intelligent Systems, Tohoku Gakuin University, Tagajo, 985-8537, Japan
| | - Xiaoshuai Chen
- Graduate School of Science and Technology, Hirosaki University, Hirosaki, 036-8561, Japan
| | - Atsushi Konno
- Graduate School of Information Science and Technology, Hokkaido University, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan
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13
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Osawa T, Abe T, Kikuchi H, Matsumoto R, Murai S, Nakao T, Tanaka S, Watanabe A, Shinohara N. Validation of an online application to identify potential immune-related adverse events associated with immune checkpoint inhibitors based on the patient’s symptoms. PLoS One 2022; 17:e0265230. [PMID: 35290407 PMCID: PMC8923505 DOI: 10.1371/journal.pone.0265230] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/24/2022] [Indexed: 11/27/2022] Open
Abstract
Background Immune checkpoint inhibitors (ICIs) are increasingly being used to treat malignancies. Some patients experience immune-related adverse events (irAEs), which may affect any organ/tissue. IrAEs are occasionally fatal and usually have nonspecific symptoms. We developed a three-step application (https://irae-search.com/) to provide healthcare professionals with information on the diagnosis, treatment options, and published reports for 38 categories of irAEs encountered in clinical practice. Methods IrAEs reported in ≥5 cases were identified from articles published between October 2018 and August 2020 by searching Japanese (SELIMIC, JAPIC-Q Service, and JMED Plus) and international (MEDLINE, EMBASE, Derwent Drug File) databases. The cases’ symptoms were entered into the application to identify irAEs, which were verified using the reported diagnosis, to evaluate the application’s sensitivity and specificity. Results Overall, 1209 cases (1067 reports) were analyzed. The three most common categories of irAEs were pituitary or adrenal disorders (14% of cases), skin disorders (13%), and diabetes mellitus (10%). The top three primary diseases were lung cancer (364 cases), melanoma (286 cases), and renal cell carcinoma (218 cases). The average sensitivity was 90.8% (range 44.4%–100.0%) initially, and improved to 94.8% (range 83.3%–100.0%) after incorporating the symptoms reported in published cases into the application’s logic for two irAE categories. The average specificity was 79.3% (range 59.1% [thyroid disorders]–98.2% [arthritis]). Conclusion irAE Search is an easy-to-use application designed to help healthcare professionals identify potential irAEs in ICI-treated patients in a timely manner to facilitate prompt management/treatment. The application showed high sensitivity and moderate-to-high specificity for detecting irAEs.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- * E-mail:
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takafumi Nakao
- Pharmacovigilance Division, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Shinji Tanaka
- Pharmacovigilance Division, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Ayu Watanabe
- Pharmacovigilance Division, Ono Pharmaceutical Co., Ltd., Osaka, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Kikuchi H, Abe T, Matsumoto R, Osawa T, Maruyama S, Murai S, Shinohara N. Outcomes of bacillus Calmette-Guérin therapy without a maintenance schedule for high-risk non-muscle-invasive bladder cancer in the second transurethral resection era. Int J Urol 2021; 29:251-258. [PMID: 34894009 PMCID: PMC9299795 DOI: 10.1111/iju.14761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/19/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022]
Abstract
Objectives We examined the outcomes of eight weekly bacillus Calmette–Guérin induction therapy after second transurethral resection, and investigated risk factors for intravesical recurrence or disease progression in high‐risk non‐muscle‐invasive bladder cancer patients. Methods This retrospective study included 146 high‐risk non‐muscle‐invasive bladder cancer patients who received eight weekly bacillus Calmette–Guérin instillations without a maintenance schedule between 2000 and 2019. Intravesical recurrence‐free and progression‐free survival rates were evaluated using the Kaplan–Meier method. The Cox proportional hazards model was used to identify risk factors. Results Pathological T staging in the first transurethral resection was pTa in 56 patients (38.4%), pT1 in 75 (51.4%) and primary carcinoma in situ in 15 (10.2%). A total of 109 (83.2%) with pTa–1 disease underwent second transurethral resection before bacillus Calmette–Guérin induction therapy, and residual disease was detected in 54 (49.5%). The completion rate of eight instillations was 82.2%. The 2‐ and 5‐year intravesical recurrence‐free survival rates were 80.7% and 75.2%, whereas the 2‐ and 5‐year progression‐free survival rates were 85.7% and 82.0%. Recurrent tumors (hazard ratio 6.5830, P = 0.0007) and residual tumors at the second transurethral resection (hazard ratio 4.0337, P = 0.0021) were risk factors for intravesical recurrence. Multiple tumors (hazard ratio 5.8056, P = 0.0302), pT1 disease (hazard ratio 3.7351, P = 0.0447) and residual tumors at second transurethral resection (hazard ratio 3.2552, P = 0.0448) were associated with disease progression. Conclusions Accurate disease staging and disease elimination by second transurethral resection followed by eight weekly bacillus Calmette–Guérin instillations achieved good disease control. Our protocol (without a maintenance schedule) after thorough surgical resection has potential as a treatment option in the current bacillus Calmette–Guérin shortage.
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Affiliation(s)
- Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Japan
| | - Satoru Maruyama
- Department of Urology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Japan
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Iwami D, Matsumoto T, Ono K, Hotta K, Ota M, Chiba Y, Sasaki H, Hirose T, Higuchi H, Takada Y, Iwahara N, Murai S, Shinohara N. Novel double-filtration plasmapheresis preserves fibrinogen while removing immunoglobulin-G antibodies before ABO blood type-incompatible kidney transplantation. Ren Replace Ther 2021. [DOI: 10.1186/s41100-021-00379-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Background
Removal of anti-blood group antibodies is important for successful ABO-incompatible kidney transplantation (ABOi-KTx). Double-filtration plasmapheresis (DFPP) using albumin solution removes antibodies effectively. However, fibrinogen is largely removed resulting in hemostatic failure. Herein, we designed an altered combination of plasma membranes in DFPP (novel DFPP, nDFPP) to retain more fibrinogen while removing IgG, and assessed its efficacy and safety compared with conventional DFPP (cDFPP).
Methods
Consecutive ABOi-KTx recipients (from 2015 to 2018) were enrolled. For the first membrane, we used Cascadeflo EC-50W in nDFPP and Plasmaflo OP-08W in cDFPP, and Cascadeflo EC-20W as the second membrane in both modalities. Removal rates (RR) of IgG, IgM and fibrinogen per DFPP session, and adverse events were compared with historical control patients who underwent cDFPP before ABOi-KTx, between 2006 and 2015.
Results
nDFPP and cDFPP groups included 12 and 23 cases, respectively. nDFPP was inferior to cDFPP in RR of IgG and IgM. nDFPP was also inferior to cDFPP in the decline in anti-blood group IgG and IgM antibody titers. However, fibrinogen was more preserved in nDFPP compared with cDFPP, indicating that nDFPP has more selective removal properties (median RR of IgG, IgM, and fibrinogen: 62.1%, 15.7% and 37.6%, respectively, in nDFPP; and 74.5%, 85.0% and 76.6%, respectively, in cDFPP). In the comparison of hemostatic function among the patients who had arteriovenous fistula for hemodialysis, prolonged hemostasis (> 20 min) at the cannulation site was significantly less frequently observed in nDFPP group (1 in 9 cases, 9.1%) than in cDFPP group (all 18 cases, 10%, p < 0.0001).
Conclusions
nDFPP preserves fibrinogen while removing anti-blood type IgG antibodies before ABOi-KTx.
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Tanabe T, Hotta K, Iwahara N, Iwami D, Murai S, Shinohara N. Spontaneous closure of arteriovenous fistula after kidney transplantation. Int J Urol 2021; 28:872-873. [PMID: 34013557 DOI: 10.1111/iju.14576] [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: 11/29/2022]
Affiliation(s)
- Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Naoya Iwahara
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Daiki Iwami
- Division of Renal Surgery and Transplantation, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
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Osawa T, Wei JT, Abe T, Honda M, Rew KT, Dunn R, Yamada S, Furumido J, Kikuchi H, Matsumoto R, Sato Y, Harabayashi T, Takada N, Minami K, Morita K, Kashiwagi A, Fukuhara S, Murai S, Ito YM, Ogasawara K, Shinohara N. Comparison of Health-Related Quality of Life Between Japanese and American Patients with Bladder Cancer as Measured by a Newly Developed Japanese Version of the Bladder Cancer Index. Bladder Cancer 2021. [DOI: 10.3233/blc-200359] [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: 11/15/2022]
Abstract
INTRODUCTION: The aim of this study is to characterize health related quality of life (HRQOL) in Japanese patients after bladder cancer surgery and to perform cross-cultural comparison between Japanese and American patients. METHODS: Firstly, we cross-sectionally assessed HRQOL of 371 patients in Japan using the Bladder Cancer Index (BCI-Japanese). HRQOL of the four groups of patients (native bladder without intravesical therapy, native bladder with intravesical therapy, cystectomy with ileal conduit, and cystectomy with neobladder) were assessed. Secondly, we compared the Japanese with the American cohort (n = 315) from the original BCI paper. After adjusting for age and gender, the differences in each BCI subdomain score was analyzed. RESULTS: Among Japanese patients, the urinary domain function score was significantly lower among the cystectomy with neobladder group, compared to the cystectomy with ileal conduit group (p < 0. 01). Despite this, the urinary bother was comparable between the two groups. Although there were apparent differences between Japanese and American patients, there were few differences in Urinary and Bowel HRQOL. In three of the four treatment groups (other than native bladder with intravesical therapy), Japanese patients were more likely than Americans to report poor sexual function (p < 0.05). However, Japanese patients were less likely than Americans to be bothered by their lower sexual function, regardless of treatment (p < 0.05). CONCLUSIONS: HRQOL outcomes following treatment of bladder cancer in Japan are comparable to those in the USA, except for sexual functioning and sexual bother. The BCI can be used for cross-cultural assessments of HRQOL in bladder cancer patients.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - John T. Wei
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Karl T. Rew
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Rod Dunn
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Shuhei Yamada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yasuyuki Sato
- Department of Urology, Keiyukai Hospital, Sapporo, Japan
| | | | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Department of General Medicine, Shirakawa STAR, Fukushima Medical University, Fukushima, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoichi M. Ito
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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18
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Nakai Y, Takeuchi A, Osawa T, Kojima T, Hara T, Sugimoto M, Eto M, Minami K, Ueda K, Ozawa M, Uemura M, Miyauchi Y, Ohba K, Kashiwagi A, Murakami M, Sazuka T, Yasumoto H, Morizane S, Kawasaki Y, Morooka D, Shimazui T, Yamamoto Y, Nakagomi H, Tomida R, Ito YM, Murai S, Kitamura H, Nishiyama H, Shinohara N. Efficacy and safety of second-line axitinib in octogenarians with metastatic renal cell carcinoma. J Geriatr Oncol 2020; 12:834-837. [PMID: 33388281 DOI: 10.1016/j.jgo.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University Hospital, Fukuoka, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan.
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tomohiko Hara
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Mikio Sugimoto
- Department of Urology, Kagawa University, Takamatsu, Japan
| | - Masatoshi Eto
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University Hospital, Kurume, Japan
| | - Michinobu Ozawa
- Department of Urology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Hospital, Suita, Japan
| | | | - Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, Nagasaki, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Masaya Murakami
- Department of Urology, The Jikei University, School of Medicine, Tokyo, Japan
| | | | | | | | | | - Daichi Morooka
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan
| | - Yoshiaki Yamamoto
- Department of Urology, Graduate School of Medicine, Yamaguchi University, Ube, Japan
| | - Hiroshi Nakagomi
- Department of Urology, University of Yamanashi Hospital, Chuo, Japan
| | - Ryotaro Tomida
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Yoichi M Ito
- Biostatistics Division, Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kitamura
- Department of Urology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Hiramatsu M, Sugiu K, Hishikawa T, Haruma J, Takahashi Y, Murai S, Nishi K, Yamaoka Y, Shimazu Y, Fujii K, Kameda M, Kurozumi K, Date I. Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery. AJNR Am J Neuroradiol 2020; 41:2082-2087. [PMID: 33004344 DOI: 10.3174/ajnr.a6790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/15/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. MATERIALS AND METHODS This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. RESULTS We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. CONCLUSIONS Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.
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Affiliation(s)
- M Hiramatsu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Sugiu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - T Hishikawa
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - J Haruma
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Takahashi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - S Murai
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Nishi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Yamaoka
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Y Shimazu
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Fujii
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - M Kameda
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - K Kurozumi
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- Department of Neurosurgery (K.K.), Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - I Date
- From the Department of Neurological Surgery (M.H., K.S., T.H., J.H., Y.T., S.M., K.N., Y.Y., Y.S., K.F., M.K., K.K., I.D.), Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Murai S, Sugiura T, Dohi Y, Takase H, Mizoguchi T, Yamashita S, Seo Y, Fujii S, Ohte N. Arterial stiffness could reflect increased cardiac load and reduced pulmonary function in the general population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2371] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary function is known to decrease with age and reduced pulmonary function has been reported to be associated with all-cause mortality and cardiovascular death. The association between pulmonary impairment and atherosclerosis was reported previously but has not been investigated sufficiently in the general population.
Purpose
We hypothesized that arterial stiffness could reflect increase of cardiac load and reduced pulmonary function. The present study aimed to investigate whether increased cardiac load and reduced pulmonary function could affect arterial stiffness in the general population.
Methods
Subjects undergoing their health check-up were enrolled. Plasma B-type natriuretic peptide (BNP) levels and serum high-sensitivity cardiac troponin I (hs-cTnI) levels were measured to evaluate cardiac load and myocardial damage. Radial augmentation index (rAI) was measured to investigate arterial stiffness using HEM-9000AI device. Subjects with an ST-T segment abnormality on the electrocardiogram, renal insufficiency, cancer, active inflammatory disease, or a history of cardiovascular events and pulmonary disease were excluded. Pulmonary function was assessed using spirometry by calculating forced vital capacity (FVC) as a percentage of predicted value (FVC%-predicted), forced expiratory volume in 1 second (FEV1) as a percentage of predicted value (FEV1%-predicted), and the ratio of FEV1 to FVC (FEV1/FVC).
Results
A total of 1100 subjects aged 57 years were enrolled and their median values of BNP and hs-cTnI were 15.5 and 2.3 pg/ml. The levels of rAI were significantly associated with the levels of BNP after adjustment for possible confounders in multivariate regression analysis, but were not with the levels of hs-TnI. While the parameters of pulmonary function were inversely associated with the levels of rAI and hs-cTnI after adjustment for possible confounders in the multivariate regression analysis, but not with the levels of BNP. The other multivariate regression analyses where BNP, hs-cTnI, parameters of pulmonary function, and the other possible factors were simultaneously included as independent variables revealed that the BNP levels and the FVC%-predicted or FEV1%-predicted, besides age, gender, smoking status, body mass index, blood pressure, heart rate, creatinine, fasting plasma glucose, and triglyceride, were significantly associated with the levels of rAI.
Conclusions
The significant associations of rAI with BNP and pulmonary function were revealed in the general population. These findings support that arterial stiffness could reflect increased cardiac load and reduced pulmonary function, in apparently healthy individuals.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Murai
- Nagoya City University Graduate School of Medical Scinece, Nagoya, Japan
| | - T Sugiura
- Nagoya City University Graduate School of Medical Scinece, Nagoya, Japan
| | - Y Dohi
- Nagoya Gakuin University, Department of Internal Medicine, Faculty of Rehabilitation, Seto, Japan
| | - H Takase
- Enshu Hospital, Department of Internal Medicine, Hamamatsu, Japan
| | - T Mizoguchi
- Nagoya City University Graduate School of Medical Scinece, Nagoya, Japan
| | - S Yamashita
- Nagoya City University Graduate School of Medical Scinece, Nagoya, Japan
| | - Y Seo
- Nagoya City University Graduate School of Medical Scinece, Nagoya, Japan
| | - S Fujii
- Asahikawa Medical University, Department of Laboratory Medicine, Asahikawa, Japan
| | - N Ohte
- Nagoya City University Graduate School of Medical Scinece, Nagoya, Japan
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21
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Higuchi M, Abe T, Hotta K, Morita K, Miyata H, Furumido J, Iwahara N, Kon M, Osawa T, Matsumoto R, Kikuchi H, Kurashima Y, Murai S, Aydin A, Raison N, Ahmed K, Khan MS, Dasgupta P, Shinohara N. Development and validation of a porcine organ model for training in essential laparoscopic surgical skills. Int J Urol 2020; 27:929-938. [PMID: 32743896 PMCID: PMC7589398 DOI: 10.1111/iju.14315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/10/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To develop a wet laboratory training model for learning core laparoscopic surgical skills and evaluating learners' competency level outside the operating room. METHODS Participants completed three tasks (task 1: tissue dissection around the aorta; task 2: tissue dissection and division of the renal artery; task 3: renal parenchymal closure). Each performance was video recorded and subsequently evaluated by two experts, according to the Global Operative Assessment of Laparoscopic Skills and task-specific metrics that we developed (Assessment Sheet of Laparoscopic Skills in Wet Lab score). Mean scores were used for analyses. The subjective mental workload was also assessed (NASA Task Load Index). RESULTS The 54 participants included 32 urologists, eight young trainees and 14 medical students. A total of 13 participants were categorized as experts (≥50 laparoscopic surgeries), eight as intermediates (10-49) and 33 as novices (0-9). There were significant differences in the Global Operative Assessment of Laparoscopic Skills and Assessment Sheet of Laparoscopic Skills in Wet Lab scores among the three groups in all three tasks. Higher NASA Task Load Index scores were observed in novices, and there were significant differences in tasks 1 (Kruskal-Wallis test, P = 0.0004) and 2 (P = 0.0002), and marginal differences in task 3 (P = 0.0745) among the three groups. CONCLUSIONS Our training model has good construct validity, and differences in the NASA Task Load Index score reflect previous laparoscopic surgical experiences. Our findings show the ability to assess both laparoscopic surgical skills and mental workloads, which could help educators comprehend trainees' level outside the operating room. Given the decreasing opportunity to carry out pure laparoscopic surgeries because of the dissemination of robotic surgery, especially in urology, our model can offer practical training opportunities.
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Affiliation(s)
- Madoka Higuchi
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Takashige Abe
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Kiyohiko Hotta
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Ken Morita
- Department of UrologyKushiro City General HospitalKushiroHokkaidoJapan
| | - Haruka Miyata
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Jun Furumido
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Naoya Iwahara
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Masafumi Kon
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Takahiro Osawa
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Ryuji Matsumoto
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Hiroshi Kikuchi
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Yo Kurashima
- Hokkaido University Clinical Simulation CenterHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Sachiyo Murai
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
| | - Abdullatif Aydin
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Nicholas Raison
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Kamran Ahmed
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Muhammad Shamim Khan
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Prokar Dasgupta
- Division of Transplantation, Immunology and Mucosal BiologyFaculty of Life Sciences and MedicineKing’s College LondonLondonUK
| | - Nobuo Shinohara
- Department of UrologyHokkaido University Graduate School of MedicineSapporoHokkaidoJapan
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22
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Osawa T, Wei JT, Abe T, Honda M, Yamada S, Furumido J, Kikuchi H, Matsumoto R, Hirakawa K, Sato Y, Sasaki Y, Harabayashi T, Takada N, Minami K, Tanaka H, Morita K, Kashiwagi A, Miyajima N, Akino T, Murai S, Ito YM, Fukuhara S, Ogasawara K, Shinohara N. Health-related quality of life in Japanese patients with bladder cancer measured by a newly developed Japanese version of the Bladder Cancer Index. Int J Clin Oncol 2020; 25:2090-2098. [PMID: 32833102 PMCID: PMC7677272 DOI: 10.1007/s10147-020-01770-2] [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: 06/08/2020] [Accepted: 08/11/2020] [Indexed: 11/12/2022]
Abstract
Introduction We validated a Japanese version of the Bladder Cancer Index (BCI) as a tool for measuring health-related quality of life (HRQOL) in bladder cancer patients treated with various surgical procedures. Methods The reliability and validity of the Japanese BCI were examined in 397 Japanese patients with bladder cancer via cross-sectional analysis. The patients simultaneously completed the Short Form (SF)-12, EQ-5D, and the Functional Assessment of Cancer Therapy-General and Bladder (FACT-G and FACT-BL). The differences in BCI subscales among various treatment groups were analyzed. Results This study involved 397 patients (301 males and 96 females), with a mean age of 70 years and a median disease duration of 29 months (IQR: 12–66 months). Of these patients, 221 underwent transurethral resection of a bladder tumor, and 176 patients underwent radical cystectomy (ileal conduit: 101 patients, ileal neobladder: 49, and ureterostomy: 26). Cronbach’s alpha coefficient was ≥ 0.78 for all subscales, except the bowel bother subscale. Despite moderate correlations being detected between the function and bother score in urinary and bowel domains, the sexual function score was inversely correlated with the sexual bother score (r = − 0.19). A missing value percentage of > 15% was associated with old age (p < 0.05). The mean domain scores differed significantly among distinct clinically relevant treatment groups. Conclusions Although revisions are needed to make it easier for elderly patients to comprehend, we confirmed the reliability and validity of the Japanese BCI. The Japanese BCI could be used for cross-cultural assessments of HRQOL in bladder cancer patients. Electronic supplementary material The online version of this article (10.1007/s10147-020-01770-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - John T Wei
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Michitaka Honda
- Department Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Shuhei Yamada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Jun Furumido
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Yasuyuki Sato
- Department of Urology, Keiyukai Hospital, Sapporo, Japan
| | | | | | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Hiroshi Tanaka
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Naoto Miyajima
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tomoshige Akino
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoichi M Ito
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Shunichi Fukuhara
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan.,Department of General Medicine, Shirakawa STAR, Fukushima Medical University, Fukushima, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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23
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Moriya K, Nishimura Y, Nakamura M, Kon M, Kitta T, Araki A, Miyashita C, Ito S, Cho K, Mitsui T, Murai S, Nonomura K, Kishi R, Shinohara N. Establishment of nocturnal bladder control and behavioral sexual dimorphism in children. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33228-6] [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: 11/28/2022] Open
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24
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Nishimura Y, Moriya K, Kobayashi S, Araki A, Sata F, Mitsui T, Itoh S, Miyashita C, Cho K, Kon M, Nakamura M, Kitta T, Murai S, Kishi R, Shinohara N. Association of exposure to prenatal phthalate esters and bisphenol A and polymorphisms in the ESR1 gene with the second to fourth digit ratio in school-aged children: Data from the Hokkaido study. Steroids 2020; 159:108637. [PMID: 32165209 DOI: 10.1016/j.steroids.2020.108637] [Citation(s) in RCA: 10] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
Phthalates and bisphenol A (BPA) are estrogenic endocrine disruptors. Polymorphisms in the gene encoding estrogen receptor 1 (ESR1) may contribute to the ratio of the lengths of the second and fourth digits (2D:4D), which is considered an index of prenatal exposure to sex hormones. Thus, we investigated whether ESR1 polymorphisms modify the effects of prenatal exposure to phthalates and BPA on 2D:4D in a birth cohort. Maternal serum in the first trimester was used to determine prenatal exposure to these compounds. Six hundred twenty-three children (7 years of age) provided mean 2D:4D from photocopies and were genotyped for single nucleotide polymorphisms in ESR1, particularly PvuII (T > C, dbSNP: rs2234693), XbaI (A > G, dbSNP: rs9340799), and rs2077647 (A > G). The associations among compound exposure, mean 2D:4D, and ESR1 polymorphisms were assessed by multiple linear regression adjusted for potential cofounding factors. Boys with the AG/GG genotype at rs2077647 in the group exposed to high levels of mono(2-ethylhexyl) phthalate (MEHP) or Σ Di(2-ethylhexyl) phthalate (DEHP) showed feminized 2D:4D compared with boys with the AA genotype at rs2077647 who had low exposure to MEHP or ΣDEHP (MEHP: increase in mean 2D:4D of 1.51%, 95% confidence interval [CI]: 0.40-2.63; ΣDEHP: increase in mean 2D:4D of 1.37%, 95% CI: 0.25-2.49). No significant differences were found among girls. There were no associations between mean 2D:4D and metabolites other than MEHP or BPA. These data suggest that ESR1 polymorphisms modify the effects of prenatal exposure to DEHP on mean 2D:4D among boys.
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Affiliation(s)
- Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan; Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan; Department of Urology, Sapporo City General Hospital, North-11, West-13, Chuo-ku, Sapporo 060-8604, Japan.
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Atsuko Araki
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Fumihiro Sata
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Health Center, Chuo University, 42-8, Ichigaya-Hommura-cho, Shinjuku-ku, Tokyo 162-8473, Japan
| | - Takahiko Mitsui
- Department of Urology, Graduate School of Medical Science, University of Yamanashi, Simokato-1110, Chuo 409-3898, Japan
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Kazutoshi Cho
- Maternity and Perinatal Care Center, Hokkaido University Hospital, North-14, West-5 Kita-ku, Sapporo 060-8648, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
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25
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Osawa T, Kojima T, Hara T, Sugimoto M, Eto M, Takeuchi A, Minami K, Nakai Y, Ueda K, Ozawa M, Uemura M, Miyauchi Y, Ohba K, Suzuki T, Anai S, Shindo T, Kusakabe N, Tamura K, Komiyama M, Goto T, Yokomizo A, Kohei N, Kashiwagi A, Murakami M, Sazuka T, Yasumoto H, Iwamoto H, Mitsuzuka K, Morooka D, Shimazui T, Yamamoto Y, Ikeshiro S, Nakagomi H, Morita K, Tomida R, Mochizuki T, Inoue T, Kitamura H, Yamada S, Ito YM, Murai S, Nishiyama H, Shinohara N. Oncological outcomes of a multicenter cohort treated with axitinib for metastatic renal cell carcinoma. Cancer Sci 2020; 111:2460-2471. [PMID: 32402135 PMCID: PMC7385391 DOI: 10.1111/cas.14449] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/17/2020] [Revised: 04/24/2020] [Accepted: 05/02/2020] [Indexed: 12/14/2022] Open
Abstract
The present study aimed to evaluate the efficacy of the real-world use of axitinib and to develop a prognostic model for stratifying patients who could derive long-term benefit from axitinib. This was a retrospective, descriptive study evaluating the efficacy of axitinib in patients with metastatic renal cell carcinoma that had been treated with 1 or 2 systemic antiangiogenic therapy regimens at 1 of 36 hospitals belonging to the Japan Urologic Oncology Group between January 2012 and February 2019. The primary outcome was overall survival (OS). Using a split-sample method, candidate variables that exhibited significant relationships with OS were chosen to create a model. The new model was validated using the rest of the cohort. In total, 485 patients were enrolled. The median OS was 34 months in the entire study population, whereas it was not reached, 27 months, and 14 months in the favorable, intermediate, and poor risk groups, respectively, according to the new risk classification model. The following 4 variables were included in the final risk model: the disease stage at diagnosis, number of metastatic sites at the start of axitinib therapy, serum albumin level, and neutrophil : lymphocyte ratio. The adjusted area under the curve values of the new model at 12, 36, and 60 months were 0.77, 0.82, and 0.82, respectively. The efficacy of axitinib in routine practice is comparable or even superior to that reported previously. The patients in the new model's favorable risk group might derive a long-term survival benefit from axitinib treatment.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Takahiro Kojima
- Department of Urology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tomohiko Hara
- Office of Pharmacovigilance II, Pharmaceuticals and Medical Devices Agency, Tokyo, Japan
| | - Mikio Sugimoto
- Department of Urology, Kagawa University, Takamatsu, Japan
| | - Masatoshi Eto
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Ario Takeuchi
- Department of Urology, Kyushu University, Fukuoka, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University Hospital, Kurume, Japan
| | - Michinobu Ozawa
- Department of Urology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Motohide Uemura
- Department of Urology, Osaka University Hospital, Suita, Japan
| | | | - Kojiro Ohba
- Department of Urology, Nagasaki University Hospital, Nagasaki, Japan
| | - Toshiro Suzuki
- Department of Urology, Shinshu University Hospital, Matsumoto, Japan
| | - Satoshi Anai
- Department of Urology, Nara Medical University, Kashihara, Japan
| | - Tetsuya Shindo
- Department of Urology, Sapporo Medical University, Sapporo, Japan
| | | | - Keita Tamura
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | | | - Takayuki Goto
- Department of Urology, Kyoto University, Kyoto, Japan
| | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Naoki Kohei
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | | | | | | | - Hideto Iwamoto
- Department of Urology, Tottori University, Yonago, Japan
| | | | - Daichi Morooka
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Toru Shimazui
- Department of Urology, Ibaraki Prefectural Central Hospital, Ibaraki Cancer Center, Kasama, Japan
| | | | - Suguru Ikeshiro
- Department of Urology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - Hiroshi Nakagomi
- Department of Urology, University of Yamanashi Hospital, Chuo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Ryotaro Tomida
- Department of Urology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Tango Mochizuki
- Department of Urology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | | | - Hiroshi Kitamura
- Department of Urology, Toyama Univerisity Hospital, Toyama, Japan
| | - Shuhei Yamada
- Department of Urology, Otaru General Hospital, Otaru, Japan
| | - Yoichi M Ito
- Department of Statistical Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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26
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Abe T, Minami K, Harabayashi T, Sazawa A, Chiba H, Kikuchi H, Miyata H, Matsumoto R, Osawa T, Maruyama S, IshizakiIshizaki J, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Murai S, Shinohara N. Erratum to: Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma. Jpn J Clin Oncol 2020; 50:726. [PMID: 32382760 PMCID: PMC7284546 DOI: 10.1093/jjco/hyz196] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/21/2022] Open
Affiliation(s)
- T Abe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - K Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Harabayashi
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - A Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - H Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - H Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - H Miyata
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - R Matsumoto
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - T Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - S Maruyama
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | | | - T Mochizuki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - S Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Akino
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - M Murakumo
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - N Miyajima
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - K Tsuchiya
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - S Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - N Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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27
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Abe T, Minami K, Harabayashi T, Sazawa A, Chiba H, Kikuchi H, Miyata H, Frumido J, Matsumoto R, Osawa T, Junji I, Tango M, Satoshi C, Tomoshige A, Masashi M, Naoto M, Kunihiko T, Satoru M, Murai S, Shinohara N. Erratum: Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy. Jpn J Clin Oncol 2020; 50:727. [PMID: 32382732 PMCID: PMC7284538 DOI: 10.1093/jjco/hyz197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/22/2019] [Accepted: 10/01/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroki Chiba
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Jun Frumido
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Ishizaki Junji
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Chiba Satoshi
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Miyajima Naoto
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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28
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Osawa T, Wei J, Abe T, Yamada S, Frumido J, Miyata H, Kikuchi H, Matsumoto R, Sato Y, Hirakawa K, Sasaki Y, Tanaka H, Kashiwagi A, Morita K, Takada N, Minami K, Harabayashi T, Murai S, Shinohara N. Health-related quality of life in Japanese patients with bladder cancer according to a newly developed Japanese version of the Bladder Cancer Index. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.427] [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
427 Background: We developed a Japanese version of the Bladder Cancer Index (BCI) to measure HRQOL in Japanese patients treated with various surgical methods. In addition, we performed a cross-cultural comparison of sexual function and bother in bladder cancer patients between the United States and Japan. Methods: The Japanese version of the BCI was developed through a multistage process after a pilot study. Its reliability and validity were examined in Japanese bladder cancer patients via a cross-sectional analysis. The patients were enrolled from August 2016 to March 2018. They also completed the Japanese version of Short Form (SF)-12, the EuroQol five-dimension scale (EQ-5D), and the Functional Assessment of Cancer Therapy-Bladder (FACT-BL). We also compared the Japanese cohort with an American cohort; i.e., the validation cohort used to develop the original version of the English BCI. Results: In total, 371 patients with a median age of 72 years and a median disease duration of 29 months were enrolled. Of these patients, 221 underwent transurethral resection of the bladder tumor, and 150 underwent radical cystectomy. The internal consistency value was ≥0.7 for all subscales, except the bowel function subscale. Each BCI domain was poorly correlated with the SF-12 and EQ-5D, but moderately well correlated with the FACT-BL. The urinary function and bowel function scales exhibited minimal (2.1–9.7%) amounts of missing data, whereas relatively high (≥15%) levels of missing data were seen in items relating to urinary bother, bowel bother, sexual function, or sexual bother. A missing data value of ≥15% was correlated with higher age (p<0.05). Japanese patients were more likely than American patients to report poor sexual function. However, Japanese were less likely than American to be concerned about sexual function. Conclusions: We confirmed the reliability and validity of the Japanese version of the BCI, although it needs to be revised to make it more comprehensible for elderly patients. We found differences between American and Japanese patients with bladder cancer. The BCI can be used for cross-cultural assessments of HRQOL in bladder cancer patients.
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Affiliation(s)
- Takahiro Osawa
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - John Wei
- University of Michigan School of Medicine, Ann Arbor, MI
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Shuhei Yamada
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Jun Frumido
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Haruka Miyata
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Hokkaido University, Sapporo, Japan
| | - Yasuyuki Sato
- Department of Urology, Keiyukai Hospital, Sapporo, Japan
| | | | | | - Hiroshi Tanaka
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | - Akira Kashiwagi
- Department of Urology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Ken Morita
- Department of Urology, Kushiro City General Hospital, Kushiro, Japan
| | - Norikata Takada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keita Minami
- Department of Urology, Sapporo City General Hospital, Sapporo, Japan
| | | | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Hokkaido University Graduate School of Medicine, Sapporo, Japan
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29
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Abe T, Minami K, Harabayashi T, Sazawa A, Chiba H, Kikuchi H, Miyata H, Frumido J, Matsumoto R, Osawa T, Junji I, Tango M, Satoshi C, Tomoshige A, Masashi M, Naoto M, Kunihiko T, Satoru M, Murai S, Shinohara N. Prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients receiving systemic chemotherapy. Jpn J Clin Oncol 2020; 50:206-213. [PMID: 31665467 DOI: 10.1093/jjco/hyz152] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/28/2019] [Accepted: 09/01/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To clarify the prognostic impact of local radiotherapy on metastatic urothelial carcinoma patients treated by systemic chemotherapy. METHODS Of the 228 metastatic urothelial carcinoma patients treated with systemic chemotherapy, 97 received radiotherapy mainly to metastatic sites. In patients for whom the purpose of radiotherapy was not specified, more than 50 Gy irradiation was considered to be for disease consolidation for survival analysis, while less than 50 Gy was categorized as palliation. According to the Kaplan-Meier method, we analysed overall survival from the initiation of treatment for metastatic urothelial carcinoma until death or the last follow-up, using the log-rank test to assess the significance of differences. The Cox model was applied for prognostic factor analysis. RESULTS Overall, there was no significant difference in survival between patients with and those without radiotherapy (P = 0.1532). When analysing the patients undergoing consolidative radiotherapy separately, these 25 patients showed significantly longer survival than the 72 patients with palliative radiotherapy (P = 0.0047), with a 3-year overall survival of 43.3%. Of the present cohort, 22 underwent metastasectomy for disease consolidation, and there was no overlapping case between the metastasectomy cohort and cohort receiving consolidative radiotherapy. After controlling for four independent prognostic factors (sex, performance status, haemoglobin level and number of organs with metastasis) in our previous study, radiotherapy for disease consolidation showed a marginal value (hazard ratio = 0.666, P = 0.0966), while metastasectomy remained significant (hazard ratio = 0.358, P = 0.0006). CONCLUSIONS In the selected patients, long-term disease control could be achieved after consolidative radiotherapy for metastatic urothelial carcinoma disease. Our observations suggest that local ablative therapy (surgery or radiotherapy) could facilitate long-term disease control. However, the treatment decision should be individualized because of the lack of randomized control trials.
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Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroki Chiba
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Haruka Miyata
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Jun Frumido
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Ishizaki Junji
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Chiba Satoshi
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Miyajima Naoto
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Sachiyo Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Abe T, Minami K, Harabayashi T, Sazawa A, Chiba H, Kikuchi H, Miyata H, Matsumoto R, Osawa T, Maruyama S, Ishizaki J, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Murai S, Shinohara N. Outcome of maintenance systemic chemotherapy with drug-free interval for metastatic urothelial carcinoma. Jpn J Clin Oncol 2020; 49:965-971. [PMID: 31187865 PMCID: PMC6886465 DOI: 10.1093/jjco/hyz084] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/15/2019] [Accepted: 05/21/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Aiming to achieve long-term disease control, maintenance systemic chemotherapy (MSC) with a 1-3-month drug-free interval is continued in selected patients. We report our experience of MSC for metastatic urothelial carcinoma (UC). METHODS Of 228 metastatic UC patients treated with systemic chemotherapy, 40 (17.5%, 40/228) had continuously undergone MSC. Data on the regimen, cycle number, and reason for the discontinuation of MSC were also collected. We analyzed OS from the initiation of MSC until death or the last follow-up, using the log-rank test to assess the significance of differences. RESULTS The median number of cycles of chemotherapy was 6, and the responses were CR in 6, PR in 20, SD in 13, and PD in 1 before MSC. Gemcitabine plus CDDP or carboplatin was mainly performed as MSC (70%, 28/40). MSC was repeated quarterly in 30 (75%, 30/40), every two months in 8 (20%, 8/40), and with other intervals in 2 (5%, 2/40). Overall, a median of 3.5 cycles (range: 1-29) of MSC was performed. The reason for the discontinuation of MSC was PD in 24 (60%, 24/40), favorable disease control in 9 (22.5%, 9/40), and myelosuppression in 3 (7.5%, 3/40), and for other reasons in 2 (5%, 2/40). MSC was ongoing in 2 (5%, 2/40). The median OS was 27 months from the initiation of MSC. PS0 (P = 0.0169), the absence of lung metastasis (P = 0.0387), and resection of the primary site (P = 0.0495) were associated with long-term survival after MSC. CONCLUSIONS In selected patients, long-term systemic chemotherapy could be performed with a drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the treatment options for long-term disease control.
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Affiliation(s)
- T Abe
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - K Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Harabayashi
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - A Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - H Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - H Kikuchi
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - H Miyata
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - R Matsumoto
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - T Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - S Maruyama
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - J Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Mochizuki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - S Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - T Akino
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - M Murakumo
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - N Miyajima
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - K Tsuchiya
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - S Murai
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
| | - N Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Japan
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Miyata H, Abe T, Hotta K, Higuchi M, Osawa T, Matsumoto R, Kikuchi H, Kurashima Y, Murai S, Shinohara N. Validity assessment of the laparoscopic radical nephrectomy module of the LapVision virtual reality simulator. Surg Open Sci 2020; 2:51-56. [PMID: 33981981 PMCID: PMC8083013 DOI: 10.1016/j.sopen.2019.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 04/23/2019] [Revised: 07/27/2019] [Accepted: 08/30/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Virtual reality simulators allow trainees to perform repeated practice and provide objective dexterity metrics regarding their performance, which means that virtual reality-based surgical training is becoming a vital part of initial learning of basic laparoscopic surgical skills. However, its educational role in learning advanced procedures remains undetermined. We evaluated the validity of the laparoscopic radical nephrectomy module of the LapVision virtual reality simulator. METHODS Urologists, medical students, and a junior resident voluntarily participated in the present study, and they performed training with a laparoscopic left radical nephrectomy module. For construct validation, dexterity metrics calculated in the simulator and the mean score of Global Operative Assessment of Laparoscopic Skills evaluated by 2 experts' video review were compared according to the certification of Japanese Endoscopic Surgical Skill Qualification or previous surgical experience. RESULTS Ten experts (≥ 50 laparoscopic surgeries), 9 intermediates (11-49), and 14 novices (0-10) voluntarily participated in the present study. Regarding the construct validity, there was a significant difference in the total number of errors, blood loss, and Global Operative Assessment of Laparoscopic Skills score among the groups for both the Endoscopic Surgical Skill Qualification status and previous surgical experience. CONCLUSION The present study demonstrated good construct validity for the LapVision nephrectomy module. Furthermore, global skill assessment was possible by experts' reviews, which indicates the usefulness of the virtual reality procedural module as a skill assessment tool. Virtual reality-based procedural simulation has marked potential to become a vital part of integrated laparoscopic training programs.
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Affiliation(s)
- Haruka Miyata
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Madoka Higuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yo Kurashima
- Hokkaido University Clinical Simulation Center, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Osawa T, Wei JT, Abe T, Kako Y, Murai S, Shinohara N. Development of the Japanese version of the health-related quality of life questionnaire for bladder cancer patients using the Bladder Cancer Index: A pilot study. Int J Urol 2019; 26:1016-1017. [PMID: 31311062 DOI: 10.1111/iju.14073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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]
Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - John T Wei
- Department of Urology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yuki Kako
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Nishimura Y, Moriya K, Kobayashi S, Araki A, Sata F, Mitsui T, Itoh S, Miyashita C, Cho K, Kon M, Nakamura M, Kitta T, Murai S, Kishi R, Shinohara N. Association between ESR1 polymorphisms and second to fourth digit ratio in school-aged children in the Hokkaido Study. Steroids 2019; 141:55-62. [PMID: 30468784 DOI: 10.1016/j.steroids.2018.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 08/10/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 01/28/2023]
Abstract
The ratio of the lengths of the 2nd and 4th digits (2D:4D) is considered an index of prenatal exposure to androgen. Indeed, androgen receptors have been linked to digit length, but estrogen receptors are rarely investigated in this context. Thus, we investigated the association between estrogen receptor 1 (ESR1) genetic polymorphisms and 2D:4D in school-aged children. The 2D:4D ratios were determined using Vernier calipers from photocopies of palms provided by 1800 children aged 7 years who were enrolled in an ongoing prospective cohort study in Hokkaido, Japan. The children were genotyped using cord blood collected at birth for single nucleotide polymorphisms in ESR1, specifically PvuII (T > C, dbSNP: rs2234693), XbaI (A > G, dbSNP: rs9340799), and rs2077647 (A > G). The association between ESR1 polymorphisms and 2D:4D was assessed by multiple linear regression adjusted for potential cofounding factors. Boys with the GG genotype at rs9340799 had a significantly lower 2D:4D in the right hand than boys with the AA/AG genotype (-0.96% lower, 95% confidence interval: -1.68 to -0.24). However, this association was detected only in boys born to non-smoking mothers. No significant differences were found between rs9340799 polymorphisms and 2D:4D among girls. There was also no link between 2D:4D and polymorphisms at rs2234693 and rs2077647. These data suggest that rs9340799 polymorphisms in ESR1 may contribute to digit length and 2D:4D.
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Affiliation(s)
- Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan; Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan.
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Atsuko Araki
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Fumihiro Sata
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan; Health Center, Chuo University, 42-8, Ichigaya-Hommura-cho, Shinjuku-ku, Tokyo 162-8473, Japan
| | - Takahiko Mitsui
- Department of Urology, Graduate School of Medical Science, University of Yamanashi, Simokato-1110, Chuo 409-3898, Japan
| | - Sachiko Itoh
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Kazutoshi Cho
- Maternity and Perinatal Care Center, Hokkaido University Hospital, North-14, West-5 Kita-ku, Sapporo 060-8648, Japan
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, Hokkaido University, North-12, West-7, Kita-ku, Sapporo 060-0812, Japan
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, North-15, West-7, Kita-ku, Sapporo 060-8638, Japan
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Abe T, Kondo T, Harabayashi T, Takada N, Matsumoto R, Osawa T, Minami K, Nagamori S, Maruyama S, Murai S, Tanabe K, Shinohara N. Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection. Jpn J Clin Oncol 2018; 48:1001-1011. [PMID: 30272169 PMCID: PMC6203124 DOI: 10.1093/jjco/hyy128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 05/14/2018] [Accepted: 08/21/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To assess the number of lymph nodes removed as a surrogate marker of the extent of lymph node dissection, and compare survival outcomes between laparoscopic radical nephroureterectomy (LRNU) and open radical nephroureterectomy (ORNU) in patients undergoing standardized lymph node dissection. Methods We retrospectively analyzed the data of 214 cTanyN0M0 patients undergoing radical NU with regional lymph node dissection according to the tumor location. The Kaplan–Meier method and Cox hazards model were utilized for survival analyses, including recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Results A total of 114 patients underwent LRNU and 100 underwent ORNU. There was no significant difference in the pT stage, pN stage, or tumor grade, but distal ureteral tumors were more frequent in the LRNU group. The number of lymph nodes removed did not differ between the two groups [LRNU: 12 (median), ORNU: 11.5, P = 0.3852]. Lymph node metastasis was pathologically identified in 19 patients (8.9%). The 5-year RFS (ORNU: 71.7%, LRNU: 74%, P = 0.7829), CSS (77.8 and, 80%, P = 0.8441) and OS (72.8, and 75.9%, P = 0.3456) did not differ between the two groups. In the sub-analysis of pT3/4 patients (n = 83), there were no significant differences in RFS, CSS, or OS between the two groups, although Kaplan–Meier survival curves were slightly better for those receiving ORNU. In the multivariate model, LRNU was not significantly correlated with a poorer RFS, CSS or OS. Conclusion Our data support the feasibility of lymph node dissection with a laparoscopic approach and the equivalent oncological outcome of LRNU compared with ORNU when regional lymph node dissection is performed. However, LRNU should be performed after careful patient selection for advanced disease.
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Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tsunenori Kondo
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | | | - Norikata Takada
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keita Minami
- Department of Urology, Hokkaido Cancer Center, Sapporo, Japan
| | | | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Matsumoto R, Abe T, Ishizaki J, Kikuchi H, Harabayashi T, Minami K, Sazawa A, Mochizuki T, Akino T, Murakumo M, Osawa T, Maruyama S, Murai S, Shinohara N. Outcome and prognostic factors in metastatic urothelial carcinoma patients receiving second-line chemotherapy: an analysis of real-world clinical practice data in Japan. Jpn J Clin Oncol 2018; 48:771-776. [PMID: 29939285 PMCID: PMC6057543 DOI: 10.1093/jjco/hyy094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/13/2018] [Accepted: 06/13/2018] [Indexed: 01/07/2023] Open
Abstract
Objectives The objective of the present study was to investigate the survival outcome and prognostic factors of metastatic urothelial carcinoma patients treated with second-line systemic chemotherapy in real-world clinical practice. Methods Overall, 114 patients with metastatic urothelial carcinoma undergoing second-line systemic chemotherapy were included in this retrospective analysis. The dominant second-line chemotherapy was a paclitaxel-based combination regimen (60%, 68/114). We assessed the progression-free survival and overall survival times using the Kaplan–Meier method. The Cox proportional hazards model was applied to identify the factors affecting overall survival. Results The median progression-free survival and overall survival times were 4 and 9 months, respectively. In the multivariate analysis, an Eastern Cooperative Oncology Group performance status score greater than 0 at presentation, C-reactive protein level ≧1 mg/dl and poor response to prior chemotherapy were adverse prognostic indicators. Patients with 0, 1, 2 and 3 of those risk factors had a median overall survival of 17, 12, 7 and 3 months, respectively. Conclusions The Eastern Cooperative Oncology Group performance status at presentation, C-reactive protein level and response to prior chemotherapy were prognostic factors for metastatic urothelial carcinoma patients undergoing second-line chemotherapy. In the future, this information might help guide the choice of salvage treatment, such as second-line chemotherapy or immune checkpoint inhibitors, after the failure of first-line chemotherapy.
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Affiliation(s)
- Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Junji Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine
| | | | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | | | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine
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Osawa T, Abe T, Takada N, Ito YM, Murai S, Shinohara N. Validation of the nomogram for predicting 90-day mortality after radical cystectomy in a Japanese cohort. Int J Urol 2018; 25:699-700. [PMID: 29682815 DOI: 10.1111/iju.13584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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]
Affiliation(s)
- Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, , Japan
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, , Japan
| | - Norikata Takada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, , Japan
| | - Yoichi M Ito
- Department of Biostatistics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, , Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, , Japan
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Matsumoto R, Abe T, Ishizaki J, Minami K, Harabayashi T, Sazawa A, Mochizuki T, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Kikuchi H, Miyata H, Osawa T, Maruyama S, Murai S, Shinohara N. MP78-20 THE MODIFIED GLASGOW PROGNOSTIC SCORE IS A POWERFUL PROGNOSTIC FACTOR IN METASTATIC UROTHELIAL CARCINOMA PATIENTS RECEIVING SECOND-LINE CHEMOTHERAPY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2568] [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: 10/17/2022]
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Abe T, Ishizaki J, Minami K, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Chiba H, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Kikuchi H, Miyata H, Matsumoto R, Osawa T, Maruyama S, Murai S, Shinohara N. MP78-13 OUTCOME OF MAINTENANCE SYSTEMIC CHEMOTHERAPY WITH DRUG-FREE INTERVAL FOR METASTATIC UROTHELIAL CARCINOMA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2561] [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: 11/30/2022]
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Abe T, Takada N, Kikuchi H, Matsumoto R, Osawa T, Murai S, Miyajima N, Maruyama S, Shinohara N. Perioperative morbidity and mortality of octogenarians treated by radical cystectomy-a multi-institutional retrospective study in Japan. Jpn J Clin Oncol 2017; 47:755-761. [PMID: 28453639 PMCID: PMC5896694 DOI: 10.1093/jjco/hyx062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/20/2017] [Indexed: 11/12/2022] Open
Abstract
Objective To determine the characteristics of 90-day morbidity and mortality after radical cystectomy in Japanese octogenarians. Methods A retrospective multi-institutional study. We reviewed the records of 834 patients treated by open radical cystectomy between 1997 and 2010. All complications within 90 days after surgery were sorted into the 11 categories proposed by the Memorial Sloan-Kettering Cancer Center and graded according to the modified Clavien-Dindo system. We compared the characteristics of complications between ≥80-year (n = 86) and <80-year (n = 748) groups. Multivariate regression models were used to determine the predictors of complications. Results American Society of Anesthesiologists score III–IV was more frequent (14% vs. 6%, respectively, P < 0.0001), and ureterocutaneostomy was more frequently performed (30% vs. 21%, respectively, P = 0.0148) in the ≥80-year group compared with <80-year group. There were no significant differences in the rates of any complication, major (Grade 3–5) complication, or 90-day mortality between the two groups (≥80-year group: 70%, 21%, 3.5%, respectively, <80-year group: 68%, 22%, 2%, respectively). The ≥80-year group had fewer genitourinary complications (7% vs. 16%, respectively, P = 0.0131). Multivariate regression analyses revealed that bowel-using urinary diversion (P = 0.0031) and the operative time (P = 0.0269) were significant predictors of any grade of complications, and a male sex (P = 0.0167), annual cystectomy volume (P = 0.0284) and prior cardiovascular comorbidity (P = 0.0034) were significant predictors of major complications. Conclusions In our experience, radical cystectomy in Japanese octogenarians caused similar perioperative comorbidities. Old age as a single criterion should not be used to abandon radical cystectomy; careful preoperative assessment is mandatory.
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Affiliation(s)
- Takashige Abe
- For reprints and all correspondence: Takashige Abe, Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo 060-8638, Japan. E-mail:
| | - Norikata Takada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Murai S, Takase H, Sugiura T, Ohte N, Dohi Y. P4552Recent changes of blood pressure levels, the prevalence and treatment rate of hypertension, and the accomplishment rate of the target blood pressure in the elderly person. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4552] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Murai S, Ando A, Ebara S, Hirayama M, Satomi Y, Hara T. Inhibition of malic enzyme 1 disrupts cellular metabolism and leads to vulnerability in cancer cells in glucose-restricted conditions. Oncogenesis 2017; 6:e329. [PMID: 28481367 PMCID: PMC5523067 DOI: 10.1038/oncsis.2017.34] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 11/21/2016] [Revised: 02/17/2017] [Accepted: 03/27/2017] [Indexed: 12/24/2022] Open
Abstract
Malic enzyme 1 (ME1) regulates one of the main pathways that provide nicotinamide adenine dinucleotide phosphate (NADPH), which is essential for cancer cell growth through maintenance of redox balance and biosynthesis processes in the cytoplasm. In this study, we found that ME1 inhibition disrupted metabolism in cancer cells and inhibited cancer cell growth by inducing senescence or apoptosis. In glucose-restricted culture conditions, cancer cells increased ME1 expression, and tracer experiments with labelled glutamine revealed that the flux of ME1-derived pyruvate to citrate was enhanced. In addition, cancer cells showed higher sensitivity to ME1 depletion in glucose-restricted conditions compared to normal culture conditions. These results suggest that in a low-glucose environment, where glycolysis and the pentose phosphate pathway (PPP) is attenuated, cancer cells become dependent on ME1 for the supply of NADPH and pyruvate. Our data demonstrate that ME1 is a promising target for cancer treatment, and a strategy using ME1 inhibitors combined with inhibition of glycolysis, PPP or redox balance regulators may provide an effective therapeutic option.
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Affiliation(s)
- S Murai
- Oncology Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company, Kanagawa, Japan
| | - A Ando
- Integrated Technology Research Laboratories, Pharmaceutical Research Division, Takeda Pharmaceutical Company, Kanagawa, Japan
| | - S Ebara
- Oncology Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company, Kanagawa, Japan
| | - M Hirayama
- Integrated Technology Research Laboratories, Pharmaceutical Research Division, Takeda Pharmaceutical Company, Kanagawa, Japan
| | - Y Satomi
- Integrated Technology Research Laboratories, Pharmaceutical Research Division, Takeda Pharmaceutical Company, Kanagawa, Japan
| | - T Hara
- Oncology Drug Discovery Unit, Pharmaceutical Research Division, Takeda Pharmaceutical Company, Kanagawa, Japan
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Abe T, Ishizaki J, Kikuchi H, Minami K, Matsumoto R, Harabayashi T, Sazawa A, Mochizuki T, Chiba S, Akino T, Murakumo M, Miyajima N, Tsuchiya K, Maruyama S, Murai S, Shinohara N. Outcome of metastatic urothelial carcinoma treated by systemic chemotherapy: Prognostic factors based on real-world clinical practice in Japan. Urol Oncol 2016; 35:38.e1-38.e8. [PMID: 27693091 DOI: 10.1016/j.urolonc.2016.08.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 08/19/2016] [Accepted: 08/27/2016] [Indexed: 11/17/2022]
Abstract
AIM To clarify prognostic factors of metatstatic urothelial carcinoma treated by systemic chemotherapy in real-world clinical practice in the Japanese population. MATERIALS AND METHODS A total of 228 patients with metastatic urothelial carcinoma undergoing systemic chemotherapy between 2000 and 2013 were included in the present multi-institutional study. The gemcitabine plus cisplatin regimen was administered as first-line chemotherapy to 131 patients, whereas methotrexate, vinblastine, doxorubicin, and cisplatin or its modified regimen was given to 71 patients. Of the 228 patients, 119 received at least 2 different regimens and 22 underwent resection of metastases (metastasectomy). Multivariate survival analysis was performed using the Cox proportional hazards model. The characteristics included were age, sex, Eastern Cooperative Oncology Group performance status (PS), primary site, pathology of primary site, hemoglobin levels, lactate dehydrogenase levels, C-reactive protein levels, corrected calcium levels, estimated glomerular filtration rate levels, history of prior chemotherapy, metastatic sites, resection of primary site, number of metastatic organs, and metastasectomy. RESULTS The median overall survival (OS) time was 17 months. On multivariate analysis, female sex, good Eastern Cooperative Oncology Group PS at presentation, hemoglobin level≥10g/dl, and single organ metastasis were significant independent predictors of prolonged OS. For the survival effect of metastasectomy, the median OS time of the 22 patients with metastasectomy was 53 months, which was significantly longer when compared with patients not undergoing metastasectomy (15mo). After adjustment for the 4 aforementioned prognostic factors, metastasectomy still remained significant (hazard ratio: 0.364, P = 0.0008). CONCLUSIONS Female sex, more favorable PS at presentation, hemoglobin level>10g/dl, and single organ metastasis were favorable prognostic factors. In addition, metastasectomy was associated with long-term disease control.
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Affiliation(s)
- Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
| | - Junji Ishizaki
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Hiroshi Kikuchi
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Keita Minami
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - Ataru Sazawa
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | - Satoshi Chiba
- Hokkaido Urothelial Cancer Research Group, Sapporo, Japan
| | | | | | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kunihiko Tsuchiya
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Osawa T, Lee CT, Abe T, Takada N, Hafez KS, Montgomery JS, Weizer AZ, Hollenbeck BK, Skolarus TA, Murai S, Shinohara N, Morgan TM. A Multi-Center International Study Assessing the Impact of Differences in Baseline Characteristics and Perioperative Care Following Radical Cystectomy. Bladder Cancer 2016; 2:251-261. [PMID: 27376144 PMCID: PMC4927825 DOI: 10.3233/blc-150043] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Indexed: 11/25/2022]
Abstract
Background: To identify potential avenues for quality improvement, we compared the variations in clinical practice and their association with perioperative morbidity and mortality following radical cystectomy (RC) for bladder cancer in the United States (US) and Japan. Methods: We reviewed our retrospectively collected database of 2240 patients who underwent RC for bladder cancer at the University of Michigan (n = 1427) and in 21 Japanese institutions (n = 813) between 1997 and 2014. We performed a systematic comparison of clinical and perioperative factors and assessed predictors of perioperative morbidity and mortality. Death within 90 days of surgery was the primary outcome. Results: There were apparent differences between the two study populations. Notably, US patients had a significantly greater BMI and higher ASA score. In Japanese institutions, median postoperative hospital stay was significantly higher (40 days vs. 7 days, p < 0.001) and 90-day readmission rates were significantly lower (0.6% vs. 26.8% , p < 0.001). There was a total of 1372/2240 (61.2%) patients with complications within 90 days and 66/2240 (2.9%) patient deaths. Significant predictors of 90-day mortality were older age (OR 1.04, CI 1.01–1.07), higher body mass index (OR 1.07, CI 1.02–1.12), node-positive disease (OR 3.14, CI 1.78–5.47), increased blood loss (OR 1.02, CI 1.01–1.03), and major (Clavien-grade 3 or greater) complication (OR 3.29, CI 1.88–5.71). Conclusion: Despite major differences in baseline characteristics and care of cystectomy patients between the two study populations, peri-operative mortality rates proved to be comparable. This data supports an exploration of non-traditional factors that may influence mortality after cystectomy.
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Affiliation(s)
- Takahiro Osawa
- Department of Urology, University of Michigan Health System, Ann Arbor, MI, USA; Department of Urology, Hokkaido University, Sapporo, Japan
| | - Cheryl T Lee
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Takashige Abe
- Department of Urology, Hokkaido University , Sapporo, Japan
| | | | - Khaled S Hafez
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Jeffrey S Montgomery
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Alon Z Weizer
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Brent K Hollenbeck
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Ted A Skolarus
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
| | - Sachiyo Murai
- Department of Urology, Hokkaido University , Sapporo, Japan
| | | | - Todd M Morgan
- Department of Urology, University of Michigan Health System , Ann Arbor, MI, USA
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Osawa T, Lee CT, Abe T, Takada N, Hafez KS, Montgomery JS, Weizer AZ, Hollenbeck BK, Skolarus TA, Murai S, Shinohara N, Morgan TM. MP06-19 A MULTI-CENTER INTERNATIONAL STUDY ASSESSING THE IMPACT OF DIFFERENCES IN BASELINE CHARACTERISTICS AND PERIOPERATIVE CARE FOLLOWING RADICAL CYSTECTOMY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2180] [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]
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Murakami Y, Suzuki T, Nii Y, Murai S, Arima T, Kainuma R, Shindo D. Application of strain to orbital-spin-coupled system MnV2O4 at cryogenic temperatures within a transmission electron microscope. Microscopy (Oxf) 2016; 65:223-32. [PMID: 26754562 DOI: 10.1093/jmicro/dfv377] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/30/2015] [Indexed: 11/14/2022] Open
Abstract
The impact of mechanical stress on the morphology of crystallographic and magnetic domains in shape-controlled specimens of an orbital-spin-coupled system, MnV2O4, was examined by cryogenic Lorentz microscopy. Because of the difference in thermal expansion coefficients of MnV2O4 and the supporting Mo mesh, compression on the order of 0.01% was applied to the thin-foil specimens near the structural/magnetic phase transformation temperatures. The extent of compression was comparable to the lattice striction associated with the cubic-to-tetragonal phase transformation in MnV2O4 The applied strain thus clearly influenced the morphology of crystallographic domains (i.e. twinning configuration in the tetragonal phase) produced during cooling. The magnetic domain structure was entirely dependent on the configuration of twinning in the tetragonal phase. The observations in this study provided useful information for understanding the relationship between the crystallographic domains and the magnetic domains in MnV2O4.
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Affiliation(s)
- Y Murakami
- The Ultramicroscopy Research Center, Kyushu University, Fukuoka 819-0395, Japan Department of Applied Quantum Physics and Nuclear Engineering, Kyushu University, Fukuoka 819-0395, Japan RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan
| | - T Suzuki
- JEOL Ltd., Akishima 196-8558, Japan
| | - Y Nii
- Department of Basic Science, The University of Tokyo, Tokyo 153-8902, Japan
| | - S Murai
- Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, Sendai 980-8577, Japan
| | - T Arima
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan Department of Advanced Materials Science, The University of Tokyo, Kashiwa 277-8561, Japan
| | - R Kainuma
- Department of Materials Science, Tohoku University, Sendai 980-8579, Japan
| | - D Shindo
- RIKEN Center for Emergent Matter Science (CEMS), Wako 351-0198, Japan Institute of Multidisciplinary Research for Advanced Materials, Tohoku University, Sendai 980-8577, Japan
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Murahashi N, Abe T, Shinohara N, Murai S, Harabayashi T, Sazawa A, Maruyama S, Tsuchiya K, Miyajima N, Hatanaka K, Nonomura K. Diagnostic outcome of ureteroscopy in urothelial carcinoma of the upper urinary tract: Incidence of later cancer detection and its risk factors after the first examination. BMC Urol 2015; 15:92. [PMID: 26337178 PMCID: PMC4558756 DOI: 10.1186/s12894-015-0086-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 01/28/2015] [Accepted: 08/26/2015] [Indexed: 11/25/2022] Open
Abstract
Background To determine the incidence of later cancer detection and its risk factors after the first diagnostic ureteroscopy. Methods One hundred and sixty-six patients undergoing diagnostic ureteroscopy based on the suspicion of urothelial carcinoma of the upper urinary tract (UC of the UUT) between 1995 and 2012 were included. We examined the diagnostic outcome of the initial ureteroscopy. Thereafter, we collected follow-up data on patients who had not been diagnosed with UC of the UUT at the first examination, and evaluated the incidence of later cancer detection and its risk factors using Cox hazard models. Results Of the 166 patients, 76 (45.8 %) were diagnosed with UC of the UUT at the first diagnostic ureteroscopy. The remaining 90 (54.2 %) were diagnosed with other malignancies (n = 22), non-malignant disorders (n = 18), or without disorders (n = 50). Of these 90 patients, follow-up data were available in 65 patients (median: 41 months, range: 3–170). During the follow-up, carcinoma was detected in 6 patients (6/65, 9.2 %) at a median of 43.5 months (range: 10–59). Episodes of gross hematuria (p = 0.0048) and abnormal cytological findings (p = 0.0335) during the follow-up and a male sex (p = 0.0316) were adverse risk factors. Conclusion Later cancer detection of UC of the UUT was not uncommon after the first examination. The risk analysis revealed the aforementioned characteristics.
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Affiliation(s)
- Norihiro Murahashi
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | | | - Ataru Sazawa
- Department of Urology, Obihiro-Kosei General Hospital, Obihiro, Japan.
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Kunihiko Tsuchiya
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Kanako Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
| | - Katsuya Nonomura
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
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Harada T, Abe T, Kato F, Matsumoto R, Fujita H, Murai S, Miyajima N, Tsuchiya K, Maruyama S, Kudo K, Shinohara N. Five-point Likert scaling on MRI predicts clinically significant prostate carcinoma. BMC Urol 2015; 15:91. [PMID: 26334874 PMCID: PMC4558639 DOI: 10.1186/s12894-015-0087-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 03/18/2015] [Accepted: 08/26/2015] [Indexed: 11/23/2022] Open
Abstract
Background To clarify the relationship between the probability of prostate cancer scaled using a 5-point Likert system and the biological characteristics of corresponding tumor foci. Methods The present study involved 44 patients undergoing 3.0-Tesla multiparametric MRI before laparoscopic radical prostatectomy. Tracing based on pathological and MRI findings was performed. The relationship between the probability of cancer scaled using the 5-point Likert system and the biological characteristics of corresponding tumor foci was evaluated. Results A total of 102 tumor foci were identified histologically from the 44 specimens. Of the 102 tumors, 55 were assigned a score based on MRI findings (score 1: n = 3; score 2: n = 3; score 3: n = 16; score 4: n = 11 score 5: n = 22), while 47 were not pointed out on MRI. The tracing study revealed that the proportion of >0.5 cm3 tumors increased according to the upgrade of Likert scores (score 1 or 2: 33 %; score 3: 68.8 %; score 4 or 5: 90.9 %, χ2 test, p < 0.0001). The proportion with a Gleason score >7 also increased from scale 2 to scale 5 (scale 2: 0 %; scale 3: 56.3 %; scale 4: 72.7 %; 5: 90.9 %, χ2 test, p = 0.0001). On using score 3 or higher as the threshold of cancer detection on MRI, the detection rate markedly improved if the tumor volume exceeded 0.5 cm3 (<0.2 cm3: 10.3 %; 0.2-0.5 cm3: 25 %; 0.5-1.0 cm3: 66.7 %; 1.0 < cm3: 92.1 %). Conclusions Each Likert scale favobably reflected the corresponding tumor’s volume and Gleason score. Our observations show that “score 3 or higher” could be a useful threshold to predict clinically significant carcinoma when considering treatment options.
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Affiliation(s)
- Taisuke Harada
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Fumi Kato
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
| | - Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Hiromi Fujita
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan.
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Kunihiko Tsuchiya
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, North-15, West-7, North Ward, Sapporo, 060-8638, Japan.
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Matsumoto R, Takada N, Abe T, Minami K, Harabayashi T, Nagamori S, Hatanaka KC, Miyajima N, Tsuchiya K, Maruyama S, Murai S, Shinohara N. Prospective mapping of lymph node metastasis in Japanese patients undergoing radical cystectomy for bladder cancer: characteristics of micrometastasis. Jpn J Clin Oncol 2015; 45:874-80. [PMID: 26109677 DOI: 10.1093/jjco/hyv091] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/20/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate node-disease prevalence including micrometastases and its survival impact on bladder cancer patients. METHODS A total of 60 patients participated in this study, in which extended lymph node dissection was carried out according to the prospective rule (below aortic bifurcation). Radical cystectomy and extended lymph node dissection were performed by open surgery (n = 23) or laparoscopically (n = 37). Perioperative, pathological and follow-up data were collected. Micrometastasis in lymph nodes was investigated by pan-cytokeratin immunohistochemistry. Recurrence-free survival was estimated with the Kaplan-Meier method. RESULTS The median number of lymph nodes removed was 29 (range: 10-103) and there was no significant difference between the two groups (open group: median 30, laparoscopic group: median 29). Routine pathological examination revealed that 10 patients had lymph node metastases. Immunohistochemistry revealed micrometastases in four additional patients (pNmicro+), who had been diagnosed with pN0 on routine pathological examination. After excluding the three patients with pure nonurothelial carcinoma on the final pathology (small cell carcinoma: n = 2, adenocarcinoma: n = 1), 10 out of the 57 urothelial carcinoma patients (17.5%) had node metastasis, and an additional 4 out of the 47 pN0 patients (4/47, 8.5%) had micrometastasis. The 2-year recurrence-free survival rates divided by pN stage were 82.4% for pN0, 66.7% for pNmicro+ and 12.5% for pN+ (three-sample log-rank test, P < 0.0001). Three out of the four patients with pNmicro+ were disease free at the last follow-up. CONCLUSIONS We confirmed under extended lymph node dissection that a substantial proportion of the patients had node metastasis (pN+: n = 10 and pNmicro+: n = 4), and the pN stage influenced patient survival. Our observations of micrometastasis yielded additional evidence for the potential survival benefit of extended lymphadenectomy by eliminating microdisease.
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Affiliation(s)
- Ryuji Matsumoto
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo Department of Urology, Hokkaido Cancer Center, Sapporo
| | - Norikata Takada
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Takashige Abe
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Keita Minami
- Department of Urology, Hokkaido Cancer Center, Sapporo
| | | | | | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Naoto Miyajima
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Kunihiko Tsuchiya
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Satoru Maruyama
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Sachiyo Murai
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo
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Murai S, Matsuda K, Ikebe K, Enoki K, Hatta K, Fujiwara K, Maeda Y. A field survey of the partially edentate elderly: Investigation of factors related to the usage rate of removable partial dentures. J Oral Rehabil 2015; 42:828-32. [PMID: 26059645 DOI: 10.1111/joor.12318] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2015] [Indexed: 11/30/2022]
Abstract
Although the shortened dental arch (SDA) concept has been known to all over the world, acceptance of the SDA concept as an oral health standard can be questionable from the patients' point of view, even if it is biologically reasonable. Furthermore, because the health insurance system covers removable partial dentures (RPDs) for all citizens in Japan, SDA patients seem to prefer to receive prosthetic treatment to replace the missing teeth. However, there were few field surveys to investigate the usage rate of RPDs in Japan. The purpose of this study was to determine the usage rate of RPDs in older Japanese subjects and to investigate the factors related to the usage of RPDs. Partially edentate participants (n = 390) were included in this study. Oral examinations were conducted to record several indices. The Cochran-Armitage trend test was used to evaluate the relationship between the number of missing teeth and the usage rate of RPDs. Chi-squared tests and logistic regression analysis were conducted to evaluate the factors related to the usage rate of RPDs. Usage of RPDs had a significantly positive association with the number of missing distal extension teeth and bilaterally missing teeth. The usage rate of RPDs increased as the number of missing distal extension teeth increased (P for trend < 0·001). The conclusion of this study was that participants with missing distal extension teeth had higher usage rates of RPDs than other participants, and the usage rate increased as the number of missing distal extension teeth increased.
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Affiliation(s)
- S Murai
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - K Matsuda
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - K Ikebe
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - K Enoki
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - K Hatta
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - K Fujiwara
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Y Maeda
- Department of Prosthodontics, Gerodontology and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Suita, Japan
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Shinohara N, Obara W, Tatsugami K, Naito S, Kamba T, Takahashi M, Murai S, Abe T, Oba K, Naito S. Prognosis of Japanese patients with previously untreated metastatic renal cell carcinoma in the era of molecular-targeted therapy. Cancer Sci 2015; 106:618-26. [PMID: 25711777 PMCID: PMC4452164 DOI: 10.1111/cas.12646] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/30/2014] [Revised: 02/14/2015] [Accepted: 02/22/2015] [Indexed: 02/02/2023] Open
Abstract
A multicenter cooperative study was conducted to clarify the prognosis of Japanese patients with metastatic renal cell carcinoma in the era of molecular-targeted therapy and the clinical usefulness of the Japanese metastatic renal cancer (JMRC) prognostic classification. Of 389 consecutive patients for whom treatment was started between 2008 and 2010 at 23 hospitals in Japan, 357 patients who received vascular endothelial growth factor receptor-tyrosine kinase inhibitor (VEGFR-TKI) or cytokine as initial systemic therapy were the subject of the present study. Patients were classified into three prognostic groups according to the JMRC prognostic classification. The endpoints were progression-free survival (PFS) and overall survival (OS) after the start of the initial treatment. The median PFS and OS for the entire cohort of 357 patients were 9.1 and 27.2 months, respectively. VEGFR-TKI were selected for patients with multiple organ metastases, those with liver metastasis, and those with bone metastasis. The median PFS and OS were 11.0 and 23.2 months and 5.4 and 38.2 months in the VEGFR-TKI group and the cytokines group, respectively. The JMRC prognostic classification was useful as a prognostic model for PFS and OS (c-indexes: 0.613 and 0.630 in patients who initially received VEGFR-TKI and 0.647 and 0.642 in patients who received cytokines, respectively). The present study showed for the first time the prognosis of Japanese patients with metastatic renal cell carcinoma in the era of molecular-targeted therapy. The JMRC prognostic classification may be clinically useful as a prognostic model.
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Affiliation(s)
- Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University, Morioka, Japan
| | - Katsunori Tatsugami
- Department of Urology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
| | - Sei Naito
- Department of Urology, Graduate School of Medicine, Yamagata University, Yamagata, Japan
| | - Tomomi Kamba
- Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masayuki Takahashi
- Department of Urology, Graduate School, University of Tokushima, Tokushima, Japan
| | - Sachiyo Murai
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takashige Abe
- Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koji Oba
- Department of Biotatistics, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Seiji Naito
- Department of Urology, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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