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Nukaya T, Ishikawa K, Takahara K, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. A case of Legionella pneumonia after robot-assisted radical prostatectomy. IJU Case Rep 2024; 7:213-216. [PMID: 38686064 PMCID: PMC11056255 DOI: 10.1002/iju5.12705] [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: 11/03/2023] [Accepted: 02/05/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Postoperative Legionella pneumonia is very rare. Case presentation A 71-year-old male patient with prostate cancer (cT2bN0M0) underwent a robotic-assisted radical prostatectomy. On the 5th postoperative day, the patient developed chills and a fever of 39.2°C. Chest radiography revealed decreased permeability in the right middle lung field, leading to the diagnosis of postoperative pneumonia. Antimicrobial therapy was initiated immediately. Blood tests on postoperative day 10 revealed mild liver function abnormalities, electrolyte abnormalities, and a markedly elevated inflammatory response. Legionella pneumonia was suspected based on blood sample results and systemic symptoms, such as diarrhea and nausea. Furthermore, Legionella antigens were detected in the patient's urine, prompting further administration of levofloxacin. The patient's subsequent clinical course was favorable. Conclusion When bacterial pneumonia fails to respond to antimicrobial therapy and systemic symptoms develop, atypical pneumonia, caused by pathogens such as Legionella pneumophila, should be considered even in cases of postoperative pneumonia.
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Affiliation(s)
- Takuhisa Nukaya
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Kiyohito Ishikawa
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Kiyoshi Takahara
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Masashi Takenaka
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Kenji Zennami
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Manabu Ichino
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Hitomi Sasaki
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Makoto Sumitomo
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
| | - Ryoichi Shiroki
- Department of UrologyFujita Health University School of MedicineToyoakeAichiJapan
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Zennami K, Takahara K, Nukaya T, Takenaka M, Ichino M, Sasaki H, Kusaka M, Sumitomo M, Shiroki R. The Role of Lymph Node Dissection in Patients With Muscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy Following Neoadjuvant Chemotherapy. Clin Genitourin Cancer 2024; 22:1-9. [PMID: 37423863 DOI: 10.1016/j.clgc.2023.06.016] [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: 05/12/2023] [Revised: 06/24/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The interaction between lymph node dissection (LND) during radical cystectomy (RC) and neoadjuvant chemotherapy (NAC) remains unclear. This study aimed to evaluate the role of LND in patients undergoing RC after NAC. PATIENTS AND METHODS We retrospectively analyzed 259 patients with muscle-invasive bladder cancer (MIBC) who underwent RC following NAC at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2010 and 2022. Baseline characteristics, pathological outcomes, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were compared between propensity score (PS)-matched cohorts. RESULTS PS matching analysis resulted in 94 matched pairs from the adequate (standard or extended template) and inadequate (limited template or unilateral- or no-LND) LND groups. The median number of dissected nodes was significantly higher in the adequate LND group than in the inadequate LND group (19 vs. 5, P < .001). Similarly, a higher pathological node-positive rate (ypN+) was observed in the adequate group than in the inadequate group (18.1% vs. 7.4%, P = .03). The adequate LND group identified more ypN+ with ≤ ypT1 cases than the inadequate group (4 vs. 1). There were no statistically significant differences between the adequate and inadequate groups in RFS (P = .94), CSS (P = .54), and OS (P = .65). Subgroup analysis also showed comparable survival rates, even in patients with ≥ pT3 or cN+ disease. ypN+ was an independent predictor of OS in the Cox regression analysis, while adequate LND and the number of lymph nodes removed (≥10 or ≥15) were not associated with survival. CONCLUSIONS Although adequate LND did not show a significant therapeutic effect in RC after NAC, adequate LND may have an important diagnostic role in detecting ypN+, which is a robust predictor, and is a useful biomarker to perform appropriate adjuvant immunotherapy especially in ≤ ypT1 cases.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan.
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Sowanthip D, Zennami K, Bejrananda T, Nukaya T, Takenaka M, Ichino M, Takahara K, Sasaki H, Kusaka M, Sumitomo M, Shiroki R. Older versus younger patients in robot-assisted radical cystectomy with intracorporeal ileal conduit comparing safety and clinical outcomes. Int J Urol 2024; 31:370-378. [PMID: 38180102 DOI: 10.1111/iju.15377] [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: 09/12/2023] [Accepted: 12/10/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE To evaluate the safety and efficacy of robot-assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients. METHODS We retrospectively analyzed 122 patients who underwent robot-assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence-free survival, cancer-specific survival, and overall survival were compared between the cohorts. RESULTS The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30-day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence-free survival, cancer-specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer-specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high-grade complications and cancer-specific survival. CONCLUSIONS Robot-assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.
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Affiliation(s)
- Dutsadee Sowanthip
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Urology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, The Thai Red Cross Society, Bangkok, Thailand
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tanan Bejrananda
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Zennami K, Kusaka M, Tomozawa S, Toda F, Ito K, Kawai A, Nakamura W, Muto Y, Saruta M, Motonaga T, Takahara K, Sumitomo M, Shiroki R. Impact of an enhanced recovery protocol in frail patients after intracorporeal urinary diversion. BJU Int 2024. [PMID: 38500447 DOI: 10.1111/bju.16340] [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: 03/20/2024]
Abstract
OBJECTIVE To determine whether an enhanced recovery after surgery (ERAS) protocol enhances bowel recovery and reduces postoperative ileus (POI) in both non-frail and frail patients after robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC). PATIENTS AND METHODS This retrospective cohort study included 186 patients (104 with and 82 without ERAS) who underwent iRARC between 2012 and 2023. 'Frail' patients was defined as those with a low Geriatric-8 questionnaire score (≤13). The primary outcomes were postoperative bowel recovery and the incidence of POI. Secondary outcomes included length of stay (LOS), 30- and 90-day complications, 90-day readmission rate, and POI predictors. RESULTS The ERAS group exhibited a significantly shorter LOS, early bowel recovery, a lower POI rate, fewer 90-day high-grade complications, and fewer 90-day readmissions than the non-ERAS group in the entire cohort. Non-frail patients in the ERAS group had a lower rate of POI (7.1% vs. 22.1%; P = 0.008), whereas ERAS did not reduce POI in frail patients (44.1% vs. 36.6%; P = 0.50). In the multivariate analysis, ERAS was associated with a reduced risk of POI in both the entire cohort (odds ratio [OR] 0.39, P = 0.01) and in non-frail patients (OR 0.24, P = 0.01), whereas ERAS was not likely to reduce POI (OR 1.14, P = 0.70) in frail patients. Prehabilitation was identified as a favourable predictor of POI. CONCLUSIONS The ERAS protocol did not reduce POI in frail patients after iRARC, although it enhanced bowel recovery and reduced POI in non-frail patients. Prehabilitation for frail patients might reduce POI.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Shuhei Tomozawa
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Fumi Toda
- Department of Rehabilitation Medicine I, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuki Ito
- Department of Rehabilitation, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Akihiro Kawai
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Wataru Nakamura
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshinari Muto
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masanobu Saruta
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomonari Motonaga
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Takahara K, Motonaga T, Okumura J, Yamakawa S, Yagi K, Nakamura W, Saruta M, Nukaya T, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. Robot-assisted retroperitoneal lymph node dissection: Initial experience in Japan. Asian J Endosc Surg 2024; 17:e13262. [PMID: 37944943 DOI: 10.1111/ases.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/25/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023]
Abstract
For patients with testicular tumors who need the surgical management, open retroperitoneal lymph node dissection (O-RPLND) is considered the gold standard treatment. However, recently, robot-assisted RPLND (R-RPLND) has gained popularity as a minimally invasive therapy alternative to O-RPLND and laparoscopic RPLND. Here, we report the case of a 32-year-old man presenting with a left testicular teratoma with several enlarged left para-aortic lymph nodes. After the orchiectomy, the patient underwent R-RPLND with an operation time of 279 min, console time of 189 min, bleeding volume of 59 mL, and no significant complications, resulting in a successful outcome. To the best of our knowledge, this is the first reported case of R-RPLND in Japan. Based on our experience, R-RPLND may provide safe and effective outcomes; however, further research is required before the widespread implementation of this technique.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Tomonari Motonaga
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Jin Okumura
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Shinji Yamakawa
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kota Yagi
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Wataru Nakamura
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masanobu Saruta
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Takahara K, Takenaka M, Zennami K, Nukaya T, Ichino M, Sasaki H, Sumitomo M, Shiroki R. Robot-assisted radical nephrectomy with inferior vena cava thrombectomy: a case report. Transl Cancer Res 2023; 12:3792-3798. [PMID: 38197070 PMCID: PMC10774061 DOI: 10.21037/tcr-23-855] [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: 05/18/2023] [Accepted: 11/06/2023] [Indexed: 01/11/2024]
Abstract
Background Recently, robot-assisted surgery has been widely used to treat several urological cancers. Robot-assisted radical nephrectomy (RARN) was approved by the health insurance system in April 2022; however, RARN with inferior vena cava tumor thrombectomy (IVCTT) is still challenging. Also, its safety and feasibility have not yet been established owing to lack of literature, especially in Japan. Case Description We performed RARN with IVCTT in four patients between April 2022 and March 2023 at Fujita Health University Hospital. To reduce the risk of tumor embolism and major hemorrhage, an "IVC-first, kidney-last" robotic technique was developed. The safety and feasibility of RARN with IVCTT were evaluated by assessing the perioperative outcomes. Three women and one man were enrolled in this study. The median age was 72 years, and the tumor was on the right side in all cases. According to the Mayo Clinic thrombus classification, two patients were classified as level I, and the others were classified as level II. The two patients at level I did not undergo presurgical treatments, whereas the others at level II underwent presurgical treatments, which were combinations of tyrosine kinase inhibitors and immune-checkpoint inhibitors. The median operation and console times were 341 and 247 min, respectively. The median bleeding volume was 577 mL, and no complications beyond grade III of the Clavien-Dindo classification were observed. The median length of postoperative hospital stay was 10 days. Conclusions Although the sample size was relatively small, we demonstrated the safety and feasibility of RARN with IVCTT in the Japanese population.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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7
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Bejrananda T, Takahara K, Sowanthip D, Motonaga T, Yagi K, Nakamura W, Saruta M, Nukaya T, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. Comparing pentafecta outcomes between nerve sparing and non nerve sparing robot-assisted radical prostatectomy in a propensity score-matched study. Sci Rep 2023; 13:15835. [PMID: 37740045 PMCID: PMC10517009 DOI: 10.1038/s41598-023-43092-z] [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: 06/27/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023] Open
Abstract
Pentafecta (continence, potency, cancer control, free surgical margins, and no complications) is an important outcome of prostatectomy. Our objective was to assess the pentafecta achievement between nerve-spring and non-nerve-sparing robot-assisted radical prostatectomy (RARP) in a large single-center cohort. The study included 1674 patients treated with RARP between August 2009 and November 2022 to assess the clinical outcomes. Cox regression analyses were performed to evaluate the prognostic significance of RARP for pentafecta achievement, and 1:1 propensity score matching (PSM) was performed between the nerve-sparing and non-nerve-sparing to test the validity of the results. Pentafecta definition included continence, which was defined as the use of zero pads; potency, which was defined as the ability to achieve and maintain satisfactory erections or ones firm enough for sexual activity and sexual intercourse. The biochemical recurrence rate was defined as two consecutive PSA levels > 0.2 ng/mL after RARP; 90-day Clavien-Dindo complications ≤ 3a; and a negative surgical pathologic margin. The median follow-up period was 61.3 months (IQR 6-159 months). A multivariate Cox regression analysis demonstrated that pentafecta achievement was significantly associated with nerve-sparing (NS) approach (1188 patients) (OR 4.16; 95% CI 2.51-6.9), p < 0.001), unilateral nerve preservation (983 patients) (OR 3.83; 95% CI 2.31-6.37, p < 0.001) and bilateral nerve preservation (205 patients) (OR 7.43; 95% CI 4.14-13.36, p < 0.001). After propensity matching, pentafecta achievement rates in the NS (476 patients) and non-NS (476 patients) groups were 72 (15.1%) and 19 (4%), respectively. (p < 0.001). NS in RARP offers a superior advantage in pentafecta achievement compared with non-NS RARP. This validation study provides the pentafecta outcome after RARP associated with nerve-sparing in clinical practice.
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Affiliation(s)
- Tanan Bejrananda
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90110, Songkhla, Thailand.
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
| | - Dutsadee Sowanthip
- Division of Urology, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Tomonari Motonaga
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Kota Yagi
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Wataru Nakamura
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Masanobu Saruta
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
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Nakamura W, Sumitomo M, Zennami K, Takenaka M, Ichino M, Takahara K, Teramoto A, Shiroki R. Combination of deep learning and ensemble machine learning using intraoperative video images strongly predicts recovery of urinary continence after robot-assisted radical prostatectomy. Cancer Rep (Hoboken) 2023; 6:e1861. [PMID: 37449339 PMCID: PMC10480482 DOI: 10.1002/cnr2.1861] [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: 05/12/2023] [Revised: 06/20/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND We recently reported the importance of deep learning (DL) of pelvic magnetic resonance imaging in predicting the degree of urinary incontinence (UI) following robot-assisted radical prostatectomy (RARP). However, our results were limited because the prediction accuracy was approximately 70%. AIM To develop a more precise prediction model that can inform patients about UI recovery post-RARP surgery using a DL model based on intraoperative video images. METHODS AND RESULTS The study cohort comprised of 101 patients with localized prostate cancer undergoing RARP. Three snapshots from intraoperative video recordings showing the pelvic cavity (prior to bladder neck incision, immediately following prostate removal, and after vesicourethral anastomosis) were evaluated, including pre- and intraoperative parameters. We evaluated the DL model plus simple or ensemble machine learning (ML), and the area under the receiver operating characteristic curve (AUC) was analyzed through sensitivity and specificity. Of 101, 64 and 37 patients demonstrated "early continence (using 0 or 1 safety pad at 3 months post-RARP)" and "late continence (others)," respectively, at 3 months postoperatively. The combination of DL and simple ML using intraoperative video snapshots with clinicopathological parameters had a notably high performance (AUC, 0.683-0.749) to predict early recovery from UI after surgery. Furthermore, combining DL with ensemble artificial neural network using intraoperative video snapshots had the highest performance (AUC, 0.882; sensitivity, 92.2%; specificity, 78.4%; overall accuracy, 85.3%) to predict early recovery from post-RARP incontinence, with similar results by internal validation. The addition of clinicopathological parameters showed no additive effects for each analysis using DL, EL and simple ML. CONCLUSION Our findings suggest that the DL algorithm with intraoperative video imaging is a reliable method for informing patients about the severity of their recovery from UI after RARP, although it is not clear if our methods are reproducible for predicting long-term UI and pad-free continence.
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Affiliation(s)
- Wataru Nakamura
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Makoto Sumitomo
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
- Fujita Cancer CenterFujita Health UniversityToyoakeJapan
| | - Kenji Zennami
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Masashi Takenaka
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Manabu Ichino
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Kiyoshi Takahara
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
| | - Atsushi Teramoto
- Faculty of Radiological Technology, School of Medical SciencesFujita Health UniversityToyoakeJapan
- Faculty of Information EngineeringMeijo UniversityNagoyaJapan
| | - Ryoichi Shiroki
- Department of Urology, School of MedicineFujita Health UniversityToyoakeJapan
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9
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Antonarakis ES, Park SH, Goh JC, Shin SJ, Lee JL, Mehra N, McDermott R, Sala-Gonzalez N, Fong PC, Greil R, Retz M, Sade JP, Yanez P, Huang YH, Begbie SD, Gafanov RA, De Santis M, Rosenbaum E, Kolinsky MP, Rey F, Chiu KY, Roubaud G, Kramer G, Sumitomo M, Massari F, Suzuki H, Qiu P, Zhang J, Kim J, Poehlein CH, Yu EY. Pembrolizumab Plus Olaparib for Patients With Previously Treated and Biomarker-Unselected Metastatic Castration-Resistant Prostate Cancer: The Randomized, Open-Label, Phase III KEYLYNK-010 Trial. J Clin Oncol 2023; 41:3839-3850. [PMID: 37290035 PMCID: PMC10419579 DOI: 10.1200/jco.23.00233] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [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: 01/31/2023] [Revised: 03/13/2023] [Accepted: 05/01/2023] [Indexed: 06/10/2023] Open
Abstract
PURPOSE There is an unmet need for therapeutic options that prolong survival for patients with heavily pretreated, metastatic castration-resistant prostate cancer (mCRPC). The phase III, open-label KEYLYNK-010 study evaluated pembrolizumab plus olaparib versus a next-generation hormonal agent (NHA) for biomarker-unselected, previously treated mCRPC. METHODS Eligible participants had mCRPC that progressed on or after abiraterone or enzalutamide (but not both) and docetaxel. Participants were randomly assigned (2:1) to pembrolizumab plus olaparib or NHA (abiraterone or enzalutamide). The dual primary end points were radiographic progression-free survival (rPFS) by blinded independent central review per Prostate Cancer Working Group-modified RECIST 1.1 and overall survival (OS). Time to first subsequent therapy (TFST) was a key secondary end point. Safety and objective response rate (ORR) were secondary end points. RESULTS Between May 30, 2019, and July 16, 2021, 529 participants were randomly assigned to pembrolizumab plus olaparib and 264 to NHA. At final rPFS analysis, median rPFS was 4.4 months (95% CI, 4.2 to 6.0) with pembrolizumab plus olaparib and 4.2 months (95% CI, 4.0 to 6.1) with NHA (hazard ratio [HR], 1.02 [95% CI, 0.82 to 1.25]; P = .55). At final OS analysis, median OS was 15.8 months (95% CI, 14.6 to 17.0) and 14.6 months (95% CI, 12.6 to 17.3), respectively (HR, 0.94 [95% CI, 0.77 to 1.14]; P = .26). At final TFST analysis, median TFST was 7.2 months (95% CI, 6.7 to 8.1) versus 5.7 months (95% CI, 5.0 to 7.1), respectively (HR, 0.86 [95% CI, 0.71 to 1.03]). ORR was higher with pembrolizumab plus olaparib versus NHA (16.8% v 5.9%). Grade ≥3 treatment-related adverse events occurred in 34.6% and 9.0% of participants, respectively. CONCLUSION Pembrolizumab plus olaparib did not significantly improve rPFS or OS versus NHA in participants with biomarker-unselected, heavily pretreated mCRPC. The study was stopped for futility. No new safety signals occurred.
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Affiliation(s)
- Emmanuel S. Antonarakis
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- Current Address: University of Minnesota Masonic Cancer Center, Minneapolis, MN
| | - Se Hoon Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | - Sang Joon Shin
- Severance Hospital Yonsei University Health System, Seoul, South Korea
| | - Jae Lyun Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Niven Mehra
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ray McDermott
- St Vincent's University Hospital, Cancer Trials Ireland, Dublin, Ireland
| | | | - Peter C. Fong
- Auckland City Hospital, University of Auckland, Auckland, New Zealand
| | - Richard Greil
- Salzburg Cancer Research Institute-CCCIT Gmbh, Paracelsus Medical University Salzburg, Cancer Cluster Salzburg, Salzburg, Austria
| | - Margitta Retz
- Rechts der Isar Medical Center, Technical University Munich, Munich, Germany
| | | | - Patricio Yanez
- James Lind Cancer Research Center, Universidad de La Frontera, Temuco, Chile
| | - Yi-Hsiu Huang
- Taipei Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | | | - Maria De Santis
- Charité Universitaetsmedizin Berlin—Campus Mitte, Berlin, Germany
- Medical University of Vienna, Vienna, Austria
| | | | | | | | - Kun-Yuan Chiu
- Taichung Veterans General Hospital, Taichung, Taiwan
| | | | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | - Francesco Massari
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | | | | | | | | | - Evan Y. Yu
- Fred Hutchinson Cancer Center, University of Washington, Seattle, WA
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10
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Sakumo K, Morihashi K, Nakamura A, Nukaya T, Sumitomo M, Nakamura M, Sofue T, Haba R, Itoh T, Kamoshida S, Ohsaki H. The usefulness of nuclear area in the diagnosis of high-grade urothelial carcinoma cells in voided urine cytology. Cytopathology 2023; 34:295-301. [PMID: 36959684 DOI: 10.1111/cyt.13229] [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: 12/28/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The Paris System for Reporting Urinary Cytology considered the nuclear-to-cytoplasmic (N:C) ratio as the most important cytomorphological feature for detecting high-grade urothelial carcinoma (HGUC) cells. Few quantitative studies have been conducted on other features although quantitative studies on the N:C ratio have been reported. Therefore, this study quantitatively analysed important cytomorphological features in distinguishing benign reactive cells from HGUC cells. METHODS We analysed 2866 cells from the urine of 52 patients. A digital image analyser was used to quantitatively measure the nuclear area, cell area, N:C ratio, and nuclear roundness for HGUC cells and benign reactive cells. Additionally, the diagnostic value of quantitative cytomorphological criteria in HGUC cells was evaluated by the receiver operating characteristic curve. RESULTS The area under the curve for the prediction of HGUC cells for all cells and the top five cells was in the following order: nuclear area (0.920 and 0.992, respectively), N:C ratio (0.849 and 0.977), cell area (0.781 and 0.920), and nuclear roundness (0.624 and 0.605). The best cutoff value of the N:C ratio to differentiate HGUC cells from benign reactive cells was 0.438, and using the N:C ratio of 0.702, the positive predictive value obtained was 100%. CONCLUSIONS Our study indicated that nuclear area is a more important cytomorphological criterion than the N:C ratio for HGUC cell detection. Moreover, extracted data of the top five cells were more valuable than the data of all cells, which can be helpful in the routine practice and future criteria definition in urine cytology.
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Affiliation(s)
- Kazuma Sakumo
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Kenta Morihashi
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Akihiro Nakamura
- Department of Clinical Laboratory Science, Faculty of Health Care, Tenri Health Care University, Tenri, Japan
| | - Takuhisa Nukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Muneo Nakamura
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Tadashi Sofue
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University, Kita-gun, Kagawa, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Kagawa University Hospital, Kita-gun, Kagawa, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shingo Kamoshida
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroyuki Ohsaki
- Department of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe, Japan
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11
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Muto Y, Takeuchi A, Zennami K, Sugihara E, Shiroki R, Saya H, Sumitomo M. Targeting glutamine addiction with potent drug combination therapy for renal cell carcinoma. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01083-7] [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: 02/12/2023]
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12
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Sumitomo M, Nukaya T, Sugihara E, Takeda M, Nohara S, Tanishima S, Takenaka M, Zennami K, Takahara K, Shiroki R, Saya H. Evaluation of copy number and allelic imbalance of BRCA2 by next-generation sequencing to predict prognosis and drug sensitivity in prostate cancer. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00421-9] [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: 02/12/2023]
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13
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Takeuchi A, Takeda M, Sugihara E, Muto Y, Nohara S, Tanishima S, Zennami K, Takahara K, Tsukamoto T, Shiroki R, Saya H, Sumitomo M. Comprehensive analysis of copy number variation and sensitivity to targeted therapy in renal cell carcinoma using in-house cancer gene panel testing. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01081-3] [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: 02/12/2023]
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14
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Nukaya T, Sumitomo M, Sugihara E, Takeda M, Nohara S, Tanishima S, Takenaka M, Zennami K, Takahara K, Shiroki R, Saya H. Estimating copy number to determine BRCA2 deletion status and to expect prognosis in localized prostate cancer. Cancer Med 2023; 12:8154-8165. [PMID: 36645189 PMCID: PMC10134377 DOI: 10.1002/cam4.5617] [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: 12/05/2022] [Revised: 12/16/2022] [Accepted: 12/29/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The significance of BRCA alterations has been implicated in the development of metastatic castration-resistant prostate cancer (PC). The details of the frequency and significance of BRCA alterations in localized PC remain unknown. In this study, we investigated the frequency and clinical significance of BRCA alterations in localized PCs using an in-house next-generation sequencer (NGS) system. METHODS DNA was extracted from formalin-fixed paraffin-embedded tissues of surgical specimens from 126 patients with clinically localized PC who underwent radical prostatectomy. The mutation information of 164 cancer genes was analyzed using the PleSSision-Rapid test. Both copy number (CN) variation and loss of heterozygosity of various genes, such as BRCA1 and BRCA2, were estimated and reported. RESULTS Next-generation sequencer analyses revealed that the BRCA2 CN was decreased in 17 patients (13.5%) and the BRCA1 CN in six (4.8%) patients. NGS-based CN values were shown to be highly correlated with droplet digital PCR-based CN values. Tissue-specific BRCA expression investigated using the Human Protein Atlas showed that the decreased CN of BRCA2, but not BRCA1, is responsible for the decreased BRCA activity in PC. Ten of the 22 patients with decreased BRCA2 CN were presumed to have somatic heterozygous deletion. There were no observed associations between the heterozygous deletion of BRCA2 and various clinicopathological parameters. Furthermore, three of 10 patients developed biochemical recurrence within 3 months after surgery. Multivariate analyses revealed that the initial prostate-specific antigen levels and BRCA2 CN were independent factors for biochemical recurrence. CONCLUSION Our results suggest that a decrease in BRCA2 CN may be used as a biomarker for predicting recurrence after surgery in localized PC. Early screening for somatic alterations in BRCA2 using NGS may help to broadly predict the risk of PC progression.
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Affiliation(s)
- Takuhisa Nukaya
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan.,Department of Urology School of Medicine, Fujita Health University, Toyoake, Japan
| | - Makoto Sumitomo
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan.,Department of Urology School of Medicine, Fujita Health University, Toyoake, Japan.,Department of Medical Research for Intractable Disease, Fujita Health University, Toyoake, Japan
| | - Eiji Sugihara
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan.,Research Promotion Headquarters, Open Facility Center, Fujita Health University, Toyoake, Japan
| | - Mayu Takeda
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan.,Department of Medical Research for Intractable Disease, Fujita Health University, Toyoake, Japan
| | - Sachio Nohara
- Department of Bio Informatics, Communication Engineering Center, Electronic System Business Group, Mitsubishi Electric Software Corp, Tokyo, Japan
| | - Shigeki Tanishima
- Department of Bio Informatics, Communication Engineering Center, Electronic System Business Group, Mitsubishi Electric Software Corp, Tokyo, Japan
| | - Masashi Takenaka
- Department of Urology School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kenji Zennami
- Department of Urology School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hideyuki Saya
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan
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15
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Ichino M, Sasaki H, Takenaka M, Ichihara K, Kawai A, Fukaya K, Zennami K, Takahara K, Sumitomo M, Shiroki R. Robotic surgery for pelvic organ prolapse with complete bladder eversion. IJU Case Rep 2022; 5:484-488. [PMID: 36341194 PMCID: PMC9626323 DOI: 10.1002/iju5.12522] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/31/2022] [Indexed: 11/08/2022] Open
Abstract
Introduction Pelvic organ prolapse with complete bladder eversion is extremely rare. Case presentation An 82‐year‐old woman was diagnosed with uterine prolapse 3 years ago and underwent occasional urethral catheter placement for difficulty in micturition. She presented with vulvar bleeding and prolapsed uterus from the vagina. Pelvic examination revealed uterine prolapse and a 65 × 65‐mm red mass ventrally with urinary outflow. Contrast medium leakage from the vulvar mass and guidewire observed on antegrade pyeloureterography indicated pelvic organ prolapse with complete bladder eversion. Manual reduction of the everted bladder, robotic sacrocolpopexy, and bladder neck reconstruction was performed. However, eversion recurred 10 months postoperatively. Subsequently, robotic Burch colposuspension, cystopexy to the rectus fascia, bladder neck reconstruction, colpoclesis, and cystostomy were performed. There was no recurrence postoperatively. Conclusion Robotic Burch colposuspension, cystopexy to the rectus fascia, bladder neck reconstruction, colpoclesis, and cystostomy were performed for complete bladder eversion.
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Affiliation(s)
- Manabu Ichino
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Hitomi Sasaki
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Masashi Takenaka
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Keiichiro Ichihara
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Akihiro Kawai
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Kosuke Fukaya
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Kenji Zennami
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Kiyoshi Takahara
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Makoto Sumitomo
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
| | - Ryoichi Shiroki
- Department of Urology Fujita Health University School of Medicine Toyoake Japan
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16
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Takahara K, Ohno Y, Fukaya K, Matsukiyo R, Nukaya T, Takenaka M, Zennami K, Ichino M, Fukami N, Sasaki H, Kusaka M, Toyama H, Sumitomo M, Shiroki R. Novel Intraoperative Navigation Using Ultra-High-Resolution CT in Robot-Assisted Partial Nephrectomy. Cancers (Basel) 2022; 14:cancers14082047. [PMID: 35454953 PMCID: PMC9032210 DOI: 10.3390/cancers14082047] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/13/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Successful surgery in robot-assisted partial nephrectomy (RAPN), especially for highly complex tumors, relies on a detailed understanding of the anatomical relations of the tumor absolute and relative to the urinary tract and the vascular structures, including the renal pedicle. Intraoperative navigation with accurate information regarding tumor position relative to the surrounding urinary vascular structures undoubtedly assists the surgeon during RAPN. In this report, we performed RAPN with intraoperative navigation using a novel computed tomography scanner (UHR-CT) and compared its perioperative and short-term functional outcomes to those of area-detector CT (ADCT). We found that this novel navigation system using UHR-CT provided a shorter warm ischemia time and lower estimated blood loss than ADCT, and concluded this could be a useful tool for patients who undergo RAPN. This is the first report to evaluate the feasibility and usefulness of UHR-CT for intraoperative navigation during RAPN. Abstract To assess the perioperative and short-term functional outcomes of robot-assisted partial nephrectomy (RAPN) with intraoperative navigation using an ultra-high-resolution computed tomography (UHR-CT) scanner, we retrospectively analyzed 323 patients who underwent RAPN using an UHR-CT or area-detector CT (ADCT). Perioperative outcomes and the postoperative preservation ratio of estimated glomerular filtration rate (eGFR) were compared. After the propensity score matching, we evaluated 99 patients in each group. Although the median warm ischemia time (WIT) was less than 25 min in both groups, it was significantly shorter in the UHR-CT group than in the ADCT group (15 min vs. 17 min, p = 0.032). Moreover, the estimated blood loss (EBL) was significantly lower in the UHR-CT group than in the ADCT group (33 mL vs. 50 mL, p = 0.028). However, there were no significant intergroup differences in the postoperative preservation ratio of eGFR at 3 or 6 months of follow-up (ADCT 91.8% vs. UHR-CT 93.5%, p = 0.195; and ADCT 91.7% vs. UHR-CT 94.0%, p = 0.160, respectively). Although no differences in short-term renal function were observed in intraoperative navigation for RAPN in this propensity score–matched cohort, this study is the first to demonstrate that UHR-CT resulted in a shorter WIT and lower EBL than ADCT.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
- Correspondence: ; Tel.: +81-562-93-2884
| | - Yoshiharu Ohno
- Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (Y.O.); (R.M.); (H.T.)
| | - Kosuke Fukaya
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Ryo Matsukiyo
- Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (Y.O.); (R.M.); (H.T.)
| | - Takuhisa Nukaya
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Masashi Takenaka
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Kenji Zennami
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Manabu Ichino
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Naohiko Fukami
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki 444-0827, Japan; (N.F.); (M.K.)
| | - Hitomi Sasaki
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Mamoru Kusaka
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki 444-0827, Japan; (N.F.); (M.K.)
| | - Hiroshi Toyama
- Department of Radiology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (Y.O.); (R.M.); (H.T.)
| | - Makoto Sumitomo
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
| | - Ryoichi Shiroki
- Department of Urology, Fujita-Health University School of Medicine, Nagoya 470-1192, Japan; (K.F.); (T.N.); (M.T.); (K.Z.); (M.I.); (H.S.); (M.S.); (R.S.)
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17
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Takahara K, Fukaya K, Nukaya T, Takenaka M, Zennami K, Ichino M, Sasaki H, Sumitomo M, Shiroki R. Perioperative and long-term functional outcomes of robot-assisted versus open partial nephrectomy: A single-center retrospective study of a Japanese cohort. Ann Med Surg (Lond) 2022; 75:103482. [PMID: 35386794 PMCID: PMC8978100 DOI: 10.1016/j.amsu.2022.103482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 12/01/2022] Open
Abstract
Objective This study aimed to compare the perioperative and long-term functional outcomes between robot-assisted partial nephrectomy (RAPN) and open partial nephrectomy (OPN) in Japanese patients. Methods We retrospectively analyzed 242 patients who underwent either RAPN or OPN between 2007 and 2017 at our hospital. Propensity score matching was carried out between the two groups at a ratio of 1:1. Perioperative outcomes and postoperative estimated glomerular filtration rates (eGFR) were compared at one and three years of follow-up. Results After propensity score matching, we evaluated 39 patients from each group. The ischemia duration of the RAPN group was significantly shorter than that of the OPN group (18 vs. 24, p < 0.001). Moreover, the estimated blood loss (EBL) was significantly lower in the RAPN group than in the OPN group (50 vs. 174, p < 0.001). However, there were no significant differences in the postoperative eGFR between the two groups at one or three years of follow-up (OPN 54.8 vs. RAPN 61.2, p = 0.109, and OPN 54.8 vs. RAPN 55.5, p = 0.262, respectively). Conclusion RAPN resulted in shorter ischemia durations and lower rates of EBL than did OPN; however, no differences in long-term renal function were observed between RAPN and OPN in our propensity-score matched Japanese cohort. This study aimed to compare the perioperative and long-term functional outcomes of RAPN and OPN in Japanese patients. RAPN resulted in shorter ischemia durations and lower rates of estimated blood loss than OPN. No differences in long-term renal function were observed between RAPN and OPN.
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18
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Zennami K, Sumitomo M, Hasegawa K, Kozako M, Takahara K, Nukaya T, Takenaka M, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Risk factors for postoperative ileus after robot-assisted radical cystectomy with intracorporeal urinary diversion. Int J Urol 2022; 29:553-558. [PMID: 35229914 DOI: 10.1111/iju.14839] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 08/07/2021] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the risk factors for postoperative ileus in patients who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion. METHODS We retrospectively analyzed 78 patients with bladder cancer who underwent robot-assisted radical cystectomy with intracorporeal urinary diversion at Fujita Health University between 2011 and 2021. Baseline characteristics and perioperative outcomes were compared between the cohorts with and without ileus. Logistic regression analysis was used to identify the risk factors for postoperative ileus. RESULTS Out of the 78 patients included in this study, 20 (25.6%) developed postoperative ileus. The ileus cohort was associated with a significantly lower Geriatric-8 score (P = 0.003) and a higher rate of previous abdominal/pelvic surgery (P = 0.04) compared with those of the nonileus cohort. Significantly longer intestinal tract reconstruction time, hospital stay, time to mobilization, fluid intake, solid intake, flatus, and stool were observed in the ileus cohort. According to the results of the logistic regression analysis, the Geriatric-8 sum (P = 0.009), time to mobilization (P = 0.03), and time to fluid intake (P = 0.004) were independent predictors of postoperative ileus. In the model predicting postoperative ileus, the area under the receiver operating characteristic curve was 0.716, and the cutoff value of the Geriatric-8 sum was 13. CONCLUSIONS Early mobilization and fluid intake and low Geriatric-8 scores were significant risk factors for postoperative ileus. Preoperative Geriatric-8 evaluation is a useful tool for predicting postoperative ileus. Comprehensive enhanced recovery after surgery, including key components, may help bowel recovery and prevent subsequent ileus.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kyu Hasegawa
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaki Kozako
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Takahara K, Sumitomo M, Ito M, Ito F, Nishino M, Nukaya T, Takenaka M, Zennami K, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Hayashi S, Toyama H, Shiroki R. Predictors of Secondary Bladder Cancer in Patients with Prostate Cancer Treated with Brachytherapy: A Single-institution Study of a Japanese Cohort. Urol J 2021; 19:209-2013. [PMID: 34655073 DOI: 10.22037/uj.v18i.6718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The incidence of secondary bladder cancer after treatment for localized prostate cancer (PCa) remains unclear. In this study, PCa cases treated with brachytherapy (BT) were evaluated to assess the incidence of a second malignancy of bladder cancer in a Japanese cohort. MATERIALS AND METHODS Overall, 969 patients treated with BT at our hospital between July 2006 and January 2019 were included in the study cohort. The incidence and predictors of secondary bladder cancer were also assessed. RESULTS The incidence of secondary bladder cancer was 1.5% (n = 14). Of the seven factors (age, pretreatment PSA, Gleason score, cTNM stage, prostate volume, total activity, and combined external beam), prostate volume and total activity showed significant differences between the cohorts with and without secondary bladder cancer (P = .03 and P = .001, respectively). Upon comparison of the seven parameters for the 969 patients treated with BT, we found that only the total activity factor was affected by the incidence of secondary bladder cancer in the multivariate analysis (P = .007). CONCLUSION The incidence of secondary bladder cancer was evaluated after BT for PCa. Total activity was associated with the incidence of secondary bladder cancer in Japanese patients who received BT.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Masayuki Ito
- Department of Radiation Oncology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | | | - Masashi Nishino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Naohiko Fukami
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki, Japan.
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Mamoru Kusaka
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki, Japan.
| | - Shinya Hayashi
- Department of Radiation Oncology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
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20
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Zennami K, Sumitomo M, Takahara K, Nukaya T, Takenaka M, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Intra-corporeal robot-assisted versus open radical cystectomy: a propensity score-matched analysis comparing perioperative and long-term survival outcomes and recurrence patterns. Int J Clin Oncol 2021; 26:1514-1523. [PMID: 34009486 DOI: 10.1007/s10147-021-01939-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/19/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To compare perioperative and long-term oncological outcomes and recurrence patterns between robot-assisted radical cystectomy with intra-corporeal urinary diversion (iRARC) and open radical cystectomy (ORC). METHODS We retrospectively analyzed 177 bladder cancer patients who received iRARC or ORC at Fujita Health University between 2008 and 2020. Our primary endpoint was long-term oncological outcomes. As a secondary endpoint, we examined perioperative outcomes, complications, and recurrence patterns. These outcome measures were compared between the propensity score (PS)-matched cohorts. RESULTS PS-matched analysis resulted in 60 matched pairs from iRARC and ORC groups. The iRARC cohort was associated with significantly longer operative time (p = 0.02), lower estimated blood loss (p < 0.001), lower blood transfusion rate (p < 0.001), shorter length of hospital stay (p < 0.001), fewer overall complications (p = 0.03), and lower rate of postoperative ileus (p = 0.02). There was no statistically significant difference between iRARC and ORC in 5-year RFS (p = 0.46), CSS (p = 0.63), and OS (p = 0.71). RFS and CSS were also comparable, even in locally advanced (≥ cT3) disease. Multivariate analysis identified lymphovascular invasion as a robust predictor of RFS, CSS, and OS. The number of recurrence was similar between the groups, while extra-pelvic lymph nodes were more frequent in iRARC than that in ORC (22.7% vs. 7.7%). CONCLUSIONS iRARC has favorable perioperative outcomes, fewer complications, and comparable long-term survival outcomes, including locally advanced (≥ cT3) disease, compared to that in ORC. Our results need to be validated in prospective randomized clinical trials.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan
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21
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Sumitomo M, Takahara K, Zennami K, Nagakawa T, Maeda Y, Shiogama K, Yamamoto Y, Muto Y, Nukaya T, Takenaka M, Fukaya K, Ichino M, Sasaki H, Saito K, Shiroki R. Tryptophan 2,3-dioxygenase in tumor cells is associated with resistance to immunotherapy in renal cell carcinoma. Cancer Sci 2021; 112:1038-1047. [PMID: 33410234 PMCID: PMC7935775 DOI: 10.1111/cas.14797] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [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: 11/12/2020] [Revised: 12/24/2020] [Accepted: 01/03/2021] [Indexed: 01/08/2023] Open
Abstract
Indoleamine 2,3‐dioxygenase 1 (IDO1) is a key enzyme associated with immunomodulation through its regulation of the tryptophan‐kynurenine (Kyn) pathway in advanced cancers, including metastatic renal cell carcinoma (mRCC). However, the failure of IDO1 inhibitors when used in combination with immune checkpoint inhibitors (ICIs), as observed in clinical trials, raises a number of questions. This study aimed to investigate the association of tryptophan 2,3‐dioxygenase (TDO) and IDO1 with cancer development and resistance to immunotherapy in patients with RCC. In our analysis of RCC tissue samples, tissue Kyn levels were elevated in advanced‐stage RCC and correlated well with TDO expression levels in RCC tumor cells. In patients with mRCC, TDO rather than IDO1 was expressed in RCC tumor cells, showing a strong association with Kyn expression. Furthermore, immunohistochemical staining of TDO was strongly associated with the staining intensity of forkhead box P3, as well as ICI therapy response and survival in patients with mRCC. Our study is the first to show that TDO expression in tumor tissues is associated with progression and survival, confirming its potential as a predictive biomarker of primary resistance to immunotherapy in patients with mRCC. Our findings suggest that strategies aimed at inhibiting TDO, rather than IDO1, in combination with ICI therapy may aid in the control of mRCC progression.
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Affiliation(s)
- Makoto Sumitomo
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan.,Department of Medical Research for Intractable Disease, Fujita Health University, Toyoake, Japan.,Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kenji Zennami
- Fujita Cancer Center, Fujita Health University, Toyoake, Japan.,Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Tomomi Nagakawa
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yasuhiro Maeda
- Research Promotion and Support Headquarters, Center for Joint Research Facilities Support, Fujita Health University, Toyoake, Japan
| | - Kazuya Shiogama
- Department of Pathology, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yasuko Yamamoto
- Department of Disease Control and Prevention, Fujita Health University, Toyoake, Japan
| | - Yoshinari Muto
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hitomi Sasaki
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kuniaki Saito
- Department of Disease Control and Prevention, Fujita Health University, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Japan
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22
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Zennami K, Takahara K, Matsukiyo R, Nukaya T, Takenaka M, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Toyama H, Sumitomo M, Shiroki R. Long-Term Functional and Oncologic Outcomes of Robot-Assisted Partial Nephrectomy for Cystic Renal Tumors: A Single-Center Retrospective Study. J Endourol 2021; 35:1006-1012. [PMID: 33267680 DOI: 10.1089/end.2020.0994] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Objectives: To evaluate the outcomes of robot-assisted partial nephrectomy (RAPN) in cystic renal tumors. Materials and Methods: We retrospectively analyzed patients who underwent RAPN for either cystic (n = 46) or solid (n = 271) renal tumors at Fujita Health University between 2010 and 2019. Cystic renal tumors were diagnosed using cross-sectional imaging. Perioperative, oncologic, and functional outcomes were assessed. Results: The median follow-up periods were 38, 41, and 37 months in the total, cystic, and solid groups, respectively. Most patient characteristics were similar among both groups, while the median age of the cystic group was significantly lower than that of the solid group (p = 0.02). Most perioperative variables and complications were comparable between the two groups. There was no significant difference between the groups in perioperative renal function. The estimated glomerular filtration rate preservation rates were 93.1% and 89.2% in the cystic and solid groups, respectively (p = 0.17). The cystic group showed a higher benign histology rate (19.6% vs 7%) and lower Fuhrman grade than the solid group (24.3% vs 15.1% in grade 1, and 73% vs 81.3% in grade 2), although there was no statistically significant difference between the two groups. In the solid group, 10 patients (3.7%) experienced recurrence, and 2 patients (0.7%) died of renal-cell carcinoma, while none of the patients with cystic tumors experienced recurrence. There was no statistically significant difference between the cystic and solid tumors with respect to 5-year recurrence-free survival (p = 0.18), cancer-specific survival (p = 0.55), and overall survival (p = 0.35). Conclusions: RAPN for cystic renal tumors appears to be safe and feasible with perioperative, long-term functional and oncologic outcomes comparable with those in solid tumors. RAPN can be a safe and effective surgical option for cystic renal tumors.
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Affiliation(s)
- Kenji Zennami
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ryo Matsukiyo
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Naohiko Fukami
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki, Japan
| | - Hitomi Sasaki
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Okazaki Medical Center, Fujita Health University, Okazaki, Japan
| | - Hiroshi Toyama
- Department of Radiology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology and School of Medicine, Fujita Health University, Toyoake, Japan
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23
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Zennami K, Sumitomo M, Takahara K, Nukaya T, Takenaka M, Fukaya K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Two cycles of neoadjuvant chemotherapy improves survival in patients with high-risk upper tract urothelial carcinoma. BJU Int 2020; 127:332-339. [PMID: 32896105 PMCID: PMC7984033 DOI: 10.1111/bju.15230] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 12/31/2022]
Abstract
OBJECTIVES To assess the impact of two cycles of neoadjuvant chemotherapy (NAC) in patients who underwent nephroureterectomy for high-risk cN0M0 upper tract urothelial carcinoma (UTUC), and to evaluate the efficacy of NAC in patients with localised disease (≤cT2). PATIENTS AND METHODS We retrospectively analysed patients with high-risk cN0M0 UTUC who received NAC followed by surgery, compared with a matched cohort who underwent initial surgery at Fujita Health University during 2005-2019. Baseline and tumour characteristics, overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were compared between the cohorts. Cox proportional hazards models were used to identify predictors of survival. RESULTS There were 117 and 67 patients in the study group and the control group, respectively. Significantly higher pathological downstaging (pDS) and lower lymphovascular invasion (LVI) were observed in the study group than in the control group (48% vs 22%, P = 0.008 and 29% vs 46%, P = 0.045, respectively). The NAC group had significantly better 5-year OS (79% vs 53%, P = 0.003), 5-year CSS (84% vs 66%, P = 0.008), and 5-year RFS (80% vs 61%, P = 0.001) than the control group. The OS benefit of NAC was observed even in patients with localised (≤cT2) disease (P = 0.019). Patients with LVI showed significantly worse CSS both in pathologically locally advanced (≥pT3) and in localised (≤pT2) tumours (P = 0.048 and P = 0.018, respectively). Multivariate analysis identified LVI, NAC, and pDS as independent predictors of OS. Male sex and post-NAC LVI were identified as predictors of worse survival in patients who underwent NAC. CONCLUSIONS Two cycles of NAC improved the survival of patients with high-risk UTUC, even in patients with localised disease. Although two cycles of NAC appear to be effective in cN0M0 high-risk UTUC including localised disease, additional larger sample size multicentre prospective studies comparing short-course NAC regimens followed by surgery and surgery alone are required.
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Affiliation(s)
- Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masashi Takenaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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24
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Takahara T, Satou A, Sugie M, Watanabe M, Kanao K, Sumitomo M, Tsuzuki T. Prognostic significance of p16 expression in high-grade prostate adenocarcinoma. Pathol Int 2020; 70:743-751. [PMID: 32776387 DOI: 10.1111/pin.12997] [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: 06/03/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/30/2022]
Abstract
Management of advanced hormone-naïve prostate cancer (HNPC) is a critical public health issue. Useful prognostic markers are thus needed to select patients who will benefit from recently introduced upfront therapies. p16 expression is an adverse prognostic marker in prostate cancer. The present study aimed to determine whether p16 expression would serve as an adverse prognostic marker in advanced HNPC. A total of 79 patients diagnosed by needle biopsy with adenocarcinoma Gleason score ≥8 between 2010 and 2013 at Aichi Medical University were included in this study. The median patient age was 73 (range 52-87) years. The median follow-up was 62 months (range 2-98). Fourteen patients had p16-positive samples. Fifteen patients died from prostate cancer, 10 of whom were in the p16-positive group. p16 positivity was associated with clinical T stage (P < 0.001), presence of IDC-P (P < 0.001), distant metastasis (P < 0.001) and lymph node metastasis (P < 0.001). These results indicate that p16 expression is associated with adverse prognostic factor of prostate cancer and suggest that p16 expression may provide useful information for treatment planning and identifying suitable candidates for upfront chemotherapy or androgen receptor axis-targeted therapy.
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Affiliation(s)
- Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
| | - Miho Sugie
- Department of Urology, Minato Medical Coop-Kyoritsu General Hospital, Tokyo, Japan
| | - Masahito Watanabe
- Department of Urology, Aichi Medical University Hospital, Aichi, Japan
| | - Kent Kanao
- Department of Uro-oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University, Aichi, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Aichi, Japan
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25
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Takahara K, Ando R, Kanao K, Ito T, Miyake H, Sumitomo M, Yasui T, Shiroki R. Prognostic Stratification of the IMDC Intermediate Risk Group After Treatment With First-line Molecular-targeted Therapy for Metastatic Renal Cell Carcinoma. Anticancer Res 2020; 40:4395-4400. [PMID: 32727768 DOI: 10.21873/anticanres.14443] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/10/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The therapeutic outcomes of patients with metastatic renal cell carcinoma (mRCC) have dramatically improved with the introduction of molecular-targeted agents. The observational multicenter study was conducted to develop a novel stratification system for the intermediate risk group of the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) model. PATIENTS AND METHODS The present study included 252 Japanese patients with mRCC who received first-line molecular-targeted therapy at four institutions. RESULTS The 252 patients were classified into the favorable, intermediate, and poor risk groups by the IMDC model. For the intermediate risk group, multivariate analysis of the six factors included in the IMDC model revealed that a low performance status, anemia, and a high platelet count were independent predictors of poor overall survival (OS). The intermediate risk group was subsequently divided into the following two groups (int -group 1 and 2) by the three independent OS predictors. Significant differences in the OS were noted among the IMDC favorable risk group, int-group 1, int-group 2, and poor risk group. CONCLUSION The novel stratification presented in this study could be a useful tool for further prognostication of patients with mRCC classified into the intermediate risk group according to the IMDC model after first-line molecular-targeted therapy.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Ryosuke Ando
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kent Kanao
- Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Takahiro Yasui
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University, School of Medicine, Toyoake, Japan
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26
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Sumitomo M, Teramoto A, Toda R, Fukami N, Fukaya K, Zennami K, Ichino M, Takahara K, Kusaka M, Shiroki R. Deep learning using preoperative magnetic resonance imaging information to predict early recovery of urinary continence after robot-assisted radical prostatectomy. Int J Urol 2020; 27:922-928. [PMID: 32729184 DOI: 10.1111/iju.14325] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/21/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To investigate whether a deep learning model from magnetic resonance imaging information is an accurate method to predict the risk of urinary incontinence after robot-assisted radical prostatectomy. METHODS This study included 400 patients with prostate cancer who underwent robot-assisted radical prostatectomy. Patients using 0 or 1 pad/day within 3 months after robot-assisted radical prostatectomy were categorized into the "good" group, whereas the other patients were categorized into the "bad" group. Magnetic resonance imaging DICOM data, and preoperative and intraoperative covariates were assessed. To evaluate the deep learning models from the testing dataset, their sensitivity, specificity and area under the receiver operating characteristic curve were analyzed. Gradient-weighted class activation mapping was used to visualize the regions of deep learning interest. RESULTS The combination of deep learning and naive Bayes algorithm using axial magnetic resonance imaging in addition to clinicopathological parameters had the highest performance, with an area under the receiver operating characteristic curve of 77.5% for predicting early recovery from post-prostatectomy urinary incontinence, whereas machine learning using clinicopathological parameters only achieved low performance, with an area under the receiver operating characteristic curve of 62.2%. The gradient-weighted class activation mapping methods showed that deep learning focused on pelvic skeletal muscles in patients in the good group, and on the perirectal and hip joint regions in patients in the bad group. CONCLUSIONS Our results suggest that deep learning using magnetic resonance imaging is useful for predicting the severity of urinary incontinence after robot-assisted radical prostatectomy. Deep learning algorithms might help in the choice of treatment strategy, especially for prostate cancer patients who wish to avoid prolonged urinary incontinence after robot-assisted radical prostatectomy.
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Affiliation(s)
- Makoto Sumitomo
- Fujita Cancer Center, Fujita Health University, Toyoake, Aichi, Japan.,Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Atsushi Teramoto
- Faculty of Radiological Technology, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Ryo Toda
- Faculty of Radiological Technology, School of Medical Sciences, Fujita Health University, Toyoake, Aichi, Japan
| | - Naohiko Fukami
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kosuke Fukaya
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kenji Zennami
- Fujita Cancer Center, Fujita Health University, Toyoake, Aichi, Japan.,Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Manabu Ichino
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Kiyoshi Takahara
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Mamoru Kusaka
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Ryoichi Shiroki
- Department of Urology, School of Medicine, Fujita Health University, Toyoake, Aichi, Japan
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Ando R, Takahara K, Ito T, Kanao K, Kobayashi I, Shiroki R, Sumitomo M, Miyake H, Yasui T. Discontinuation of first-line molecular-targeted therapy and prognosis in patients with metastatic renal cell carcinoma: Impact of disease progression vs. adverse events. Urol Oncol 2020; 38:937.e19-937.e25. [PMID: 32693975 DOI: 10.1016/j.urolonc.2020.06.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/03/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We evaluated the impact of discontinuation of first-line (1L) molecular-targeted therapy on prognostic outcomes among patients with metastatic renal cell carcinoma (mRCC). METHODS Study patients with mRCC were treated with 1L molecular-targeted agents at 4 separate institutions. Prognostic outcomes in this patient cohort were analyzed retrospectively based on whether discontinuation of 1L therapy was related to adverse events (AEs) or progression of disease (PD). RESULTS Of the 201 patients enrolled, 117 patients (58%) and 84 patients (42%) discontinued 1L targeted therapy due to PD and AEs, respectively. Second-line therapy was subsequently provided to 101 (86%) and 66 (79%) of the patients who discontinued 1L therapy secondary to PD or AEs, respectively. Patients who discontinued 1L therapy due to AEs were significantly older than those with PD. The progression-free survival and overall survival from the initiation of 1L targeted therapy were significantly longer in patients who discontinued 1L therapy due to AE than in those who discontinued 1L therapy due to PD. The OS from the initiation of second-line targeted therapy was significantly longer in patients who discontinued 1L therapy due to AE than those with PD. Furthermore, AE as a reason for discontinuation of 1L targeted therapy as opposed to PD was independently associated with longer progression-free survival and OS as determined by multivariate analysis. CONCLUSIONS Our findings suggest that mRCC patients who discontinue 1L therapy due to AEs have a more favorable prognosis than those who discontinue therapy due to PD.
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Affiliation(s)
- Ryosuke Ando
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan; Department of Uro-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Yoshizawa A, Takahara K, Saruta M, Zennami K, Nukaya T, Fukaya K, Ichino M, Fukami N, Niimi A, Sasaki H, Kusaka M, Suzuki M, Sumitomo M, Shiroki R. Combined α-methylacyl-CoA racemase inhibition and docetaxel treatment reduce cell proliferation and decrease expression of heat shock protein 27 in androgen receptor-variant-7-positive prostate cancer cells. Prostate Int 2020; 9:18-24. [PMID: 33912510 PMCID: PMC8053692 DOI: 10.1016/j.prnil.2020.07.001] [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: 04/02/2020] [Revised: 06/19/2020] [Accepted: 07/03/2020] [Indexed: 12/24/2022] Open
Abstract
Background Disease progression in castrate-resistant prostate cancer (PCa) is most commonly driven by the reactivation of androgen receptor (AR) signaling and involves AR splice variants including ARV7. Materials and methods We used the ARV7-positive PCa cell line, 22Rv1, to study the relationship of the PCa marker α-methylacyl-CoA racemase (AMACR), AR, and ARV7 in PCa. Results Docetaxel addition but not AMACR inhibition decreased the proliferation of 22Rv1 cells. The combination of AMACR inhibition and docetaxel treatment resulted in a maximum reduction of cell proliferation. The Western blotting analysis revealed that both AR and ARV7 expression were significantly decreased with the use of charcoal-stripped serum following AMACR inhibition and docetaxel treatment. AMACR inhibition and docetaxel treatment in the charcoal-stripped serum condition reduced the proliferation of 22Rv1, possibly via the downregulation of the heat shock protein 27. Conclusion Using cell proliferation and Western blot analysis, we demonstrated that AMACR inhibition and docetaxel treatment, under androgen deprivation conditions, significantly reduced the proliferation of ARV7 positive cancer cells and decreased the levels of AR and ARV7 expression, possibly via downregulation of heat shock protein 27.
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Affiliation(s)
- Atsuhiko Yoshizawa
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Corresponding author. Department of Urology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukakecho, Toyoake, Aichi, 470-1192 Japan
| | - Masanobu Saruta
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Atsuko Niimi
- Department of Molecular Oncology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Motoshi Suzuki
- Department of Molecular Oncology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Takahara K, Sumitomo M, Fukaya K, Jyoudai T, Nishino M, Hikichi M, Nukaya T, Zennami K, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Predictors for trifecta achievement of robot-assisted partial nephrectomy in high-complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10). Asian J Endosc Surg 2020; 13:390-396. [PMID: 31823487 PMCID: PMC7384074 DOI: 10.1111/ases.12767] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/17/2019] [Accepted: 10/22/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Robot-assisted partial nephrectomy (RAPN) is emerging as an effective treatment oncologically and functionally for clinically localized renal tumors. However, RAPN in high-complexity tumors with a Preoperative Aspects and Dimensions Used for an Anatomical score ≥10 remains challenging. In this study, the feasibility of RAPN for high-complexity tumors was assessed. METHODS The study cohort consisted of 177 cases with clinically localized renal cell carcinoma who had undergone RAPN at our hospital from July 2010 to February 2018. They were assessed for perioperative parameters and trifecta achievement (ie, negative surgical margins, warm ischemia time <25 minutes, and no complications). RESULTS Among the 177 cases who had undergone RAPN, 60 had high-complexity tumors, and 117 had non-high-complexity (ie, intermediate- or low-complexity) tumors. There were no significant differences in the operative and console times between the cohorts, but estimated intraoperative blood loss was much lower in the non-high-complexity group. Although the average warm ischemia time was less than 25 minutes in both groups, it was significantly shorter in the non-high-complexity group. Trifecta achievement rates significantly differed between the high- and non-high-complexity groups (68.3% vs 86.3%). Comparisons of four operative parameters (ie, BMI, tumor size, endophytic properties, and hilar tumor) using univariate analysis in the 60 high-complexity tumor cases showed that BMI and tumor size were independent factors (P = 0.05 and 0.018, respectively). In multivariate analysis, tumor size was the only factor directly associated with trifecta achievement (P = 0.029). CONCLUSION The trifecta achievement rate was significantly lower in the high-complexity group. Only tumor size affected trifecta achievement during RAPN in cases with high-complexity tumors (Preoperative Aspects and Dimensions Used for an Anatomical score ≥10).
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Affiliation(s)
- Kiyoshi Takahara
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Makoto Sumitomo
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Kosuke Fukaya
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Takahito Jyoudai
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Masashi Nishino
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Masaru Hikichi
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Takuhisa Nukaya
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Kenji Zennami
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Manabu Ichino
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Naohiko Fukami
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Hitomi Sasaki
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Mamoru Kusaka
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
| | - Ryoichi Shiroki
- Department of UrologyFujita Health University School of MedicineToyoakeJapan
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Sumitomo M, Teramoto A, Fukami N, Fukaya K, Zennami K, Ichino M, Takahara K, Kusaka M, Shiroki R. Deep learning using preoperative MRI information to predict early recovery of urinary continence after robot-assisted radical prostatectomy. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.310] [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
310 Background: Urinary incontinence remains one of the most bothersome postoperative complications even after robot-assisted radical prostatectomy (RARP). We aimed to make a novel prediction system that can be used preoperatively to inform patients of the accuracy of early recovery of urinary continence after RARP using a deep learning (DL) model from magnetic resonance imaging (MRI) information and preoperative clinicopathological parameters. Methods: A retrospective cohort study was conducted on prostate cancer (PC) patients who had undergone RARP at our hospital between August 2015 and July 2019. Patients using no pads/no leakage of urine or the use of a safety pad within 3 months after RARP is categorized into “good” continence and others into “no good” continence. MRI DICOM data from axial, coronal and sagittal imaging as well as preoperative clinicopathological covariates (age, BMI, prostate volume, serum PSA level, Gleason score, clinical stage) were assessed. Supervised DL algorithms, which included AdaBoost, Naive Bayes, Neural Network, Random Forest, and SVM were trained and tested as binary classifiers (good or no good). To evaluate the DL models from the testing data set, their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), as well as area under the receiver operating characteristic curve (AUC) were analyzed. Results: Data were available for 497 patients in the study period. The AdaBoost DL algorithm using MRI information in addition to clinicopathological parameters had the highest performance with sensitivity at 92%, specificity at 77%, PPV at 79%, NPV at 91%, and AUC at 84% for predicting good continence, while that using clinicopathological parameters only had the performance with sensitivity at 50%, specificity at 69%, PPV at 60%, NPV at 60%, and AUC at 60%. Conclusions: Our results suggest that the DL algorithms using MRI imaging information are highlighted as an accurate method for strongly predicting early recovery of urinary continence after RARP. Thus, DL predictions may help allocation of treatment strategies for PC patients who dislike prolonged urinary incontinence after RARP.
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Affiliation(s)
- Makoto Sumitomo
- Department of Urology and Fujita Canacer Center, Fujita Health University, Toyoake, Japan
| | - Atsushi Teramoto
- Faculty of Radiological Technology, School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenji Zennami
- Department of Urology and Fujita Cancer Center, Fujita Health University, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Zennami K, Takahara K, Fukaya K, Ichino M, Fukami N, Sasaki H, Sumitomo M, Kusaka M, Shiroki R. The efficacy of two cycles of neoadjuvant chemotherapy for upper tract urothelial carcinoma patients. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.505] [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
505 Background: Upper tract urothelial carcinoma (UTUC) is frequently upstaged after surgery and is associated with poor prognosis. However, the efficacy of neoadjuvant chemotherapy (NAC) and optimal No. of NAC cycles for UTUC have been poorly defined. In this study, we evaluated if two cycles of NAC improves survival of UTUC patients in our institute. Methods: A total of 167 patients who underwent radical nephroureterectomy at Fujita Health University between November 2005 and December 2018 were retrospectively analyzed. The study group comprised 114 patients with UTUC who received NAC followed by surgery. The control group consisted of 53 patients who underwent initial surgery without NAC. We compared two groups in overall survival (OS), cancer specific survival (CSS), recurrence free survival (RFS, urinary tract, visceral) and independent prognostic factors. Kaplan-Meier methods, log-rank test and cox proportional-hazards models were used for statistical analysis. Results: Median follow up was 1108 days, and there were no significant differences in preoperative patient characteristics between NAC group and initial surgery (IS) group. NAC had significantly improved 5-year OS (75% vs 55%, p=0.004) and 5-year CSS (84% vs 65%, p=0.024). That is more significant in the analysis with cT3 patients (p=0.0002). NAC also significantly improved visceral RFS (p=0.001). However, NAC does not affect urinary tract RFS (p=0.96) when compared to IS. pDS were observed in 55 out of 114 (48%) in NAC group, and 12 out of 53 (22%) in IS group. Comparison of OS between with pDS and without pDS demonstrated significantly better OS in with pDS group (p=0.0001). Multivariate cox proportional-hazards models identified NAC, pDS, resection margin, pN and cT3 as independent prognostic factors for OS. Conclusions: Two cycles of NAC induced pDS and improved survival of UTUC patients. Reduced number of NAC cycles may offer clinical benefits of low chemo-associated toxicity, appropriate surgery without delay in chemo-resistant case and sufficient cancer regression with pDS.
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Affiliation(s)
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | | | - Makoto Sumitomo
- Department of Urology and Fujita Canacer Center, Fujita Health University, Toyoake, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Kosaka T, Uemura H, Sumitomo M, Harada K, Sugimoto M, Hayashi N, Yoshimura K, Fukasawa S, Ecstein-Fraisse E, Sunaga Y, Oya M. Impact of pegfilgrastim as primary prophylaxis for metastatic castration-resistant prostate cancer patients undergoing cabazitaxel treatment: an open-label study in Japan. Jpn J Clin Oncol 2020; 49:766-771. [PMID: 31329922 PMCID: PMC6939836 DOI: 10.1093/jjco/hyz051] [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: 10/25/2018] [Revised: 02/06/2019] [Accepted: 03/25/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cabazitaxel is an efficacious treatment for patients with metastatic castration-resistant prostate cancer who have previously progressed on docetaxel, but febrile neutropenia during the first cycle is a frequent complication. Asian patients are at increased risk of febrile neutropenia. Although primary prophylaxis with granulocyte colony-stimulating factor can reduce the incidence, its efficacy has not been prospectively demonstrated in Japanese patients with cabazitaxel treatment. METHODS PEGAZUS, a prospective, single-arm study conducted at eight clinical sites in Japan, enrolled 21 heavily pretreated patients with metastatic castration-resistant prostate cancer. Patients received cabazitaxel 25 mg/m2 every 3 weeks, up to 10 cycles. Oral prednisolone 10 mg was taken daily. Pegfilgrastim 3.6 mg was administered at least 24 h after the cabazitaxel infusion. The primary endpoint was the incidence of febrile neutropenia in the first cycle. RESULTS The median number of treatment cycles was seven. The relative dose intensity of cabazitaxel was 67.4% (range, 53.2-91.3%). Two of 21 patients (9.5%) experienced febrile neutropenia in the first cycle. This rate was lower than the rate (43%) previously observed without prophylactic granulocyte colony-stimulating factor in a similar patient population. Six patients showed a prostate-specific antigen response (28.6%). Three of four patients evaluable for tumor response had stable disease and one had progressive disease. Grade ≥3 diarrhea was not observed. Primary prophylaxis with granulocyte colony-stimulating factor significantly reduced the incidence of febrile neutropenia in this study. CONCLUSIONS Cabazitaxel plus granulocyte colony-stimulating factor is safe and effective for Japanese patients with metastatic castration-resistant prostate cancer who have previously progressed on docetaxel. Clinical trial registration: ClinicalTrials.gov (NCT02441894).
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Affiliation(s)
- Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hiroji Uemura
- Department of Urology/Renal Transplantation, Yokohama City University Medical Center, 4-57 Urafune, Minami-ku, Yokohama 232-0024, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan
| | - Kenichi Harada
- Department of Urology, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Mikio Sugimoto
- Department of Urology, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita-gun, Kagawa 761-0793, Japan
| | - Narihiko Hayashi
- Department of Urology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Kazuhiro Yoshimura
- Department of Urology, Kindai University Hospital, 377-2 Ohno-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Satoshi Fukasawa
- Department of Urology/Prostate Cancer, Chiba Cancer Center, 666-2 Nitona-cho, Chuo-ku, Chiba 260-0801, Japan
| | | | - Yoshinori Sunaga
- Biostatistics Programming, Oncology, Sanofi, 640 Memorial Drive, Cambridge MA 02142, USA
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
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Watanabe M, Kanao K, Suzuki S, Muramatsu H, Morinaga S, Kajikawa K, Kobayashi I, Nishikawa G, Kato Y, Zennami K, Nakamura K, Tsuzuki T, Yoshikawa K, Ueda R, Sumitomo M. Increased infiltration of CCR4-positive regulatory T cells in prostate cancer tissue is associated with a poor prognosis. Prostate 2019; 79:1658-1665. [PMID: 31390096 DOI: 10.1002/pros.23890] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Regulatory T cells (Tregs) play important roles in the suppression of immune responses, including antitumor immune responses. C-C chemokine receptor 4 (CCR4) is highly expressed on effector Tregs, and anti-CCR4 antibody is attracting attention as a novel immunotherapeutic agent for solid tumors. This study aimed to evaluate the expression of CCR4-positive Tregs (CCR4+Tregs) in prostate cancer and estimate the clinical potential of CCR4-targeting therapy for prostate cancer. METHODS A total of 15 radical prostatectomy (RP) specimens and 60 biopsy specimens from individuals diagnosed with prostate cancer were analyzed to evaluate the infiltration of CCR4+Tregs in prostate cancer. The relationships between the number of CCR4+Tregs and clinical parameters were investigated in RP and biopsy specimens. Moreover, the total number of Tregs, CCR4+Tregs, and T cells and the ratio of CCR4+Tregs to Tregs and T cells in biopsy specimens were compared between patients with poor prognosis who progressed to castration-resistant prostate cancer (CRPC) within 12 months (n = 13) and those with good prognosis who were stable with hormone-sensitive prostate cancer over 12 months (n = 47). Furthermore, biopsy specimens were divided into two groups: low and high CCR4+Treg expression groups and the prognosis was compared between them. RESULTS There was a higher expression of CCR4+Tregs in RP specimens with a higher (≥8) Gleason score than in those with a lower (<8) Gleason score (P = .041). In biopsy specimens, 65.9% Tregs were positive for CCR4. The number of CCR4+Tregs positively correlated with clinical stage (P < .001) and Gleason score (P = .006). The total number of Tregs and CCR4+Tregs significantly increased in the poor prognosis group compared with that in the good prognosis group (P = .024 and .01, respectively). Furthermore, patients with lower CCR4+Treg expression levels showed a significantly longer time to progression to CRPC (not reached vs 27.3 months; P < .001) and median survival time (not reached vs 69.0 months; P = .014) than those with higher expression levels. CONCLUSIONS CCR4+Tregs are highly infiltrated in the prostate tissue of patients with poor prognosis with potential to progress to CRPC. Furthermore, the degree of infiltration of CCR4+Tregs is related to the prognosis of prostate cancer.
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Affiliation(s)
- Masahito Watanabe
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Susumu Suzuki
- Department of Tumor Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Hiroyuki Muramatsu
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Singo Morinaga
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Genya Nishikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Yoshiharu Kato
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Kenji Zennami
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kogenta Nakamura
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Kazuhiro Yoshikawa
- Division of Advanced Research Promotion, Institute of Comprehensive Medical Research, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Ryuzo Ueda
- Department of Tumor Immunology, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Japan
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Kanao K, Ito T, Takahara K, Ando R, Yasui T, Shiroki R, Miyake H, Sumitomo M. Prostate-specific antigen response patterns during cabazitaxel therapy in patients with metastatic castration-resistant prostate cancer. Jpn J Clin Oncol 2019; 49:1043-1048. [DOI: 10.1093/jjco/hyz110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/13/2019] [Accepted: 07/26/2019] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
The objective of this study was to categorize prostate-specific antigen (PSA) response during cabazitaxel therapy in patients with metastatic castration-resistant prostate cancer (mCRPC) into different patterns and to investigate the prognostic impact of the PSA response patterns.
Methods
We reviewed data from patients with mCRPC who had been treated with cabazitaxel therapy at four institutions belonging to Tokai Urologic Oncology Research Seminar. Patients eligible for this study had received at least three cycles of cabazitaxel treatment at three- or four-week intervals. The PSA response patterns were categorized as primary resistance (PR), response (RE), stabilization (ST), and fluctuating (FL). The overall survival (OS) was compared among the patterns.
Results
Data from a total of 50 patients were analyzed in this study. The number of patients exhibiting PR, RE, ST and FL patterns were 18 (36%), 14 (28%), 12 (24%) and 6 (12%), respectively. The median (95% CI) OS of patients with PR and RE patterns was 10.7 (5.6–15.9) and 14.9 (6.8–23.0) months, respectively, and was not reached for patients with ST and FL patterns. The OS of patients with the FL pattern was significantly better than that of patients with PR (P = 0.012) and RE (P = 0.010) patterns.
Conclusion
There were some patients whose PSA were fluctuating during cabazitaxel therapy in patients with mCRPC. Because the prognosis of such patients was relatively good, the judgment to discontinue the cabazitaxel therapy after PSA rise followed by decrease should be made prudently.
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Affiliation(s)
- Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
| | - Toshiki Ito
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ryosuke Ando
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hideaki Miyake
- Department of Urology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, Japan
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Japan
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Takahara K, Sumitomo M, Fukaya K, Jyoudai T, Nishino M, Hikichi M, Zennami K, Nukaya T, Ichino M, Fukami N, Sasaki H, Kusaka M, Shiroki R. Clinical and oncological outcomes of robot-assisted radical prostatectomy with nerve sparing vs. non-nerve sparing for high-risk prostate cancer cases. Oncol Lett 2019; 18:3896-3902. [PMID: 31579411 DOI: 10.3892/ol.2019.10692] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 06/28/2019] [Indexed: 01/09/2023] Open
Abstract
Robot-assisted radical prostatectomy (RARP) is one of the most widely used procedures for localized prostate cancer (PCa). In the present study, the clinical and oncological outcomes of RARP with bilateral or unilateral nerve sparing (NS) for D'Amico high-risk PCa cases were assessed. Among the 767 cases who received RARP at Fujita Health University Hospital between August 2009 and December 2016, 230 high-risk PCa cases who were observed for >6 months comprised the retrospective study cohort. Bilateral NS was performed with the bilateral neurovascular bundle in eight, unilateral in 125 and none in 97 cases. Perioperative parameters [surgery time, console time, estimated blood loss, pathological stage, positive lymph node metastases [pN (+)], and surgical margin positivity] did not exhibit significant differences between the NS and non-NS cohorts. During a median follow-up time of 25 months, the 1- and 3-year biochemical recurrence (BCR)-free survival rates in the NS/non-NS cohorts were 84.4/86.0 and 72.7/75.0%, respectively. There were no significant differences identified between the two groups at each time period. According to multivariate analysis, the resection margin was an important factor for time to BCR, regardless of the NS technique used. The numbers of pads used daily at 3 and 6 months after RARP between the NS/non-NS cohorts were 1.1/1.5 and 0.6/1.0, respectively (P=0.045 and P=0.009), suggesting that the NS technique resulted in significantly improved outcomes regarding urinary continence recovery. In selected high-risk PCa cases, the NS technique resulted in equivalent oncological outcomes and improved urinary continence compared with the non-NS RARP group.
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Affiliation(s)
- Kiyoshi Takahara
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Makoto Sumitomo
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Kosuke Fukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Takahito Jyoudai
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Masashi Nishino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Masaru Hikichi
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Kenji Zennami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Takuhisa Nukaya
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Manabu Ichino
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Naohiko Fukami
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Hitomi Sasaki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Mamoru Kusaka
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
| | - Ryoichi Shiroki
- Department of Urology, Fujita Health University School of Medicine, Toyoake, Aichi 470-1192, Japan
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Zennami K, Rafiqi F, Liao R, Sealover K, Simons B, Sumitomo M, Shiroki R, Lupold S. Abstract 4501: Loss of miR-21 delays myc-driven prostate cancer progression in the hi-myc transgenic mouse model. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-4501] [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: 11/16/2022]
Abstract
Abstract
Introduction and Objectives: MicroRNA 21 (miR-21) is overexpressed in virtually all types of cancers including prostate cancer (PCa). We have previously reported that the androgen receptor (AR) induces miR-21 expression, and that elevated miR-21 is sufficient to drive PCa growth and castration resistance. However, the role of miR-21 in PCa initiation and progression has not been fully elucidated. To determine if the absence of miR-21 inhibits or delays prostate cancer incidence or progression, we crossed miR-21 KO mice with Hi-Myc mice. In this study, we identify that loss of miR-21 delays Myc-driven prostate cancer progression in the Hi-Myc transgenic mouse model.
Methods: miR-21 KO mice were backcrossed to FVB mice to generation F10. Resulting miR-21 WT or KO FVB progeny were crossed with Hi-Myc mice to generate Hi-Myc/miR-21 WT or KO mice. Prostates were harvested at 4 weeks (n=10), 3 months (n=10), 5 months (n=58), 6 months (n=25), 8 months (n=20) of age and prostate weight, histology, miR-21 expression levels and protein expression levels were quantified. Proliferation and apoptosis were examined by immunohistochemistry using Ki-67 and cleaved caspase-3.
Results: Cancerous prostates of Hi-Myc mice showed high miR-21 expression at 5m and 8m, when compared to FVB controls, suggesting high miR-21 expression in the Myc-driven prostate cancer. Hi-Myc/miR-21 KO mice demonstrated a marked reduction in adenocarcinoma when compared to Hi-Myc/miR-21 WT mice at 5m. This is apparent in the reduced weight of effected prostate lobes of Hi-Myc/miR-21 KO versus WT mice at 8m. Protein levels of established miR-21 target genes, PDCD4 and PTEN, were up-regulated in the prostates of Hi-Myc/miR-21 KO mice. Also, IHC showed lower Ki-67 and higher cleaved caspase-3 positive cells in miR-21 KO than WT. However, miR-21 KO did not affect prostatic intraepithelial neoplasia (PIN) development.
Conclusions: Our results demonstrate that miR-21 delays Myc-driven prostate cancer progression through reduced proliferation and enhanced apoptosis, and that endogenous miR-21 suppresses prostatic PDCD4 and PTEN protein expression levels. Therefore, targeting of miR-21 or its downstream target genes may be useful for cancer prevention or cancer therapy.
Citation Format: Kenji Zennami, Fatima Rafiqi, Ross Liao, Kim Sealover, Brian Simons, Makoto Sumitomo, Ryoichi Shiroki, Shawn Lupold. Loss of miR-21 delays myc-driven prostate cancer progression in the hi-myc transgenic mouse model [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4501.
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Affiliation(s)
| | - Fatima Rafiqi
- 2Johns Hopkins University School of Medicine, Baltimore, MD
| | - Ross Liao
- 2Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kim Sealover
- 2Johns Hopkins University School of Medicine, Baltimore, MD
| | - Brian Simons
- 2Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | - Shawn Lupold
- 2Johns Hopkins University School of Medicine, Baltimore, MD
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Muramatsu H, Sumitomo M, Morinaga S, Kajikawa K, Kobayashi I, Nishikawa G, Kato Y, Watanabe M, Zennami K, Kanao K, Nakamura K, Suzuki S, Yoshikawa K. Targeting lactate dehydrogenase‑A promotes docetaxel‑induced cytotoxicity predominantly in castration‑resistant prostate cancer cells. Oncol Rep 2019; 42:224-230. [PMID: 31180564 DOI: 10.3892/or.2019.7171] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/13/2019] [Indexed: 11/05/2022] Open
Abstract
Docetaxel (DOC) is one of the most effective chemotherapeutic agents against castration‑resistant prostate cancer (CRPC). Despite an impressive initial clinical response, the majority of patients eventually develop resistance to DOC. In tumor metabolism, where tumors preferentially utilize anaerobic metabolism, lactate dehydrogenase (LDH) serves an important role. LDH controls the conversion of pyruvate to lactate, with LDH‑A, one of the predominant isoforms of LDH, controlling this metabolic process. In the present study, the role of LDH‑A in drug resistance of human prostate cancer (PC) was examined by analyzing 4 PC cell lines, including castration‑providing strains PC3, DU145, LNCaP and LN‑CSS (which is a hormone refractory cell line established from LNCaP). Sodium oxamate (SO) was used as a specific LDH‑A inhibitor. Changes in the expression level of LDH‑A were analyzed by western blotting. Cell growth and survival were evaluated with a WST‑1 assay. Cell cycle progression and apoptotic inducibility were evaluated by flow cytometry using propidium iodide and Annexin V staining. LDH expression was strongly associated with DOC sensitivity in PC cells. SO inhibited growth of PC cells, which was considered to be caused by the inhibition of LDH‑A expression. Synergistic cytotoxicity was observed by combining DOC and SO in LN‑CSS cells, but not in LNCaP cells. This combination treatment induced additive cytotoxic effects in PC‑3 and DU145 cells, caused cell cycle arrest in G2‑M phase and increased the number of cells in the sub‑G1 phase of cell cycle in LN‑CSS cells. SO promoted DOC induced apoptosis in LN‑CSS cells, which was partially caused by the inhibition of DOC‑induced increase in LDH‑A expression. The results strongly indicated that LDH‑A serves an important role in DOC resistance in advanced PC cells and inhibition of LDH‑A expression promotes susceptibility to DOC, particularly in CRPC cells. The present study may provide valuable information for developing targeted therapies for CRPC in the future.
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Affiliation(s)
- Hiroyuki Muramatsu
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Shingo Morinaga
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Genya Nishikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Yoshiharu Kato
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Masahito Watanabe
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Kenji Zennami
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Kogenta Nakamura
- Department of Urology, Aichi Medical University School of Medicine, Nagakute 480‑1195, Japan
| | - Susumu Suzuki
- Division of Research Support, Research Creation Support Center, Aichi Medical University, Nagakute 480‑1195, Japan
| | - Kazuhiro Yoshikawa
- Division of Research Creation, Research Creation Support Center, Aichi Medical University, Nagakute 480‑1195, Japan
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Kanao K, Sugie M, Morinaga S, Muramatsu H, Kajikawa K, Kobayashi I, Nishikawa G, Watanabe M, Zennami K, Nakamura K, Sumitomo M. Prognostic impact of pT3a subclassification based on extent of extraprostatic extension after robot-assisted radical prostatectomy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy434.009] [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: 11/14/2022] Open
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39
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Watanabe M, Kanao K, Sugie M, Morinaga S, Muramatsu H, Kobayashi I, Kajikawa K, Nishikawa G, Zennami K, Nakamura K, Sumitomo M. Prognostic and predictive clinical factors for progression to castration refractory prostate cancer in patients with hormone sensitive prostate cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy434.019] [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: 11/13/2022] Open
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40
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Kanao K, Kajikawa K, Kobayashi I, Morinaga S, Muramatsu H, Nishikawa G, Watanabe M, Zennami K, Nakamura K, Sumitomo M. Impact of a novel biopsy instrument with a 25-mm side-notch needle on the detection of prostate cancer in transrectal biopsy. Int J Urol 2018; 25:746-751. [PMID: 30021242 DOI: 10.1111/iju.13722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/08/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate the impact of a novel biopsy instrument that extends the length of the side-notch on the detection of prostate cancer in transrectal needle biopsy. METHODS We collaborated with a biopsy needle manufacturer and developed a novel biopsy instrument (PRIMECUT II long-notch type) with a 25-mm side-notch length and 28-mm stroke length to take longer tissue cores. The sampled core length, cancer detection rate, pain and complications of 489 patients who underwent transrectal biopsy using the long-notch needle were compared with those of 469 patients who underwent biopsy using a normal instrument with a 19-mm side-notch length and 22-mm stroke length. RESULTS The mean length of tissue taken by the long-notch needle was significantly longer than that of tissue taken by the normal-notch needle (16.3 vs 22.4 mm, P < 0.001). The overall cancer detection rate was 42.0% for the normal-notch needle and 51.1% for the long-notch needle (P = 0.005). In patients with a prostate volume of 20-40 mL, the cancer detection rate for the long-notch needle was especially higher than that for the normal-notch needle (74.2% vs 47.5%, P < 0.001). Multivariate analysis showed that the long-notch needle improved cancer detection significantly (odds ratio 1.702, P < 0.001). There were no differences of pain during biopsy and complication between the two groups. CONCLUSIONS The novel biopsy instrument with a 25-mm side-notch can take longer tissue samples safely and has a significantly higher rate of prostate cancer detection in transrectal biopsy.
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Affiliation(s)
- Kent Kanao
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Shingo Morinaga
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | | | - Genya Nishikawa
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Masahito Watanabe
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kenji Zennami
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Kogenta Nakamura
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
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Kajikawa K, Kanao K, Sugie M, Morinaga S, Muramatsu H, Kobayashi I, Nishikawa G, Kato Y, Watanabe M, Nakamura K, Sumitomo M. PD64-09 A LONG TERM COMPARISON OF PERSISTENCE OF DRUG THERAPY IN 1,970 PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2981] [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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42
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Kanao K, Sugie M, Muramatsu H, Morinaga S, Kajikawa K, Kobayashi I, NIshikawa G, Kato Y, Watanabe M, Nakamura K, Sumitomo M. MP05-07 SHOULD GLEASON SCORE AT THE POSITIVE SURGICAL MARGIN APPEAR ON THE PATHOLOGY REPORT FOR ROBOT-ASSISTED RADICAL PROSTATECTOMY? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.178] [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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43
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Kobayashi T, Kanao K, Araki M, Terada N, Kobayashi Y, Sawada A, Inoue T, Ebara S, Watanabe T, Kamba T, Sumitomo M, Nasu Y, Ogawa O. Impact of a robotic surgical system on treatment choice for men with clinically organ-confined prostate cancer. Int J Clin Oncol 2017; 23:347-352. [PMID: 29127531 DOI: 10.1007/s10147-017-1203-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/10/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Introducing a new surgical technology may affect behaviors and attitudes of patients and surgeons about clinical practice. Robot-assisted laparoscopic radical prostatectomy (RALP) was approved in 2012 in Japan. We investigated whether the introduction of this system affected the treatment of organ-confined prostate cancer (PCa) and the use of radical prostatectomy (RP). METHODS We conducted a retrospective multicenter study on 718 patients with clinically determined organ-confined PCa treated at one of three Japanese academic institutions in 2011 (n = 338) or 2013 (n = 380). Two patient groups formed according to the treatment year were compared regarding the clinical characteristics of PCa, whether referred or screened at our hospital, comorbidities and surgical risk, and choice of primary treatment. RESULTS Distribution of PCa risk was not changed by the introduction of RALP. Use of RP increased by 70% (from 127 to 221 cases, p < 0.0001), whereas the number of those undergoing radiotherapy or androgen deprivation therapy decreased irrespective of the disease risk of PCa. Increased use of RP (from 34 to 100 cases) for intermediate- or high-risk PCa patients with mild perioperative risk (American Society of Anesthesiologists score 2) accounted for 70% of the total RP increase, whereas the number of low- or very low-risk PCa patients with high comorbidity scores (Charlson Index ≥ 4) increased from 8 to 25 cases, accounting for 18%. Use of expectant management (active surveillance, watchful waiting) in very low-risk PCa patients was 15% in 2011 and 12% in 2013 (p = 0.791). CONCLUSIONS Introduction of a robotic surgical system had little effect on the risk distribution of PCa. Use of RP increased, apparently due to increased indications in patients who are candidates for RP but have mild perioperative risk. Although small, there was an increase in the number of RPs performed on patients with severe comorbidities but with low-risk or very low-risk PCa.
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Affiliation(s)
- Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Naoki Terada
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
- Department of Urology, Miyazaki University, Miyazaki, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Atsuro Sawada
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Takahiro Inoue
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
| | - Shin Ebara
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Tomomi Kamba
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan
- Department of Urology, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University, Nagakute, Aichi, Japan
| | - Yasutomo Nasu
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Okayama, Japan
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, Kyoto, 606-8507, Japan.
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Uemura H, Kosaka T, Sumitomo M, Harada K, Sugimoto M, Hayashi N, Yoshimura K, Fukasawa S, Ecstein-Fraisse E, Sunaga Y, Oya M. Cabazitaxel plus prednisolone with primary prophylaxis with pegfilgrastim (PEG) in Japanese patients with metastatic castration-resistant prostate cancer: An open label prospective phase 2 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx676.018] [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: 11/13/2022] Open
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Hibi H, Sumitomo M, Fukunaga N, Sonohara M, Asada Y. Superior clinical pregnancy rates after microsurgical epididymal sperm aspiration. Reprod Med Biol 2017; 17:59-63. [PMID: 29371822 PMCID: PMC5768967 DOI: 10.1002/rmb2.12069] [Citation(s) in RCA: 7] [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: 06/28/2017] [Accepted: 09/24/2017] [Indexed: 11/05/2022] Open
Abstract
Purpose To assess normal fertilization, clinical pregnancy, and live birth rates after the use of microscopic epididymal sperm aspiration (MESA). Methods One-hundred-and-sixty azoospermic participants who underwent MESA were evaluated. The MESA was performed by using a micropuncture method with a micropipette. In cases in which motile sperm were not obtained after the MESA, conventional or micro-testicular sperm extraction (TESE) was completed. Results Adequate motile sperm were retrieved in 71 participants by using MESA and in 59 out of 89 participants by using TESE. Of the total number of patients, 123 underwent intracytoplasmic sperm injection. After MESA, the normal fertilization rate was 73.5% and the clinical pregnancy rate per case was 95.7%. Healthy deliveries resulted after MESA in 65 (92.9%) cases and after TESE in 38 (71.7%) cases. Conclusion The MESA specimen collection does not have any special requirements, such as mincing tissue disposition. The MESA also can reduce the amount of laboratory work that is needed for cryopreservation. In the authors' experience, MESA is a beneficial procedure and should be given priority over TESE.
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Affiliation(s)
- Hatsuki Hibi
- Department of Urology Kyoritsu General Hospital Nagoya Japan
| | - Makoto Sumitomo
- Department of Urology Aichi Medical University School of Medicine Nagakute Japan
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Nakamura K, Ikawa K, Nishikawa G, Kobayashi I, Narushima M, Muramatsu H, Morinaga S, Kajikawa K, Kato Y, Watanabe M, Zennami K, Kanao K, Morikawa N, Sumitomo M. Clinical pharmacokinetics and pharmacodynamic target attainment of pazufloxacin in prostate tissue: Dosing considerations for prostatitis. J Infect Chemother 2017; 23:809-813. [PMID: 28923301 DOI: 10.1016/j.jiac.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 07/25/2017] [Accepted: 08/13/2017] [Indexed: 11/27/2022]
Abstract
The present study examined the clinical pharmacokinetics of pazufloxacin in prostate tissue and estimated the probability of target attainment for tissue-specific pharmacodynamic goals related to treating prostatitis using various intravenous dosing regimens. Patients with prostatic hypertrophy received prophylactic infusions of pazufloxacin (500 mg, n = 23; 1000 mg, n = 25) for 0.5 h prior to transurethral prostate resection. Drug concentrations in plasma (0.5-5 h) and prostate tissue (0.5-1.5 h) were measured by high-performance liquid chromatography and used for subsequent noncompartmental and three-compartmental analysis. Monte Carlo simulation was performed to evaluate the probability of target attainment of a specific minimum inhibitory concentration (MIC) in prostate tissue: the proportion that achieved both area under the drug concentration over time curve (AUC)/MIC = 100 and maximum concentration (Cmax)/MIC = 8. Prostatic penetration of pazufloxacin was good with mean Cmax ratios (prostate tissue/plasma) of 0.82-0.99 and for AUC, 0.80-0.98. The probability of reaching target MIC concentrations in prostate tissue was more than 90% for dosing schedules of 0.25 mg/L for 500 mg every 24 h (500 mg daily), 0.5 mg/L for 500 mg every 12 h (1000 mg daily), 1 mg/L for 1000 mg every 24 h (1000 mg daily), and 2 mg/L for 1000 mg every 12 h (2000 mg daily). Importantly, the 2000 mg daily regimen of pazufloxacin produced a profile sufficient to have an antibacterial effect in prostate tissue against clinical isolates of Escherichia coli and Klebsiella pneumonia with MIC values less than 2 mg/L.
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Affiliation(s)
- Kogenta Nakamura
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan.
| | - Kazuro Ikawa
- Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Genya Nishikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Masahiro Narushima
- Department of Urology, Meitetsu Hospital, 2-26-11 Sako, Nishi-ku, Nagoya, 451-8511, Japan
| | - Hiroyuki Muramatsu
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Shingo Morinaga
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Yoshiharu Kato
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Masahito Watanabe
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Kenji Zennami
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
| | - Norifumi Morikawa
- Department of Clinical Pharmacotherapy, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University School of Medicine, Nagakute, Aichi, 480-1195, Japan
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Nakamura K, Saiki H, Muramatsu H, Morinaga S, Kobayashi I, Kajikawa K, Nishikawa G, Kato Y, Watanabe M, Kanao K, Sumitomo M. Axitinib-induced reversible posterior leukoencephalopathy syndrome in a patient with metastatic renal cell carcinoma. Int Cancer Conf J 2017; 6:197-199. [PMID: 31149502 DOI: 10.1007/s13691-017-0306-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/07/2017] [Accepted: 07/25/2017] [Indexed: 10/19/2022] Open
Abstract
A 61-year-old woman with metastatic renal carcinoma was treated with axitinib as a second-line tyrosine kinase inhibitor. Thirteen days after the treatment, the patient developed reversible posterior leukoencephalopathy syndrome (RPLS). Her symptoms and imaging findings resolved after withdrawal of axitinib, blood pressure control, and administration of glycerin and levetiracetam. RPLS should be kept in mind as a possible rare adverse event after axitinib administration.
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Affiliation(s)
- Kogenta Nakamura
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Hiroshi Saiki
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Hiroyuki Muramatsu
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Shingo Morinaga
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Ikuo Kobayashi
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Keishi Kajikawa
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Genya Nishikawa
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Yoshiharu Kato
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Masahito Watanabe
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Kent Kanao
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
| | - Makoto Sumitomo
- Department of Urology, Aichi Medical University School of Medicine, 1-1 Karimata, Yazako, Nagakute, Aichi 480-1195 Japan
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Hibi H, Yamashita K, Sumitomo M, Asada Y. Leydig cell tumor of the testis, presenting with azoospermia. Reprod Med Biol 2017; 16:392-395. [PMID: 29259494 PMCID: PMC5715892 DOI: 10.1002/rmb2.12046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Case A case of Leydig cell tumor, associated with azoospermia, is presented. Outcome The levels of sex hormones obviously were decreased, including luteinizing hormone (LH) and follicle‐stimulating hormone (FSH), with elevated testosterone. Computed tomography revealed no adrenal gland tumor, but a significant calcification in the right scrotal content was observed. He received a right radical orchiectomy and then he was unable to ejaculate. An endocrine panel revealed significantly decreased levels of testosterone and the low LH level had remained. Hormone replacement therapy with combined LH and FSH successfully recovered and preserved spermatogenesis. Conclusions Although the patient’s sexual function deteriorated after surgery, hormone replacement therapy was successful in establishing spermatogenesis.
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Affiliation(s)
- Hatsuki Hibi
- Department of Urology Kyoritsu General Hospital Nagoya Japan
| | - Kyoko Yamashita
- Department of Pathology and Biological Responses Nagoya University Graduate School of Medicine Nagoya Japan
| | - Makoto Sumitomo
- Department of Urology Aichi Medical University School of Medicine Nagakute Japan
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Muramatsu H, Sumitomo M, Morinaga S, Saiki H, Kobayashi I, Kajikawa K, Nishikawa G, Kato Y, Watanabe M, Kanao K, Nakamura K, Yoshikawa K. Abstract 4400: Targeting lactate dehydrogenase-A promotes docetaxel induced cytotoxicity predominantly in castration-resistant prostate cancer cells. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-4400] [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: 11/16/2022]
Abstract
Abstract
Introduction and objectives: It is well known as Warburg effect that anaerobic glycolytic pathway is activated in various type of advanced cancers including prostate cancer (PC). Lactate dehydrogenase-A (LDH-A) controls the conversion of pyruvate to lactate and plays an important role in glucose metabolism. Since LDH-A pathways have been implicated in chemoresistance in various cancers, we investigated whether inhibition of LDH-A pathway could mediate the sensitivity to docetaxel (DOC) in human PC cells.
Materials and Method: Four PC cell lines (PC3, DU145, LNCaP, LN-CSS ) were used. LN-CSS is one of the LNCaP-derived castration-resistant PC (CRPC) cell lines established in our laboratories. Sodium oxamate (SO) was used as a specific LDH-A inhibitor. The protein expression was detected by western blot analysis using specific antibodies. Cell growth and survival were evaluated by WST-1 assays. Cell cycle progression and apoptotic inducibility were evaluated by flow cytometry using propidium iodide and Annexin V. The cytotoxicity of SO/DOC combination on PC cells was evaluated using the Chou-Talalay combination index (CI) method which offers quantitative definition for additive effect (CI = 1), synergism (CI < 1), and antagonism (CI > 1) in drug combinations.
Result: Western blot analysis showed that LDH-A protein was highly expressed in LN-CSS cells compared with other PC cell lines including the parental LNCaP. WST-1 assays showed that treatment with SO (50 mM) for 72 hours in PC cells resulted in growth inhibition (PC3; ~30%, DU145; ~55%, LNCaP; ~20%,LN-CSS; ~55% ), while SO has little growth inhibitory effects on normal lymphocytes in the concentrations between 1-100 mM. IC50 to DOC in PC cells were showed to be 4 nM, 1 nM, 1nM, and 4.5 nM in PC3, DU145, LNCaP and LN-CSS, respectively, suggesting that both PC3 and LN-CSS were relatively resistant to DOC compared with DU145 and LNCaP. Synergistic cytotoxicity was observed after the combination therapy with DOC and SO in LN-CSS (CI: 0.5) but not in PC3 (CI: 1.9), DU145 (CI: 2.0), or LNCaP (CI: 6.5). Cell cycle analyses revealed that the combination with DOC and SO for 72 hours resulted in the accumulation of cells in G2-M phase followed by sub-G1 accumulation in LN-CSS cells. Annexin V assays showed that 43% apoptosis was induced by the combination therapy in LN-CSS cells, while only 12% by DOC only in LN-CSS cells.
Conclusion: Our results strongly suggest that LDH-A plays an important role in DOC resistance in advanced PC cells and inhibition of LDH-A promotes DOC-sensitivity especially in CRPC cells. Our study may provide valuable information for the future development of targeted therapies in patients with CRPC.
Citation Format: Hiroyuki Muramatsu, Makoto Sumitomo, Shingo Morinaga, Hiroshi Saiki, Ikuo Kobayashi, Keishi Kajikawa, Genya Nishikawa, Yoshiharu Kato, Masahito Watanabe, Kent Kanao, Kogenta Nakamura, kazuhiro Yoshikawa. Targeting lactate dehydrogenase-A promotes docetaxel induced cytotoxicity predominantly in castration-resistant prostate cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4400. doi:10.1158/1538-7445.AM2017-4400
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Watanabe M, Kanao K, Suzuki S, Muramatsu H, Morinaga S, Kajikawa K, Kobayashi I, Nishikawa G, Kato Y, Nakamura K, Yoshikawa K, Ueda R, Sumitomo M. Abstract 3961: Increased CCR4-positive regulatory T cells in biopsy specimen of poor prognosis prostate cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-3961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction & Objective:
Regulatory T cells (Treg) play important roles in suppression of the immune response, including anti-tumor immunity. C-C chemokine receptor 4 (CCR4) is highly expressed on effector Tregs, and the anti-CCR4 antibody is attracting attention as a novel immunotherapeutic agent for solid tumors. The purpose of this study was to evaluate the expression of CCR4-positive Tregs in biopsy specimens of men with prostate cancer with a poor prognosis and to estimate the clinical potential of CCR4-targeting therapy for prostate cancer.
Material & Methods:
Data for 60 men diagnosed with prostate cancer based on transrectal 12-core systemic biopsy were retrospectively analyzed. They were divided into two groups, a good prognosis group comprising men with no disease progression during the observation period and a poor prognosis group comprising men with progression to castration resistant prostate cancer. In the biopsy cores, the core with the highest tumor volume was selected for immunohistochemical evaluation. Tregs were evaluated using immunohistochemistry with double staining using anti-forkhead box protein 3 (FOXP3) antibodies and anti-CCR4 antibodies. The number of CCR4+/- FOXP3+ cells in the biopsy specimens were compared between the two groups. Furthermore, the correlation between the number of CCR4+ FOXP3+ cells and clinical stage, PSA at diagnosis, and Gleason score were evaluated.
Results:
The good prognosis group included 29 men and the poor prognosis group included 31 men. Approximately 70-80% of FOXP3+ cells were positive for CCR4. There was no significant difference in the ratio of number of CCR4+ FOXP3+ cells to the number of total FOXP3+ cells between the poor and good prognosis groups. However, the total number of FOXP3+ cells significantly increased in the poor prognosis group than in the good prognosis group (200.1 ± 174.8 vs. 38.1 ± 38.1, p < 0.01). Furthermore, the number of CCR4+ FOXP3+ cells significantly increased in the poor prognosis group than in the good prognosis group (123.6 ± 99.1 vs. 58.88 ± 26.4, p < 0.01). The number of CCR4+ FOXP3+ cells positively correlated with clinical stage (ρ = 0.558, p < 0.001) and Gleason score (ρ = 0.458, p = 0.006) in prostate cancer. However, there was no significant correlation between the number of CCR4+ FOXP3+ cells and PSA at diagnosis. The men with a lower number of CCR4+ FOXP3+ cells had a significantly longer median survival time than those with high expression (not reached vs. 69.0 months; p = 0.040).
Conclusions:
Our results suggest the clinical potential of CCR4-targeted therapy for poor prognosis prostate cancer.
Citation Format: Masahito Watanabe, Kent Kanao, Susumu Suzuki, Hiroyuki Muramatsu, Shingo Morinaga, Keishi Kajikawa, Ikuo Kobayashi, Genya Nishikawa, Yoshiharu Kato, Kogenta Nakamura, Kazuhiro Yoshikawa, Ryuzo Ueda, Makoto Sumitomo. Increased CCR4-positive regulatory T cells in biopsy specimen of poor prognosis prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3961. doi:10.1158/1538-7445.AM2017-3961
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Affiliation(s)
| | - Kent Kanao
- Aichi Medical University, Nagakute, Aichi, Japan
| | | | | | | | | | | | | | | | | | | | - Ryuzo Ueda
- Aichi Medical University, Nagakute, Aichi, Japan
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