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Nishiike S, Michiba T, Ito R, Ashida N, Kato H, Kuki A, Ogawa K, Tamura K, Uetsuka S. Quantitative measurement of airborne particles during endoscopic and microscopic ear surgery in the operating room. J Laryngol Otol 2024; 138:405-409. [PMID: 37646247 DOI: 10.1017/s0022215123001433] [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] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy. METHOD In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter. RESULTS The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes. CONCLUSION Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.
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Affiliation(s)
- S Nishiike
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - T Michiba
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - R Ito
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - N Ashida
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - H Kato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Kuki
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Tamura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - S Uetsuka
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
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Kouzu K, Tsujimoto H, Ishinuki T, Shinji S, Shinkawa H, Tamura K, Uchino M, Ohge H, Shimizu J, Haji S, Mohri Y, Yamashita C, Kitagawa Y, Suzuki K, Kobayashi M, Kobayashi M, Hanai Y, Nobuhara H, Imaoka H, Yoshida M, Mizuguchi T, Mayumi T, Kitagawa Y. The effectiveness of fascial closure with antimicrobial-coated sutures in preventing incisional surgical site infections in gastrointestinal surgery: a systematic review and meta-analysis. J Hosp Infect 2024; 146:174-182. [PMID: 37734678 DOI: 10.1016/j.jhin.2023.09.006] [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: 06/21/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis of the efficacy of fascial closure using antimicrobial-sutures specifically for the prevention of surgical site infections (SSIs) in gastrointestinal surgery, as part of the revision of the SSI prevention guidelines of the Japanese Society of Surgical Infectious Diseases (JSSI). We searched CENTRAL, PubMed and ICHUSHI-Web in May 2023, and included randomized controlled trials (RCTs) comparing antimicrobial-coated and non-coated sutures for fascial closure in gastrointestinal surgery (PROSPERO No. CRD42023430377). Three authors independently screened the RCTs. We assessed the risk of bias and the GRADE criteria for the extracted data. The primary outcome was incisional SSI and the secondary outcomes were abdominal wall dehiscence and the length of postoperative hospital stay. This study was supported partially by the JSSI. A total of 10 RCTs and 5396 patients were included. The use of antimicrobial-coated sutures significantly lowered the risk of incisional SSIs compared with non-coated suture (risk ratio: 0.79, 95% confidence intervals: 0.64-0.98). In subgroup analyses, antimicrobial-coated sutures reduced the risk of SSIs for open surgeries, and when monofilament sutures were used. Antimicrobial-coated sutures did not reduce the incidence of abdominal wall dehiscence and the length of hospital stay compared with non-coated sutures. The certainty of the evidence was rated as moderate according to the GRADE criteria, because of risk of bias. In conclusion, the use of antimicrobial-coated sutures for fascial closure in gastrointestinal surgery is associated with a significantly lower risk of SSI than non-coated sutures.
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Affiliation(s)
- K Kouzu
- Department of Surgery, National Defense Medical College, Japan
| | - H Tsujimoto
- Department of Surgery, National Defense Medical College, Japan.
| | - T Ishinuki
- Department of Nursing, Division of Surgical Science, Sapporo Medical University, Japan
| | - S Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Japan
| | - H Shinkawa
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - K Tamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - M Uchino
- Department of Gastroenterological Surgery, Division of Inflammatory Bowel Disease, Hyogo Medical University, Japan
| | - H Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - J Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Japan
| | - S Haji
- Department of Surgery, Soseikai General Hospital, Japan
| | - Y Mohri
- Department of Surgery, Mie Prefectural General Medical Center, Japan
| | - C Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Japan
| | - Y Kitagawa
- Department of Infection Control, National Center for Geriatrics and Gerontology, Japan
| | - K Suzuki
- Department of Infectious Disease Medicine, School of Medicine, University of Occupational and Environmental Health, Japan
| | - M Kobayashi
- Department of Anesthesiology, Hokushinkai Megumino Hospital, Japan
| | - M Kobayashi
- Laboratory of Clinical Pharmacokinetics, School of Pharmacy, Kitasato University, Japan
| | - Y Hanai
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, Toho University, Japan
| | - H Nobuhara
- Department of Dentistry, Hiroshima Prefectural Hospital, Japan
| | - H Imaoka
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Japan
| | - M Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare, School of Medicine, Japan
| | - T Mizuguchi
- Department of Nursing, Division of Surgical Science, Sapporo Medical University, Japan
| | - T Mayumi
- Department of Intensive Care Unit, Japan Community Healthcare Organization Chukyo Hospital, Japan
| | - Y Kitagawa
- Keio University, School of Medicine, Japan
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Saura C, Modi S, Krop I, Park YH, Kim SB, Tamura K, Iwata H, Tsurutani J, Sohn J, Mathias E, Liu Y, Cathcart J, Singh J, Yamashita T. Trastuzumab deruxtecan in previously treated patients with HER2-positive metastatic breast cancer: updated survival results from a phase II trial (DESTINY-Breast01). Ann Oncol 2024; 35:302-307. [PMID: 38092229 DOI: 10.1016/j.annonc.2023.12.001] [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: 04/27/2023] [Revised: 08/02/2023] [Accepted: 12/04/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Primary analysis of the multicenter, open-label, single-arm, phase II DESTINY-Breast01 trial (median follow-up 11.1 months) demonstrated durable antitumor activity with trastuzumab deruxtecan (T-DXd) in patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (mBC) previously treated with trastuzumab emtansine (T-DM1). We report updated cumulative survival outcomes with a median follow-up of 26.5 months (data cut-off 26 March 2021). PATIENTS AND METHODS Patients with HER2-positive mBC resistant or refractory to T-DM1 received T-DXd 5.4 mg/kg intravenously every 3 weeks until disease progression, unacceptable adverse events, or withdrawal of consent. The primary endpoint was confirmed objective response rate (ORR) by independent central review (ICR). Secondary endpoints included overall survival (OS), duration of response (DoR), progression-free survival (PFS), and safety. RESULTS The ORR by ICR was 62.0% [95% confidence interval (CI) 54.5% to 69.0%] in patients who received T-DXd 5.4 mg/kg every 3 weeks (n = 184). Median OS was 29.1 months (95% CI 24.6-36.1 months). Median PFS and DoR were 19.4 months (95% CI 14.1-25.0 months) and 18.2 months (95% CI 15.0 months-not evaluable), respectively. Drug-related treatment-emergent adverse events (TEAEs) were observed in 183 patients (99.5%), and 99 patients (53.8%) had one or more grade ≥3 TEAEs. Adjudicated drug-related interstitial lung disease/pneumonitis occurred in 15.8% of patients (n = 29), of which 2.7% (n = 5) were grade 5. CONCLUSIONS These updated results provide further evidence of sustained antitumor activity of T-DXd with a consistent safety profile in heavily pretreated patients with HER2-positive mBC.
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Affiliation(s)
- C Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - S Modi
- Memorial Sloan Kettering Cancer Center, New York
| | - I Krop
- Yale Cancer Center, New Haven, USA
| | | | - S-B Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - K Tamura
- Shimane University Hospital, Izumo
| | - H Iwata
- Aichi Cancer Center Hospital, Nagoya
| | - J Tsurutani
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - J Sohn
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - E Mathias
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - Y Liu
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - J Cathcart
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - J Singh
- Daiichi Sankyo, Inc., Basking Ridge, USA
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Ishioka C, Minami H, Ohe Y, Tamura K, Saijo N. [History of the Japanese Society of Medical Oncology]. Gan To Kagaku Ryoho 2024; 51:45-52. [PMID: 38247091] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
The Japanese Society of Medical Oncology(JSMO)was founded in 1993 by the Research Society of Clinical Oncology, the predecessor of the Society. Twenty years have passed since the transition to JSMO in 2003. During this time, JSMO has contributed to the establishment of the academic field of medical oncology in Japan for many years. On the other hand, over the last 20 years, cancer treatment by anti-cancer agents, which forms the basis of medical oncology, has made significant progress, prolonging the survival period of many advanced cancers. In the last 5 years in particular, there have been remarkable advances in the development and clinical introduction of immune checkpoint inhibitors, cancer molecular targeted agents based on genetic abnormalities, and cancer genomic medicine. Furthermore, in addition to conventional multidisciplinary treatment with surgery, radiology, and palliative medicine, collaboration with cancer-related interdisciplinary fields has become extremely important in recent years. For this reason, there is an increasing need for medical oncologists who specialize in organ(cancer type)cross-sectional treatment including cancer genomic medicine, and treat advanced cancer as a systemic disease as a specialist in internal medicine. In this article, we review the history of the Japanese Society of Medical Oncology and the history of medical oncology in Japan and look forward to the future of medical oncology.
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Affiliation(s)
- Chikashi Ishioka
- Dept. of Clinical Oncology, Tohoku University Graduate School of Medicine
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Tamura K, Yoshida T, Masuda K, Matsumoto Y, Shinno Y, Okuma Y, Goto Y, Horinouchi H, Yamamoto N, Ohe Y. Comparison of clinical outcomes of osimertinib and first-generation EGFR-tyrosine kinase inhibitors (TKIs) in TKI-untreated EGFR-mutated non-small-cell lung cancer with leptomeningeal metastases. ESMO Open 2023; 8:101594. [PMID: 37517364 PMCID: PMC10485398 DOI: 10.1016/j.esmoop.2023.101594] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/07/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Leptomeningeal metastases (LM) are devastating complications of epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC). Although osimertinib, a third-generation EGFR-tyrosine kinase inhibitor (TKI), has better penetration into the central nervous system than first-generation EGFR-TKIs, data on the distinct activity of EGFR-TKIs in untreated advanced EGFR-mutated NSCLC with LM are lacking. PATIENTS AND METHODS We retrospectively reviewed patients treated with EGFR-TKIs for TKI-untreated common EGFR-mutated NSCLC with LM between July 2002 and July 2021 at the National Cancer Center Hospital. The patients were divided into two groups: patients treated with osimertinib (Osi group) and those treated with gefitinib or erlotinib [first-generation (1G)-TKI group]. RESULTS Of the 967 patients, 71 were eligible, including 29 in the Osi group and 42 in the 1G-TKI group. The median progression-free survival (PFS) and overall survival (OS) in the Osi group were better than those in the 1G-TKI group (PFS: 16.9 months versus 8.6 months, P = 0.007, and OS: 26.6 months versus 20.0 months, P = 0.158). The LM-overall response rate (ORR) and LM-PFS were significantly better in the Osi group than in the 1G-TKI group (LM-ORR: 62.5% versus 25.7%, P = 0.007; LM-PFS: 23.4 months versus 12.1 months, P = 0.021). In the subgroup analysis of EGFR mutation status, LM-PFS for patients with exon 19 deletion was significantly longer in the Osi group than in the 1G-TKI group (32.7 months versus 13.4 months, P = 0.013), whereas those with L858R mutation in exon 21 did not differ between the two groups. In the multivariate analysis, osimertinib and exon 19 deletion were significant factors for better LM-PFS and OS. CONCLUSION Osimertinib can be more effective for untreated common EGFR-mutated NSCLC patients with LM, especially those with exon 19 deletion, compared to first-generation TKIs.
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Affiliation(s)
- K Tamura
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo; Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo
| | - T Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo; Department of Experimental Therapeutics, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan.
| | - K Masuda
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
| | - Y Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
| | - Y Shinno
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
| | - Y Okuma
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
| | - Y Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
| | - H Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
| | - N Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo; Department of Experimental Therapeutics, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
| | - Y Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Chuo-ku, Tokyo
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Inoue D, Yamamoto M, Arima H, Tamura K, Yoshida Y. Author Correction: A nationwide web-based survey of oncologic surgeons to clarify the current status of preoperative assessment for elderly cancer surgery patients in Japan. Sci Rep 2023; 13:9705. [PMID: 37322052 DOI: 10.1038/s41598-023-36673-5] [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: 06/17/2023] Open
Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, 7-45-1 Nanakuma, Jhonan-Ku, Fukuoka, Fukuoka, Japan
| | - Kazuo Tamura
- Emeritus Professor, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jhonan-Ku, Fukuoka, Fukuoka, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-Cho, Yoshida-Gun, Fukui, 910-1193, Japan.
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Im SA, Gennari A, Park YH, Kim JH, Jiang ZF, Gupta S, Fadjari TH, Tamura K, Mastura MY, Abesamis-Tiambeng MLT, Lim EH, Lin CH, Sookprasert A, Parinyanitikul N, Tseng LM, Lee SC, Caguioa P, Singh M, Naito Y, Hukom RA, Smruti BK, Wang SS, Kim SB, Lee KH, Ahn HK, Peters S, Kim TW, Yoshino T, Pentheroudakis G, Curigliano G, Harbeck N. Pan-Asian adapted ESMO Clinical Practice Guidelines for the diagnosis, staging and treatment of patients with metastatic breast cancer. ESMO Open 2023; 8:101541. [PMID: 37178669 PMCID: PMC10186487 DOI: 10.1016/j.esmoop.2023.101541] [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: 09/27/2022] [Revised: 03/27/2023] [Accepted: 04/01/2023] [Indexed: 05/15/2023] Open
Abstract
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, staging and treatment of patients with metastatic breast cancer (MBC) was published in 2021. A special, hybrid guidelines meeting was convened by ESMO and the Korean Society of Medical Oncology (KSMO) in collaboration with nine other Asian national oncology societies in May 2022 in order to adapt the ESMO 2021 guidelines to take into account the differences associated with the treatment of MBC in Asia. These guidelines represent the consensus opinions reached by a panel of Asian experts in the treatment of patients with MBC representing the oncological societies of China (CSCO), India (ISMPO), Indonesia (ISHMO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), the Philippines (PSMO), Singapore (SSO), Taiwan (TOS) and Thailand (TSCO). The voting was based on the best available scientific evidence and was independent of drug access or practice restrictions in the different Asian countries. The latter were discussed when appropriate. The aim of these guidelines is to provide guidance for the harmonisation of the management of patients with MBC across the different regions of Asia, drawing from data provided by global and Asian trials whilst at the same time integrating the differences in genetics, demographics and scientific evidence, together with restricted access to certain therapeutic strategies.
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Affiliation(s)
- S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea.
| | - A Gennari
- Department of Translational Medicine, University Piemonte Orientale, Novara, Italy
| | - Y H Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - J H Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Z-F Jiang
- Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - S Gupta
- Tata Memorial Centre and Homi Bhabha National Institute, Mumbai, India
| | - T H Fadjari
- Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - K Tamura
- Department of Medical Oncology, Shimane University Hospital, Shimane, Japan
| | - M Y Mastura
- Cancer Centre, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - M L T Abesamis-Tiambeng
- Section of Medical Oncology, Department of Internal Medicine, Cardinal Santos Cancer Center, San Juan, The Philippines
| | - E H Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - C-H Lin
- Department of Medical Oncology, National Taiwan University Hospital, Cancer Center Branch, Taipei, Taiwan
| | - A Sookprasert
- Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - N Parinyanitikul
- Medical Oncology Unit, Department of Medicine, Faculty of Medicine, King Chulalongkorn Memorial Hospital and Chulalongkorn University, Bangkok, Thailand
| | - L-M Tseng
- Taipei-Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - S-C Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore (NCIS), Singapore, Singapore
| | - P Caguioa
- The Cancer Institute of St Luke's Medical Center, National Capital Region, The Philippines; The Cancer Institute of the University of Santo Tomas Hospital, National Capital Region, The Philippines
| | - M Singh
- Department of Radiotherapy, Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia; Department of Oncology, Pantai Cancer Institute, Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Y Naito
- Department of General Internal Medicine, National Cancer Center Hospital East, Kashiwa, Japan
| | - R A Hukom
- Department of Hematology and Medical Oncology, Dharmais Hospital (National Cancer Center), Jakarta, Indonesia
| | - B K Smruti
- Medical Oncology, Lilavati Hospital and Research Centre and Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - S-S Wang
- Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - S B Kim
- Department of Oncology, Asan Medical Centre, Seoul, Republic of Korea
| | - K-H Lee
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - H K Ahn
- Division of Medical Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - S Peters
- Oncology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - T W Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - T Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Haematology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Center, Department of Obstetrics and Gynaecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
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Ninomiya K, Inoue D, Sugimoto K, Tanaka C, Murofushi K, Okuyama T, Watanuki S, Imamura CK, Sakai D, Sakurai N, Watanabe K, Tamura K, Saeki T, Ishiguro H. Significance of the comprehensive geriatric assessment in the administration of chemotherapy to older adults with cancer: Recommendations by the Japanese Geriatric Oncology Guideline Committee. J Geriatr Oncol 2023:101485. [PMID: 37062639 DOI: 10.1016/j.jgo.2023.101485] [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: 10/23/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023]
Abstract
INTRODUCTION The number of older patients with cancer is expected to continue to increase owing to the aging population. Recently, the usefulness of geriatric assessment (GA) conducted by multiple staff members from different medical backgrounds has been reported; however, a consensus on the effectiveness of GA has not yet been achieved. MATERIALS AND METHODS We, as the Japanese Geriatric Oncology Guideline Committee for elderly patients with cancer, conducted a literature search of randomized controlled trials published before August 2021 that used GA or comprehensive GA (CGA) as an intervention for patients with cancer undergoing chemotherapy. As the key outcomes for answering the clinical question, we focused on survival benefit, adverse events, and quality of life (QOL). After a systematic review of these studies, the expert panel member developed recommendations according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. RESULTS For older patients with cancer, GA or CGA is suggested during or before chemotherapy (weakly recommended). Chemotherapy-induced adverse events were significantly reduced by GA/CGA interventions without any adverse effects on survival. Health-related QOL tended to improve with the GA/CGA interventions. DISCUSSION Although, in our opinion, GA/CGA does require time and resources, it poses no harm patients. Therefore, we suggest expanding the human resources and educating skills of medical providers for clinical implementation of GA/CGA.
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Affiliation(s)
- Kiichiro Ninomiya
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan.
| | - Daisuke Inoue
- Department of Obstetrics and Gynecology, University of Fukui, Fukui, Japan
| | - Ken Sugimoto
- Department of General Geriatric Medicine, Kawasaki Medical School, Okayama, Japan
| | - Chie Tanaka
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Keiko Murofushi
- Division of Radiation Oncology, Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toru Okuyama
- Department of Psychiatry / Palliative Care Center, Nagoya City University West Medical Center, Aichi, Japan
| | - Shigeaki Watanuki
- National Center for Global Health and Medicine, National College of Nursing, Tokyo, Japan
| | - Chiyo K Imamura
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Daisuke Sakai
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Kiyotaka Watanabe
- Division of Medical Oncology, Department of Medicine, School of Medicine, Teikyo University, Tokyo, Japan
| | - Kazuo Tamura
- NPO Clinical Hematology/Oncology Treatment Study Group, Fukuoka, Japan
| | - Toshiaki Saeki
- Breast Oncology Service, Saitama Medical University International Medical Center, Saitama, Japan
| | - Hiroshi Ishiguro
- Breast Oncology Service, Saitama Medical University International Medical Center, Saitama, Japan
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Hayashi T, Sato R, Tamura K. Relationships among falls and dietary patterns, nutritional inadequacy and prefrailty in community-dwelling older Japanese females: A cross-sectional study. Asia Pac J Clin Nutr 2023; 32:106-119. [PMID: 36997492 DOI: 10.6133/apjcn.202303_32(1).0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
BACKGROUND AND OBJECTIVES Falls are common among older females. This study investigated the relationships among falls and dietary patterns, nutritional inadequacy and prefrailty in community-dwelling older Japanese females. METHODS AND STUDY DESIGN This cross-sectional study involved 271 females aged 65 and over. Prefrailty was defined as exhibiting one or two of the five Japanese version of the Cardiovascular Health Study criteria. Frailty was excluded (n=4). Energy, nutrient and food intakes were estimated using a validated FFQ. Dietary patterns were determined from intakes of 20 food groups assessed with FFQ, by cluster analysis. Nutritional inadequacy for the selected 23 nutrients in each dietary pattern was examined based on DRIs. Binomial logistic regression was applied to examine the relationships among falls and dietary pat-terns, prefrailty, and inadequate nutrients. RESULTS Data from 267 participants were included. The incidence of falls was 27.3%, and 37.4% of participants were classified as prefrailty. Three dietary patterns identified were namely; 'rice and fish and shellfish' (n=100); 'vegetables and dairy products' (n=113); and 'bread and beverages' (n=54). A binomial logistic regression analysis revealed that dietary patterns of 'rice and fish and shellfish' (OR, 0.41; 95% CI, 0.16-0.95), and 'vegetables and dairy products' (OR, 0.30; 95% CI, 0.12-0.78) were negatively correlated with falls, and falls was positively associated with prefrailty. CONCLUSIONS Dietary patterns characterized by 'rice and fish and shellfish', and 'vegetables and dairy products' were associated with a reduced incidence of falls in community-dwelling older Japanese females. Larger prospective studies are needed to validate these results.
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Affiliation(s)
- Tatsumi Hayashi
- Faculty of Economics, Shimonoseki City University, Yamaguchi, Japan. ;
- Faculty of Food and Nutrition, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Rumi Sato
- Council of Social Welfare, Bungo Ono city, Oita, Japan
| | - Kazuo Tamura
- Research Promotion Division, Fukuoka University, Fukuoka, Japan
- NPO Clinical Hematology Oncology Treatment Study Group, Fukuoka, Japan
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Matsumoto T, Umeno J, Jimbo K, Arai M, Iwama I, Kashida H, Kudo T, Koizumi K, Sato Y, Sekine S, Tanaka S, Tanakaya K, Tamura K, Hirata K, Fukahori S, Esaki M, Ishikawa H, Iwama T, Okazaki Y, Saito Y, Matsuura N, Mutoh M, Tomita N, Akiyama T, Yamamoto T, Ishida H, Nakayama Y. Clinical Guidelines for Diagnosis and Management of Juvenile Polyposis Syndrome in Children and Adults-Secondary Publication. J Anus Rectum Colon 2023; 7:115-125. [PMID: 37113581 PMCID: PMC10129355 DOI: 10.23922/jarc.2023-002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/16/2023] [Indexed: 04/29/2023] Open
Abstract
Juvenile polyposis syndrome (JPS) is a rare disease characterized by multiple hamartomatous polyps within the gastrointestinal tract. SMAD4 or BMPR1A is known as a causative gene of JPS. Approximately 75% of newly diagnosed cases have an autosomal-dominantly inherited condition, whereas 25% are sporadic without previous history of polyposis in the family pedigree. Some patients with JPS develop gastrointestinal lesions in childhood and require continuous medical care until adulthood. JPS is classified into three categories according to phenotypic features of polyp distributions, including generalized juvenile polyposis, juvenile polyposis coli, and juvenile polyposis of the stomach. Juvenile polyposis of the stomach is caused by germline pathogenic variants of SMAD4 with a high risk leading to gastric cancer. Pathogenic variants of SMAD4 are also associated with hereditary hemorrhagic telangiectasia-JPS complex, inducing regular cardiovascular survey. Despite growing concerns regarding the managing JPS in Japan, there are no practical guidelines. To address this situation, the guideline committee was organized by the Research Group on Rare and Intractable Diseases granted by the Ministry of Health, Labor and Welfare involving specialists from multiple academic societies. The present clinical guidelines explain the principles in the diagnosis and management of JPS with three clinical questions and corresponding recommendations based on a careful review of the evidence and involve incorporating the concept of the Grading of Recommendations, Assessment, Development, and Evaluation system. Herein, we present the clinical practice guidelines of JPS to promote seamless implementation of accurate diagnosis and appropriate management of pediatric, adolescent, and adult patients with JPS.
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Affiliation(s)
- Takayuki Matsumoto
- Division of Gastroenterology, Department of Medicine, Iwate Medical University, Morioka, Japan
| | - Junji Umeno
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keisuke Jimbo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masami Arai
- Department of Clinical Genetics, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Itaru Iwama
- Division of Gastroenterology and Hepatology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kashida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takahiro Kudo
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Koichi Koizumi
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasushi Sato
- Department of Community Medicine for Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Shigeki Sekine
- Division of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Kohji Tanakaya
- Department of Surgery, Iwakuni Clinical Center, Iwakuni, Japan
| | - Kazuo Tamura
- Division of Genetic Medicine, Graduate School of Science and Engineering Research, Kindai University, Higashiosaka, Japan
| | - Keiji Hirata
- Department of Surgery 1, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Suguru Fukahori
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Motohiro Esaki
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Hideki Ishikawa
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Ishikawa Gastroenterology Clinic, Osaka, Japan
| | - Takeo Iwama
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yasushi Okazaki
- Intractable Disease Research Center, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | | | - Michihiro Mutoh
- Department of Molecular-Targeting Prevention, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Naohiro Tomita
- Cancer Treatment Center, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Takashi Akiyama
- Department of Pediatric Surgery, Chuden Hospital, Hiroshima, Japan
| | - Toshiki Yamamoto
- Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Yoshiko Nakayama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Muscular Echo-Intensity of the Quadriceps by Ultrasound Is More Related to Improvement of Gait Independence than Muscle Thickness in Older Inpatients. J Nutr Health Aging 2023; 27:103-110. [PMID: 36806865 DOI: 10.1007/s12603-023-1880-6] [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] [Indexed: 01/18/2023]
Abstract
OBJECTIVES This study aimed to examine whether the decrease in muscular echo-intensity of the quadriceps by ultrasound in older inpatients is related to the improvement of gait independence than the increase of muscle thickness. DESIGN Longitudinal study. SETTING Hospital-based study. PARTICIPANTS This study included 171 inpatients aged ≥ 65 years (median age: 84.0 [77.0-88.0], 56.1% female). Patients who were able to walk independently at hospital admission were excluded from the study. MEASUREMENTS Improvement of gait independence during hospital stay was assessed using the change in Functional Independence Measure (FIM) gait score (i.e., FIM gait score at hospital discharge minus FIM gait score at hospital admission) and FIM gait score at hospital discharge. Muscular echo-intensity and muscle thickness of the quadriceps were assessed at hospital admission and discharge using ultrasound images, respectively. Muscular echo-intensity has been shown to be mainly related to intramuscular adipose tissue. Multiple linear regression analysis was performed to identify the factors independently associated with the change in FIM gait score and FIM gait score at discharge. RESULTS Change in quadriceps echo-intensity was independently and significantly associated with the change in FIM gait score (β = -0.22, p = 0.017) and FIM gait score at hospital discharge (β = -0.21, p = 0.017). In contrast, change in quadriceps thickness was not independently and significantly associated with the change in FIM gait score (β = 0.16, p = 0.050) and FIM gait score at hospital discharge (β = 0.15, p = 0.050). CONCLUSIONS Our study indicates that a decrease in muscular echo-intensity of the quadriceps by ultrasound is more related to the improvement of gait independence than an increase of muscle thickness in older inpatients. Intervention for intramuscular adipose tissue of the quadriceps may be important for improving gait independence in older inpatients.
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Affiliation(s)
- N Akazawa
- Naoki Akazawa, Assistant Professor, Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-cho, Tokushima-city, Tokushima 770-8514, Japan, Tel +81 88 602 8000, Fax +81 88 602 8146,
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Kimata A, Ishigaki K, Tamura K, Iizuka K, Sakurai N, Terai K, Heishima T, Yoshida O, Asano K. Transarterial chemoembolisation for palliative treatment of renal cell carcinoma in two dogs with pulmonary metastasis. J Small Anim Pract 2022; 63:904-910. [PMID: 36226325 PMCID: PMC10092729 DOI: 10.1111/jsap.13559] [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] [Received: 09/18/2021] [Revised: 08/24/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022]
Abstract
Two dogs with anorexia and rapid weight loss were referred to our hospital due to a right renal mass and several pulmonary nodules. Both dogs underwent needle core biopsy of the mass, followed by transarterial chemoembolisation of the renal mass. A catheter was inserted from the femoral artery and advanced into the right renal artery. A suspension of carboplatin (100 mg/m2 ) and equivalent lipiodol was administered via the inserted multipurpose catheter. Immediately after, under fluoroscopic guidance, pulse injections of small amounts of gelatin particles (diameter 1 mm) dissolved in iohexol were administered until complete embolisation of the renal artery. Histopathologic diagnosis was renal cell carcinoma in both dogs. Clinical signs improved for 134 and 358 days after transarterial chemoembolisation. In addition, postoperative radiographs demonstrated a decrease in the tumour size. The dogs died 215 and 525 days after the initial evaluation, respectively. As a palliative treatment, transarterial chemoembolisation might help reduce the tumour volume and improve the quality of life in dogs with renal cell carcinoma and distant metastases.
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Affiliation(s)
- A Kimata
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - K Ishigaki
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - K Tamura
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - K Iizuka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - N Sakurai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - K Terai
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - T Heishima
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - O Yoshida
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
| | - K Asano
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, College of Bioresource Sciences, Nihon University, Fujisawa, Kanagawa, 252-0880, Japan
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13
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Hayashi T, Sato R, Ito Y, Ninomiya M, Tanaka S, Tamura K. High Blood Pressure and Changes in the Body Mass Index Category Among Japanese Children: A Follow-Up Study Using the Updated American Academy of Pediatrics Guidelines. Cureus 2022; 14:e26377. [PMID: 35911320 PMCID: PMC9329601 DOI: 10.7759/cureus.26377] [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] [Accepted: 06/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background High blood pressure (HBP) has become a public health issue worldwide. The relationship between high BP and changes in the body mass index (BMI) category in Japanese pubertal children has not yet been examined. To resolve this issue, we examined existing data with a focus on the primordial prevention of high BP signs, including elevated BP, among pubertal children aged 12 and 15 years. Methods Height, body weight, and BP data were examined from health checkups of 18,247 children conducted between 1993 and 2000 in the Karatsu Study, which was a cohort of pediatric lifestyle-related disease prevention medical health checkups in Japan. BP and BMI were assessed using the updated American Academy of Pediatrics (AAP) guidelines and Endocrine Society’s clinical practice guidelines definitions, respectively. Results Follow-up data were obtained from 7,090 subjects (50.5% boys). Stage 2 hypertension (HTN) was detected in 3% and 2.7% of boys and girls aged 12 years, respectively, and in 2.7% and 1% of boys and girls aged 15 years, respectively. Among children aged 15 years, 1.4% were newly classified with stage 2 hypertension, and 15.6% exhibited improvements to a normal BP. A binomial logistic regression analysis of high BP and BMI category changes revealed odds ratios (OR) in the group with a deteriorated BMI category of 1.51 (95% confidence interval (CI), 1.17-1.94), 2.30 (95%CI, 1.66-3.17), and 6.83 (95%CI, 4.14-11.29) for elevated BP, stage 1 hypertension, and stage 2 hypertension, respectively. Conclusion High BP in puberty positively correlated with BMI category changes. Considering the presence of the tracking phenomenon in hypertension, BP monitoring is an essential part of the early strategy for the prevention of lifestyle-related diseases in childhood, and improvements in BP control are crucial in early life.
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Frenel JS, Kim JW, Aryal N, Asher R, Berton D, Vidal L, Pautier P, Ledermann JA, Penson RT, Oza AM, Korach J, Huzarski T, Pignata S, Colombo N, Park-Simon TW, Tamura K, Sonke GS, Freimund AE, Lee CK, Pujade-Lauraine E. Efficacy of subsequent chemotherapy for patients with BRCA1/2-mutated recurrent epithelial ovarian cancer progressing on olaparib versus placebo maintenance: post-hoc analyses of the SOLO2/ENGOT Ov-21 trial. Ann Oncol 2022; 33:1021-1028. [PMID: 35772665 DOI: 10.1016/j.annonc.2022.06.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the SOLO2 trial (ENGOT Ov-21; NCT01874353), maintenance olaparib in patients with platinum-sensitive relapsed ovarian cancer (PSROC) and BRCA mutation significantly improved progression-free survival (PFS) and prolonged overall survival (OS). Following disease progression on olaparib, efficacy of subsequent chemotherapy remains unknown. PATIENTS AND METHODS We conducted a post-hoc hypothesis-generating analysis of SOLO2 data to determine the efficacy of different chemotherapy regimens following RECIST disease progression in patients who received olaparib or placebo. We evaluated time to second progression (TTSP) calculated from the date of RECIST progression to the next progression/death. RESULTS The study population comprised 147 patients who received chemotherapy as their first subsequent treatment after RECIST progression. Of these, 69 (47%) and 78 (53%) were originally randomized to placebo and olaparib arms, respectively. In the placebo-treated cohort, 27/69 and 42/69 received non-platinum and platinum-based chemotherapy, respectively, compared with 24/78 and 54/78, respectively, in the olaparib-treated cohort. Among patients treated with chemotherapy (N = 147), TTSP was significantly longer in the placebo than in the olaparib arm: 12.1 versus 6.9 months [hazard ratio (HR) 2.17, 95% confidence interval (CI) 1.47-3.19]. Similar result was obtained on multivariable analysis adjusting for prognostic factors at RECIST progression (HR 2.13, 95% CI 1.41-3.22). Among patients treated with platinum-based chemotherapy (n = 96), TTSP was significantly longer in the placebo arm: 14.3 versus 7.0 months (HR 2.89, 95% CI 1.73-4.82). Conversely, among patients treated with non-platinum-based chemotherapy (n = 51), the TTSP was comparable in the placebo and olaparib arms: 8.3 versus 6.0 months (HR 1.58, 95% CI 0.86-2.90). CONCLUSIONS Following progression from maintenance olaparib in the recurrent setting, the efficacy of platinum-based subsequent chemotherapy seems to be reduced in BRCA1/2-mutated patients with PSROC compared to patients not previously receiving poly (ADP-ribose) polymerase inhibitors (PARPi). The optimal strategy for patients who relapse after PARPi is an area of ongoing research.
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Affiliation(s)
- J S Frenel
- Institut de Cancerologie de l'Ouest, GINECO, GINEGEPS, Centre René Gauducheau, Saint-Herblain, France.
| | - J W Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - N Aryal
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | - R Asher
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
| | - D Berton
- Institut de Cancerologie de l'Ouest, GINECO, GINEGEPS, Centre René Gauducheau, Saint-Herblain, France
| | - L Vidal
- GEICO & H Clínic de Barcelona, Barcelona, Spain
| | - P Pautier
- GINECO & Gustave Roussy Cancer Center, Villejuif, France
| | | | - R T Penson
- Massachusetts General Hospital, Boston, USA
| | - A M Oza
- Princess Margaret Cancer Centre, Toronto, Canada
| | - J Korach
- ISGO & Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - T Huzarski
- Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - S Pignata
- MITO & Department of Urology and Gynecology, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale Napoli, Naples, Italy
| | - N Colombo
- MaNGO & European Institute of Oncology IRCCS and University of Milan-Bicocca, Milano, Italy
| | - T W Park-Simon
- AGO & Medical School, Department of Gynecologic Oncology, Hannover, Hannover, Germany
| | - K Tamura
- Department of Breast and Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - G S Sonke
- DGOG & Netherlands Cancer Institute, Amsterdam, Netherlands
| | - A E Freimund
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C K Lee
- NHMRC CTC Centre, University of Sydney, Camperdown, Sydney, Australia
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Naito T, Uchino J, Kojima T, Matano Y, Minato K, Tanaka K, Mizukami T, Atagi S, Higashiguchi T, Muro K, Takayama K, Furuse J, Morishima E, Takiguchi T, Tamura K. A multicenter, open-label, single-arm study of anamorelin (ONO-7643) in patients with cancer cachexia and low body mass index. Cancer 2022; 128:2025-2035. [PMID: 35195274 PMCID: PMC9303784 DOI: 10.1002/cncr.34154] [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: 10/26/2021] [Revised: 01/20/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022]
Abstract
Background Cancer cachexia is a syndrome characterized by anorexia and decreased body weight. This study evaluated the efficacy and safety of anamorelin, an orally active, selective ghrelin receptor agonist, in patients with cancer cachexia and a low body mass index (BMI). Methods This multicenter, open‐label, single‐arm study enrolled Japanese patients with non–small cell lung cancer or gastrointestinal cancer with cancer cachexia (BMI < 20 kg/m2, involuntary weight loss > 2% in the last 6 months, and anorexia). Patients were administered 100 mg of anamorelin once daily for up to 24 weeks. The primary end point was a composite clinical response (CCR) at 9 weeks, which was defined as an increase in body weight of ≥5% from the baseline, an increase of ≥2 points in the score of the 5‐item Anorexia Symptom Scale of the Functional Assessment of Anorexia/Cachexia Therapy, and being alive. Results One hundred two patients were eligible and enrolled. The means and standard deviations for age and BMI were 71.0 ± 8.2 years and 17.47 ± 1.48 kg/m2, respectively. The CCR rate at 9 weeks was 25.9% (95% confidence interval [CI], 18.3%‐35.3%), which met the primary end point with a lower 95% CI exceeding the prespecified minimum of 8%. Improvements in body weight and anorexia were durable and were accompanied by improvements in patients' global impression of change for appetite/eating‐related symptoms and overall condition. Adverse drug reactions occurred in 37 of 101 treated patients (36.6%), with the most common being glycosylated hemoglobin increases, constipation, and peripheral edema. Conclusions Anamorelin improved body weight and anorexia‐related symptoms in patients with cancer cachexia and a low BMI with durable efficacy and favorable safety and tolerability. Lay Summary Anamorelin is a drug that stimulates appetite and promotes weight gain. This clinical trial was aimed at determining its efficacy and safety in Japanese cancer patients with a low body mass index and cachexia, a syndrome associated with anorexia and weight loss. Anamorelin was found to improve body weight and anorexia‐related symptoms in these patients, and these effects were durable for up to 24 weeks. Moreover, anamorelin was generally well tolerated. These findings suggest that anamorelin is a valuable treatment option for patients with cancer cachexia and a low body mass index.
This single‐arm trial is aimed at investigating the efficacy and safety of anamorelin in Japanese patients with cancer cachexia and a low body mass index. Anamorelin improves body weight and anorexia‐related symptoms with durable efficacy and favorable safety and tolerability.
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Affiliation(s)
- Tateaki Naito
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junji Uchino
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Kojima
- Department of Respiratory Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Yutaka Matano
- Department of Internal Medicine, Komatsu Municipal Hospital, Komatsu, Japan
| | - Koichi Minato
- Division of Respiratory Medicine, Gunma Prefectural Cancer Center, Ota, Japan
| | - Kentaro Tanaka
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takuro Mizukami
- Department of Clinical Oncology, St. Marianna University, Kawasaki, Japan
| | - Shinji Atagi
- Department of Thoracic Oncology, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai, Japan
| | | | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center, Nagoya, Japan
| | - Koichi Takayama
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Mitaka, Japan
| | - Eiichiro Morishima
- Department of Statistical Analysis, Ono Pharmaceutical Co, Ltd, Osaka, Japan
| | - Toru Takiguchi
- Clinical Development Planning, Ono Pharmaceutical Co, Ltd, Osaka, Japan
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Yoshida Y, Tamura K. Implementation of geriatric assessment and long-term care insurance system by medical professionals in cancer treatment: a nationwide survey in Japan. Jpn J Clin Oncol 2022; 52:449-455. [PMID: 35199168 DOI: 10.1093/jjco/hyac020] [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: 11/29/2021] [Accepted: 01/28/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND A questionnaire survey was conducted to assess the implementation status of geriatric assessment in cancer treatment and the potential for collaboration between medical care and the long-term care insurance system. METHODS Questionnaires were sent to 795 facilities in Japan. The questions were instructed to be answered via an online survey (SurveyMonkey®), which began in September 2020 and closed on 31 October 2020. The questionnaire consisted of 8 questions on the status of geriatric assessment implementation and 15 questions on the long-term care insurance system. RESULTS In total, 631 departments in 340 (42.8%) of 795 hospitals and clinics provided responses. Approximately 81.5% of the departments did not perform geriatric assessment. The common reasons were lack of knowledge about geriatric assessment (54.0%) and lack of personnel (35.5%). Even if geriatric assessment was conducted, 63.6% of departments did not utilize geriatric assessment results in clinical practice. Approximately 61.7% of respondents were familiar with the long-term care insurance system and 62.9% with the certification process. Moreover, 28% of respondents used certification examination results in treatment planning. CONCLUSIONS Geriatric assessment is less recognized than the long-term care insurance system, and its results are rarely used in clinical practice. However, 28% of certification examination results are utilized in treatment decision-making. Notably, this survey first showed the incorporation of the long-term care insurance system into the medical care of vulnerable elderly patients with cancer.
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Affiliation(s)
- Yoichiro Yoshida
- Department of Gastroenterological Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Kazuo Tamura
- Professor Emeritus, Fukuoka University, Fukuoka Japan
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Akiyama N, Okamura T, Yoshida M, Kimura SI, Yano S, Yoshida I, Kusaba H, Takahashi K, Fujita H, Fukushima K, Iwasaki H, Tamura K, Saeki T, Takamatsu Y, Zenda S. Difference of compliance rates for the recommendations in Japanese Guideline on Febrile Neutropenia according to respondents’ attributes: the second report on a questionnaire survey among hematology-oncology physicians and surgeons. Support Care Cancer 2022; 30:4327-4336. [PMID: 35094140 PMCID: PMC8942955 DOI: 10.1007/s00520-022-06834-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose The Japanese Society of Medical Oncology (JSMO) published a guideline (GL) on febrile neutropenia (FN) in 2017. This study aims to identify promoting factors and disincentives for complying with GL recommendations according to attributes of doctors providing chemotherapy. Methods A questionnaire survey was conducted with SurveyMonkey™ for physician members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed according to the respondents’ attributes. Result Seven hundred eighty-eight out of retrieved 801 responses were available for analysis. Multivariable analysis demonstrated that the percentage of GL users was higher among women and Japanese Society of Clinical Oncology members. The overall compliance rate was higher among women, JSMO members, and board-certified medical oncologists. Internists emphasized the significance of collecting blood cultures at FN onset, and surgeons stressed the importance of G-CSF prophylaxis. Hematologists were less likely to adhere to recommendations on risk assessment of FN by the Multinational Association of Supportive Care in Cancer score and administration of gammaglobulin products. However, those are acceptable due to the characteristics of their practice. Eight recommendations had no difference in compliance rates between users and non-users, some of whose statements were ambiguous and discretionary. Conclusion Women were more likely to use and adhere to GL. The recommendations should be developed considering the characteristics of specialty and subspecialty and avoiding ambiguity and discretionary statements. Supplementary Information The online version contains supplementary material available at 10.1007/s00520-022-06834-9.
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Affiliation(s)
- Nobu Akiyama
- Department of Internal Medicine, School of Medicine, Teikyo University, Kaga 2-11-1, Itabashi ward, Tokyo, 173-8605, Japan.
| | - Takuho Okamura
- Department of Breast Surgery, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
| | - Minoru Yoshida
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Isao Yoshida
- Department of Hematologic Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Hitoshi Kusaba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Kosuke Takahashi
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiromichi Iwasaki
- Department of Infection Control and Prevention, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | - Kazuo Tamura
- Professor Emeritus, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yasushi Takamatsu
- Department of Hematology, Oncology, Endocrinology and Infectious Disease, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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Akazawa N, Kishi M, Hino T, Tsuji R, Tamura K, Hioka A, Moriyama H. Higher Body Mass Index in Hospitalized Older Patients Is Related to Higher Muscle Quality. J Nutr Health Aging 2022; 26:495-500. [PMID: 35587762 DOI: 10.1007/s12603-022-1785-9] [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] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between muscle mass, intramuscular adipose tissue, and body mass index (BMI) in older inpatients. DESIGN Cross-sectional study. SETTING Hospital-based study. PARTICIPANTS This study included 413 inpatients aged ≥ 65 years (186 men and 227 women). MEASUREMENTS Muscle mass and intramuscular adipose tissue of the quadriceps were assessed by measuring the muscle thickness and echo intensity on ultrasound images. To examine the relationship between quadriceps thickness and echo intensity and BMI in total participants and each sex, the Kendall rank correlation coefficient was used. Multiple regression analysis was performed to examine whether BMI was independently and significantly related to the quadriceps thickness and echo intensity, even after adjusting for other variables for total participants and each sex. The independent variables in multiple regression analyses were BMI, age, disease, days from onset disease. RESULTS The results of the correlation analyses showed that BMI was significantly related to the quadriceps thickness (total participants, τ = 0.431; men, τ = 0.491; women, τ = 0.388) and echo intensity (total participants, τ = -0.239; men, τ = -0.318; women, τ = -0.188). In the multiple regression analysis, BMI was independently and significantly associated with the quadriceps thickness (total participants, β = 0.535; men, β = 0.548; women, β = 0.519) and echo intensity (total participants, β = -0.287; men, β = -0.398; women, β = -0.210). CONCLUSION This study indicated that older inpatients with a higher BMI have greater muscle mass and less intramuscular adipose tissue of the quadriceps. These results suggested that a higher BMI in older inpatients is related to higher quadriceps muscle quality.
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Affiliation(s)
- N Akazawa
- Naoki Akazawa, Assistant Professor, Department of Physical Therapy, Faculty of Health and Welfare, Tokushima Bunri University, Hoji 180, Nishihama, Yamashiro-cho, Tokushima-city, Tokushima 770-8514, Japan, Tel +81 88 602 8000, Fax +81 88 602 8146, Email
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Nakano D, Ishitsuka K, Ishihara M, Tsuchihashi R, Okawa M, Tamura K, Kinjo J. Screening of Promising Chemotherapeutic Candidates from Plants against Human Adult T-Cell Leukemia/Lymphoma (VII): Active Principles from Thuja occidentalis L. Molecules 2021; 26:7619. [PMID: 34946696 PMCID: PMC8707666 DOI: 10.3390/molecules26247619] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
During the screening of novel chemotherapeutic candidates from plants against adult T-cell leukemia/lymphoma, we identified that the extracts of Thuja occidentalis (Cupressaceae) showed potent anti-proliferative activity in MT-1 and MT-2 cells. Therefore, we attempted to isolate the active components from this plant. We isolated and identified 32 compounds (1-32; eight lignans, 18 terpenoids, and six flavonoids) from the extracts of the leaves and cones. Their structures were determined by spectroscopic analysis. Several of the isolated compounds inhibited the growth of both cell lines. Lignans showed more potent activity than other classes of compounds. A comparison of the activities of compounds 1-8 revealed that the presence of a trans-lactone (linkage of C-6 to C-7) correlated with increased activity. Diterpenes showed moderate activity, and the presence of a ketone moiety at the C-7 position correlated with increased activity in compounds 12-21. In addition, biflavones showed moderate activity, and the presence of methoxy functions appeared to influence the activity of these compounds. Several lignans were lead compound of anti-cancer reagent (etoposide). In conclusion, not only lignans, but also diterpenes and/or biflavones, may be promising candidates for the treatment of adult T-cell leukemia/lymphoma.
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Affiliation(s)
- Daisuke Nakano
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (D.N.); (M.I.); (R.T.); (J.K.)
| | - Kenji Ishitsuka
- Division of Hematology and Rheumatology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima 890-8544, Japan;
| | - Madoka Ishihara
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (D.N.); (M.I.); (R.T.); (J.K.)
| | - Ryota Tsuchihashi
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (D.N.); (M.I.); (R.T.); (J.K.)
| | - Masafumi Okawa
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (D.N.); (M.I.); (R.T.); (J.K.)
| | - Kazuo Tamura
- Division of Medical Oncology, Hematology and Infectious Disease, Department of Internal Medicine, Fukuoka University, Fukuoka 814-0180, Japan;
| | - Junei Kinjo
- Faculty of Pharmaceutical Sciences, Fukuoka University, Fukuoka 814-0180, Japan; (D.N.); (M.I.); (R.T.); (J.K.)
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Inoue D, Yamamoto M, Arima H, Tamura K, Yoshida Y. A nationwide web-based survey of oncologic surgeons to clarify the current status of preoperative assessment for elderly cancer surgery patients in Japan. Sci Rep 2021; 11:22789. [PMID: 34815510 PMCID: PMC8611021 DOI: 10.1038/s41598-021-02319-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022] Open
Abstract
Elderly cancer patients requiring surgical treatment are increasing, and the deterioration of quality of life and shortening of healthy life expectancy due to postoperative complications represent major problems. This study investigated the current status of medical treatment, including perioperative evaluations, for elderly cancer patients requiring surgical treatment at cancer treatment facilities nationwide. A total of 436 cancer care facilities around Japan were invited to participate in this web-based survey regarding management of cancer patients ≥ 65 years old who had undergone surgical treatment in 2018. A total of 919 department heads from 245 facilities agreed to participate. Although most respondents answered that performance status, preoperative examinations, and comorbidities were important when deciding on a treatment plan, age, Geriatric Assessment (GA), and guidelines were "not important" for > 10% of all respondents. GA was familiar to 195 department heads (21%), and awareness of GA was significantly lower among respondents from medical education institutions than the other types of hospitals (18.5% vs 26.3%; P = 0.006). This large survey revealed that the use of GA is not widespread, and its awareness in medical education institutions remains low. We believe that accumulating evidence of geriatric oncology surgery is an urgent issue in Japan.
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Affiliation(s)
- Daisuke Inoue
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Makoto Yamamoto
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hisatomi Arima
- Department of Preventive Medicine and Public Health, Fukuoka University, 7-45-1 Nanakuma, Jhonan-ku, Fukuoka, Fukuoka, Japan
| | - Kazuo Tamura
- Emeritus Professor, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jhonan-ku, Fukuoka, Fukuoka, Japan
| | - Yoshio Yoshida
- Department of Obstetrics and Gynecology, University of Fukui, 23-3 Matsuoka-Shimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
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21
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Akiyama N, Okamura T, Yoshida M, Kimura SI, Yano S, Yoshida I, Kusaba H, Takahashi K, Fujita H, Fukushima K, Iwasaki H, Tamura K, Saeki T, Takamatsu Y, Zenda S. A questionnaire survey on evaluation for penetration and compliance of the Japanese Guideline on Febrile Neutropenia among hematology-oncology physicians and surgeons. Support Care Cancer 2021; 29:6831-6839. [PMID: 34008079 PMCID: PMC8464578 DOI: 10.1007/s00520-021-06277-8] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/04/2021] [Indexed: 10/25/2022]
Abstract
PURPOSE The Japanese Society of Medical Oncology published a guideline (GL) on febrile neutropenia (FN) in 2017. The study's purpose is to reveal how widely GL penetrated among physicians and surgeons providing chemotherapy. METHODS A questionnaire survey was conducted with SurveyMonkey™ for members of the Japanese Association of Supportive Care in Cancer and relevant academic organizations. Each question had four options (always do, do in more than half of patients, do in less than half, do not at all) and a free description form. Responses were analyzed with statistical text-analytics. RESULT A total of 800 responses were retrieved. Major respondents were experts with more than 10-year experience, physicians 54%, and surgeons 46%. Eighty-seven percent of respondents knew and used GL. Forty-eight percent assessed FN with Multinational Association of Supportive Care in Cancer (MASCC) score "always" or "more than half." Eighty-one percent chose beta-lactam monotherapy as primary treatment in high-risk patients. Seventy-seven percent did oral antibacterial therapy in low-risk patients ambulatorily. Seventy-eight percent administered primary prophylactic G-CSF (ppG-CSF) in FN frequency ≥ 20% regimen. Fifty-nine percent did ppG-CSF for high-risk patients in FN frequency 10-20% regimen. Ninety-seven percent did not use ppG-CSF in FN frequency < 10% regimen. The medians of complete and complete plus partial compliance rates were 46.4% (range 7.0-92.8) and 77.8% (range 35.4-98.7). The complete compliance rates were less than 30% in seven recommendations, including the MASCC score assessment. CONCLUSION GL is estimated to be widely utilized, but some recommendations were not followed, presumably due to a mismatch with actual clinical practices in Japan.
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Affiliation(s)
- Nobu Akiyama
- Department of Internal Medicine, School of Medicine, Teikyo University, Kaga 2-11-1, Itabashi ward, 173-8605, Tokyo, Japan.
| | - Takuho Okamura
- Department of Breast and Endocrine Surgery, School of Medicine, Tokai University, Isehara, Kanagawa, Japan
| | - Minoru Yoshida
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, Kanagawa, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Saitama, Japan
| | - Shingo Yano
- Division of Clinical Oncology and Hematology, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Isao Yoshida
- Department of Hematologic Oncology, National Hospital Organization Shikoku Cancer Center, Matuyama, Ehime, Japan
| | - Hiroyuki Kusaba
- Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University, Fukuoka, Fukuoka, Japan
| | - Kosuke Takahashi
- Department of Respiratory Medicine, Anjo Kosei Hospital, Anjo, Aichi, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Yokohama, Kanagawa, Japan
| | - Keitaro Fukushima
- Department of Pediatrics, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Hiromichi Iwasaki
- Department of Infection Control and Prevention, Faculty of Medical Sciences, University of Fukui, Eiheiji, Fukui, Japan
| | | | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Yasushi Takamatsu
- Department of Hematology, Oncology, Endocrinology and Infectious Disease, Fukuoka University, Fukuoka, Fukuoka, Japan
| | - Sadamoto Zenda
- Department of Radiation Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
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22
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Kimura SI, Kanda Y, Oyake T, Yamaguchi H, Fujiwara SI, Okamoto A, Fujita H, Saburi Y, Tamura K. Fungal biomarker monitoring and CT scans for early detection of invasive fungal disease in neutropenic hematological patients. J Infect 2021; 84:80-86. [PMID: 34710391 DOI: 10.1016/j.jinf.2021.10.018] [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: 09/06/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES By using data from the CEDMIC trial (n = 413), we conducted a post-hoc analysis of the diagnostic value of biomarker monitoring and chest computed tomography (CT) scans for the early detection of invasive fungal disease (IFD) in neutropenic hematological patients. METHODS IFDs were defined in accordance with the EORTC/MSG definition with some modifications. Biomarkers such as Aspergillus galactomannan (GM) and (1→3)-β-D-glucan (βDG) were measured weekly. RESULTS The positive predictive value (PPV) of GM and βDG in cases of high-risk treatment were 0.70 and 0.69, while those in low-risk treatment were 0.08 and 0, respectively. All of the positive biomarkers that were measured before the development of fever in low-risk treatment were false positives. The proportion of patients who had abnormal chest CT findings was 19% in persistent fever at 4-6 days, 57% at 7 days or later and 36% in recurrent fever. Sixty-nine percent of the patients who had abnormal findings at 7 days or later did not have abnormalities at 4-6 days. CONCLUSIONS Afebrile screening of biomarkers in low-risk treatment is not useful. Chest CT should be reevaluated in persistent fever lasting for 7 days or longer even in patients who did not have abnormalities within 6 days.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, 1-847, Amanuma-cho, Omiya-ku, Saitama-city, Saitama 330-8503, Japan; Department of Internal Medicine, Division of Hematology, Jichi Medical University, Japan.
| | - Tatsuo Oyake
- Department of Internal Medicine, Division of Hematology and Oncology, Iwate Medical University School of Medicine, Japan
| | | | - Shin-Ichiro Fujiwara
- Department of Internal Medicine, Division of Hematology, Jichi Medical University, Japan
| | - Akinao Okamoto
- Department of Hematology, Fujita Health University School of Medicine, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Japan
| | - Yoshio Saburi
- Department of Hematology, Oita Prefectural Hospital, Japan
| | - Kazuo Tamura
- Clinical Hematology Oncology Treatment Study Group, Japan
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23
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Harbeck N, Rastogi P, Martin M, Tolaney SM, Shao ZM, Fasching PA, Huang CS, Jaliffe GG, Tryakin A, Goetz MP, Rugo HS, Senkus E, Testa L, Andersson M, Tamura K, Del Mastro L, Steger GG, Kreipe H, Hegg R, Sohn J, Guarneri V, Cortés J, Hamilton E, André V, Wei R, Barriga S, Sherwood S, Forrester T, Munoz M, Shahir A, San Antonio B, Nabinger SC, Toi M, Johnston SRD, O'Shaughnessy J. Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study. Ann Oncol 2021; 32:1571-1581. [PMID: 34656740 DOI: 10.1016/j.annonc.2021.09.015] [Citation(s) in RCA: 185] [Impact Index Per Article: 61.7] [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: 07/15/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Adjuvant abemaciclib combined with endocrine therapy (ET) previously demonstrated clinically meaningful improvement in invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) in hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer at the second interim analysis, however follow-up was limited. Here, we present results of the prespecified primary outcome analysis and an additional follow-up analysis. PATIENTS AND METHODS This global, phase III, open-label trial randomized (1 : 1) 5637 patients to adjuvant ET for ≥5 years ± abemaciclib for 2 years. Cohort 1 enrolled patients with ≥4 positive axillary lymph nodes (ALNs), or 1-3 positive ALNs and either grade 3 disease or tumor ≥5 cm. Cohort 2 enrolled patients with 1-3 positive ALNs and centrally determined high Ki-67 index (≥20%). The primary endpoint was IDFS in the intent-to-treat population (cohorts 1 and 2). Secondary endpoints were IDFS in patients with high Ki-67, DRFS, overall survival, and safety. RESULTS At the primary outcome analysis, with 19 months median follow-up time, abemaciclib + ET resulted in a 29% reduction in the risk of developing an IDFS event [hazard ratio (HR) = 0.71, 95% confidence interval (CI) 0.58-0.87; nominal P = 0.0009]. At the additional follow-up analysis, with 27 months median follow-up and 90% of patients off treatment, IDFS (HR = 0.70, 95% CI 0.59-0.82; nominal P < 0.0001) and DRFS (HR = 0.69, 95% CI 0.57-0.83; nominal P < 0.0001) benefit was maintained. The absolute improvements in 3-year IDFS and DRFS rates were 5.4% and 4.2%, respectively. Whereas Ki-67 index was prognostic, abemaciclib benefit was consistent regardless of Ki-67 index. Safety data were consistent with the known abemaciclib risk profile. CONCLUSION Abemaciclib + ET significantly improved IDFS in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer, with an acceptable safety profile. Ki-67 index was prognostic, but abemaciclib benefit was observed regardless of Ki-67 index. Overall, the robust treatment benefit of abemaciclib extended beyond the 2-year treatment period.
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Affiliation(s)
- N Harbeck
- Breast Center, Department of OB & GYN and CCC Munich, LMU University Hospital, Munich, Germany.
| | - P Rastogi
- University of Pittsburgh/UPMC, NSABP Foundation, Pittsburgh, USA
| | - M Martin
- Hospital General Universitario Gregorio Marañon, Universidad Complutense, CIBERONC, GEICAM, Madrid, Spain
| | | | - Z M Shao
- Fudan University Shanghai Cancer Center, Shanghai, China
| | - P A Fasching
- University Hospital Erlangen, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C S Huang
- National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - G G Jaliffe
- Grupo Medico Camino S.C., Mexico City, Mexico
| | - A Tryakin
- N.N.Blokhin Russian Cancer Research Center, Moscow, Russia
| | | | - H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco, San Francisco, USA
| | - E Senkus
- Department of Oncology & Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - L Testa
- Instituto D'Or de Pesquisa e Ensino (IDOR), Sao Paulo, Brazil
| | | | - K Tamura
- National Cancer Center Hospital, Tokyo, Japan
| | - L Del Mastro
- IRCSS Ospedale Policlinico San Martino, UO Breast Unit, Genoa, Italy; Università di Genova, Department of Internal Medicine and Medical Specialties (DIM), Genoa, Italy
| | - G G Steger
- Medical University of Vienna, Vienna, Austria
| | - H Kreipe
- Medizinische Hochschule Hannover, Hannover, Germany
| | - R Hegg
- Clin. Pesq. e Centro São Paulo, São Paulo, Brazil
| | - J Sohn
- Yonsei Cancer Center, Seoul, Korea
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; Istituto Oncologico Veneto IOV-IRCCS, Padua, Italy
| | - J Cortés
- International Breast Cancer Center (IBCC), Madrid & Barcelona, and Vall d'Hebron Institute of Oncology, Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - E Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, USA
| | - V André
- Eli Lilly and Company, Indianapolis, USA
| | - R Wei
- Eli Lilly and Company, Indianapolis, USA
| | - S Barriga
- Eli Lilly and Company, Indianapolis, USA
| | - S Sherwood
- Eli Lilly and Company, Indianapolis, USA
| | | | - M Munoz
- Eli Lilly and Company, Indianapolis, USA
| | - A Shahir
- Eli Lilly and Company, Indianapolis, USA
| | | | | | - M Toi
- Kyoto University Hospital, Kyoto, Japan
| | | | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, USA
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Satou R, Matsuzawa Y, Akiyama E, Konishi M, Yoshii T, Nakahashi H, Minamimoto Y, Okada K, Maejima N, Iwahashi N, Hibi K, Kosuge M, Ebina T, Tamura K, Kimura K. Inflammation-frailty linkage and its long-term prognostic impact in patients with acute coronary syndrome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Chronic inflammation has been receiving considerable attention as an emerging risk factor for cardiovascular disease. In contrast, with the aging of the population, frailty has been also attracting a great deal of attention as the residual risk for cardiovascular disease. Although inflammation and frailty exacerbate each other and have an adverse effect on many diseases, the relationship between chronic inflammation and frailty and the impact of these combination on long-term prognosis in patients with acute coronary syndrome (ACS) are not elucidated.
Purpose
The aims of this study were to determine the association between chronic inflammation and frailty and its impact on long-term cardiovascular outcomes in patients with ACS.
Methods
A total of 482 consecutive ACS patients with obstructive coronary artery disease (age 66±12 years, male 81%) were enrolled in this observational study. We evaluated patients' gait speed as a measure of frailty before discharge. C-reactive protein (CRP) levels at 1 month after discharge were also evaluated as inflammation in the chronic phase. According to commonly used criteria of the residual inflammation (CRP>0.2 mg/dL) and the definition of the European Working Group for Sarcopenia (gait speed ≤0.8 m/sec), patients were stratified by 4 subgroups: low/high CRP with slow/normal gait speed. The primary endpoint was composite outcomes of cardiovascular death, myocardial infarction and ischemic stroke.
Results
While there was no significant association between CRP levels and gait speed in all patients, a significant negative association between two variables was observed in the high CRP group (Spearman's ρ = −0.31, p=0.001). During the median follow-up of 6 years, primary endpoints have occurred in 82 patients. Overall, event-free rates differed significantly among the 4 groups, demonstrating the lowest event-free rate in the patients with high CRP and slow gait speed (p<0.0001; Figure). In the multivariate analysis, high CRP (adjusted HR 1.99, 95% CI 1.14–3.46, p=0.02) and slow gait speed (adjusted HR 1.82, 95% CI 1.09–3.04, p=0.02) were independently and significantly associated with the primary endpoint. Moreover, the patients with both high CRP and slow gait speed had a 2.6-fold higher risk of cardiovascular events compared to others (adjusted HR 2.62, 95% CI 1.36–5.05, p=0.004).
Conclusion
In the patients with ACS, CRP levels and gait speed were negatively associated in the high CRP group. Chronic inflammation and frailty were both associated with poor prognosis in ACS and in particular, the combination of these factors was strongly associated with poor prognosis.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- R Satou
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - Y Matsuzawa
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - E Akiyama
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - M Konishi
- Yokohama City University, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - T Yoshii
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - H Nakahashi
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - Y Minamimoto
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - K Okada
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - N Maejima
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - N Iwahashi
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - K Hibi
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - M Kosuge
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - T Ebina
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - K Tamura
- Yokohama City University, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
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25
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Jones RL, Wagner AJ, Kawai A, Tamura K, Shahir A, Van Tine BA, Martín-Broto J, Peterson PM, Wright J, Tap WD. Prospective Evaluation of Doxorubicin Cardiotoxicity in Patients with Advanced Soft-tissue Sarcoma Treated in the ANNOUNCE Phase III Randomized Trial. Clin Cancer Res 2021; 27:3861-3866. [PMID: 33632930 DOI: 10.1158/1078-0432.ccr-20-4592] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/15/2021] [Accepted: 02/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Few prospective studies have assessed anthracycline-associated cardiotoxicity in patients with sarcoma. We evaluated cardiotoxicity in patients with soft-tissue sarcomas administered doxorubicin in the phase III ANNOUNCE trial (NCT02451943). PATIENTS AND METHODS Patients were anthracycline-naïve adults with locally advanced or metastatic disease and left ventricular ejection fraction (LVEF) ≥50%. Patients could receive eight cycles of doxorubicin at 75 mg/m2. The cardioprotectant, dexrazoxane, was allowed at investigator discretion. Symptomatic cardiac adverse events (AEs) were recorded using Medical Dictionary for Regulatory Activities and graded using Common Terminology Criteria for Adverse Events 4.0. LVEF deterioration was measured by echocardiogram or multigated acquisition scan, defined as a decrease to <50%, or decrease from baseline value >10%. RESULTS A total of 504 patients received ≥1 cycles of doxorubicin [median cumulative dose, 450.3 mg/m2 (range, 72.3-634.0)]. Median follow-up of cardiac AEs was 28 weeks. Dexrazoxane was coadministered more frequently to patients receiving higher cumulative doxorubicin doses (38.6% receiving <450 mg/m2, 88.5% receiving 450-<600 mg/m2, and 90% receiving ≥600 mg/m2) and did not affect treatment efficacy. LVEF deterioration was seen in 62 of 153 (40.5%) patients who received a cumulative dose <450 mg/m2, 82 of 159 patients (51.6%) who received 450-<600 mg/m2, and 50 of 89 patients (56.2%) who received ≥600 mg/m2. Grade ≥3 cardiac dysfunction occurred in 2% of patients at <450 mg/m2, 3% at 450-<600 mg/m2, and 1.1% at ≥600 mg/m2. Incidence of treatment-related cardiac AEs was low across all dose ranges. CONCLUSIONS Although follow-up was short, these results suggest doxorubicin can be administered at high cumulative doses (>450 mg/m2), with a low rate of cardiotoxicities, in the context of dexrazoxane coadministration.See related commentary by Benjamin and Minotti, p. 3809.
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Affiliation(s)
- Robin L Jones
- Sarcoma Unit, Royal Marsden NHS Foundation Trust, London, England, United Kingdom. .,Institute of Cancer Research, London, England, United Kingdom
| | - Andrew J Wagner
- Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Chuo City, Tokyo, Japan
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University, Fukuoka, Japan
| | - Ashwin Shahir
- Eli Lilly and Company, Surrey, England, United Kingdom
| | - Brian A Van Tine
- Barnes and Jewish Hospital, Washington University in St. Louis, St Louis, Missouri
| | - Javier Martín-Broto
- Department of Medical Oncology in University Hospital Virgen del Rocio and Institute of Biomedicine of Sevilla (IBIS) (HUVR, CSIC, University of Sevilla), Seville, Spain
| | | | | | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, New York
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26
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Nakano D, Ishitsuka K, Takashima M, Arima R, Satou A, Tsuchihashi R, Okawa M, Tamura K, Kinjo J. Screening of Promising Chemotherapeutic Candidates from Plants against Human Adult T-Cell Leukemia/Lymphoma (VI): Cardenolides from Asclepias curassavica. Biol Pharm Bull 2021; 43:1609-1614. [PMID: 32999172 DOI: 10.1248/bpb.b20-00465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the course of our screening program for novel chemotherapeutic candidates from plants against adult T-cell leukemia/lymphoma, the extracts of Asclepias curassavica L. showed potent activity against MT-1 and MT-2 cells. Therefore, we attempted to isolate their active components. We identified a new cardenolide, 19-dihydrocalactinic acid methyl ester (1), along with 16 known cardenolides (2-17). Their structures were determined on the basis of spectroscopic data. Almost all of the isolated cardenolides inhibited the growth of both tumor cell lines. All the doubly linked cardenolides (11-17) except for 14 showed more potent activity than the other cardenolides. A comparison of the activities of 11, 14 and 16 revealed that the presence of hydroxy or acetoxy functional groups at C-16 led to a decrease in the activity. The 50% effective concentration (EC50) value of calotropin (11) against MT-2 cells was comparable to the potency of the clinical antineoplastic drug doxorubicin. The cytotoxic effect of 11 toward normal mononuclear cells obtained from the peripheral blood (PB-MNCs) was observed at a concentration 6 to 12 times higher than that used to induce growth inhibition against MT-1 and MT-2 cells. The proportions of annexin V-positive cells after 72 h of treatment with 11 were increased, indicating that it significantly induced apoptosis in MT-1 and MT-2 cells in a concentration-dependent manner. Cell cycle experiments demonstrated that 11 arrested MT-1 and MT-2 cells at the G2/M phase. Therefore, compound 11 may be a promising candidate for the treatment of adult T-cell leukemia/lymphoma.
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Affiliation(s)
| | - Kenji Ishitsuka
- Division of Hematology and Immunology, Center for Chronic Viral Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University
| | | | - Rie Arima
- Faculty of Pharmaceutical Sciences, Fukuoka University
| | - Aya Satou
- Faculty of Pharmaceutical Sciences, Fukuoka University
| | | | | | - Kazuo Tamura
- Department of Internal Medicine, Division of Medical Oncology, Hematology and Infectious Disease, Fukuoka University
| | - Junei Kinjo
- Faculty of Pharmaceutical Sciences, Fukuoka University
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27
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Maeda S, Anan K, Koga K, Kuba S, Yano H, Kai Y, Nishimura R, Toh U, Yamaguchi M, Mashino K, Mitsuyama S, Tamura K, Tanaka T, Iwase H. Baseline neutrophil-to-lymphocyte ratio and absolute lymphocyte count in patients with HER2-negative breast cancer treated with eribulin may predict overall survival. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e13005] [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
e13005 Background: In Japan, eribulin has been approved for inoperative or recurrent breast cancer, following treatment with an anthracyclines and a taxanes. We reported the efficacy and safety of eribulin as a first-line to third-line treatment in patients with advanced/metastatic breast cancer (MBC) previously treated with anthracylinsanthracyclines and taxanes (Breast 2017). Briefly, the main inclusion criteria were as follows: no history of eribulin administration; an Eastern Cooperative Oncology Group performance status (ECOG PS) of 0 to 2,; human epidermal growth factor receptor 2 (HER2)-negative,; 20–75 years; ≥4 weeks from the last dose of chemotherapy, or ≥2 weeks from the last dosing of endocrine or radiation therapy; measurable lesion based on Response Evaluation Criteria in Solid Tumors (RECIST) ver. 1.1; sufficient organ function; life expectancy of ≥3 months; and no significant abnormalities on electrocardiogram. Patients in this clinical trial were enrolled between December 1, 2011, and November 30, 2013. Eribulin was administered intravenously at a dose of 1.4 mg/m2 during a 2-5 min infusion on days 1 and 8 every 3 weeks. In contrast, baseline neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) were reported to predict progression-free survival (PFS) or overall survival (OS). However, these reports were mainly retrospective analysis. Therefore, retrospective evaluation of NLR/ALC in a prospective clinical trial is important to understand the association between NLR/ALC and OS/PFS. Methods: Of 47 prospectively enrolled patients in a previous trial, 45 patients were retrospectively evaluated for baseline NLR/ACL and at the time of 3 cycles of eribulin. The association between NLR/ALC and OS/PFS was also were analyzed for association with OS/PFS. The Kaplan-Meier method was used to estimate the OS/PFS distribution. The cut-off values for baseline NLR and ALC were set at 3 and 1500 /ul, respectively. Results: The median OS of patients with a baseline NLR < 3 was significantly longer than that of patients with a baseline NLR ≥ ≧3 (769 days vs. 409 days; log-rank test p = 0.0333). The median OS of patients with a baseline ALC ≥ ≧1500 was also significantly longer than that of patients with a baseline ALC < 1500 (964 days vs.vs 427 days; log-rank test p = 0.0425). Association between baseline NLR/ALC and PFS were not seen, and also association between at the time of 3 cycles of NLR/ALC and OS/PFS were not seen neither. Conclusions: Baseline NLR and ALC in the patients with HER2- negative breast cancer who plan to treat eribulin may predict overall survival. Clinical trial information: UMIN000007121.
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Affiliation(s)
- Shigeto Maeda
- National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Keisei Anan
- Kitakyushu Municipal Medical Center, Kitakyushu, Fukuoka, Japan
| | | | - Sayaka Kuba
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaski, Japan
| | - Hiroshi Yano
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | - Reiki Nishimura
- Breast Center, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Uhi Toh
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | | | | | | | - Kazuo Tamura
- Division of Oncology, Hematology and Infectious Diseases, Department of Internal Medicine, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Toshihiro Tanaka
- Division of Oncology, Hematology and Infectious Diseases, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
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28
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Kusama K, Fukushima Y, Yoshida K, Sakakibara H, Tsubata N, Yoshie M, Kojima J, Nishi H, Tamura K. Endometrial epithelial-mesenchymal transition (EMT) by menstruation-related inflammatory factors during hypoxia. Mol Hum Reprod 2021; 27:6275231. [PMID: 33983443 DOI: 10.1093/molehr/gaab036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 02/06/2021] [Revised: 04/27/2021] [Indexed: 12/16/2022] Open
Abstract
Endometriosis is characterised by inflammation and fibrotic changes. Our previous study using a mouse model showed that proinflammatory factors present in peritoneal haemorrhage exacerbated inflammation in endometriosis-like grafts, at least in part through the activation of prostaglandin (PG) E2 receptor and protease-activated receptor (PAR). In addition, hypoxia is a well-known inducer of fibrosis that may be associated with epithelial-mesenchymal transition (EMT). However, the complex molecular interactions between hypoxia and proinflammatory menstruation-related factors, PGE2 and thrombin, a PAR1 agonist, on EMT in endometriosis have not been fully characterised. To explore the effects of hypoxia and proinflammatory factors on EMT-like changes in endometrial cells, we determined the effects of PGE2 and thrombin (P/T) on EMT marker expression and cell migration in three dimensional cultured human endometrial epithelial cells (EECs) and endometrial stromal cells (ESCs). Treatment of EECs with P/T under hypoxia stimulated cell migration, increased the expression of mesenchymal N-cadherin, vimentin and C-X-C chemokine receptor type 4 (CXCR4), and reduced the expression of epithelial E-cadherin. Furthermore, treatment with C-X-C motif chemokine ligand 12 (CXCL12), a ligand for CXCR4, increased EMT marker expression and cell migration. In ESCs, P/T or oestrogen treatment under hypoxic conditions increased the expression and secretion of CXCL12. Taken together, our data show that hypoxic and proinflammatory stimuli induce EMT, cell migration and inflammation in EECs, which was increased by CXCL12 derived from ESCs. These data imply that inflammatory mediators in retrograde menstrual fluid contribute to ectopic endometrial EMT and migration in the presence of peritoneal hypoxia.
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Affiliation(s)
- K Kusama
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - Y Fukushima
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - K Yoshida
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - H Sakakibara
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - N Tsubata
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - M Yoshie
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
| | - J Kojima
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - H Nishi
- Department of Obstetrics and Gynecology, Tokyo Medical University, Tokyo 160-0023, Japan
| | - K Tamura
- Department of Endocrine Pharmacology, Tokyo University of Pharmacy and Life Sciences, Tokyo 192-0392, Japan
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29
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Funato M, Tsunematsu Y, Yamazaki F, Tamura C, Kumamoto T, Takagi M, Kato S, Sugimura H, Tamura K. Characteristics of Li-Fraumeni Syndrome in Japan; A Review Study by the Special Committee of JSHT. Cancer Sci 2021; 112:2821-2834. [PMID: 33932062 PMCID: PMC8253286 DOI: 10.1111/cas.14919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/14/2021] [Accepted: 03/23/2021] [Indexed: 01/25/2023] Open
Abstract
Li-Fraumeni syndrome (LFS) is a hereditary cancer predisposition syndrome, and the majority of patients with LFS have been identified with germline variants in the p53 tumor suppressor (TP53) gene. In the past three decades, considerable case reports of TP53 germline variants have been published in Japan. To the best of our knowledge, there have been no large-scale studies of Japanese patients with LFS. In this study, we aimed to identify Japanese patients with TP53 germline variants and to reveal the characteristics of LFS in Japan. We collected reported cases by reviewing the medical literature and cases diagnosed at the institutions of the authors. We identified 68 individuals from 48 families with TP53 germline pathogenic or likely pathogenic variants. Of the 48 families, 35 (72.9%) had missense variants, most of which were located within the DNA-binding loop. A total of 128 tumors were identified in the 68 affected individuals. The 128 tumor sites were as follows: breast, 25; bones, 16; brain, 12; hematological, 11; soft tissues, 10; stomach, 10; lung, 10; colorectum, 10; adrenal gland, 9; liver, 4; and others, 11. Unique phenotype patterns of LFS were shown in Japan in comparison to those in a large national LFS cohort study in France. Above all, a higher frequency of patients with stomach cancer was observed in Japanese TP53 germline variant carriers. These results may provide useful information for the clinical management of LFS in Japan.
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Affiliation(s)
- Michinori Funato
- Department of Clinical ResearchNational Hospital OrganizationNagara Medical CenterGifuJapan
| | - Yukiko Tsunematsu
- Department of PediatricsJuntendo University School of MedicineTokyoJapan
| | - Fumito Yamazaki
- Department of Clinical GenomicsNational Cancer Center Research InstituteTokyoJapan
| | - Chieko Tamura
- Department of PediatricsJuntendo University School of MedicineTokyoJapan
- Medical Information & Genetic Counseling DivisionFMC Tokyo ClinicTokyoJapan
| | - Tadashi Kumamoto
- Department of Pediatric OncologyNational Cancer Center HospitalTokyoJapan
| | - Masatoshi Takagi
- Department of Pediatrics and Developmental BiologyGraduate SchoolTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Shunsuke Kato
- Department of Clinical OncologyJuntendo University Graduate School of MedicineTokyoJapan
| | - Haruhiko Sugimura
- Department of Tumor PathologyHamamatsu University School of MedicineShizuokaJapan
| | - Kazuo Tamura
- Division of Genetic MedicineMaster of ScienceGraduate School of Science and Engineering ResearchKindai UniversityHigashiosakaJapan
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30
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Nishikubo T, Masui K, Koyama F, Uchiyama T, Ohbayashi C, Tamura K. Immunohistochemistry and RNA-sequencing have been useful in evaluating the pathological significance of a non-consensus site intronic variant in suspected cases of Lynch syndrome. Int Cancer Conf J 2021; 10:186-190. [PMID: 34221829 DOI: 10.1007/s13691-021-00474-2] [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: 10/09/2020] [Accepted: 02/08/2021] [Indexed: 12/27/2022] Open
Abstract
Immunohistochemistry of mismatch repair proteins is a universal strategy for Lynch syndrome screening. In this case, Lynch syndrome was suspected, because MLH1 and PMS2 expression was negative by IHC. However, mismatch repair genetic analysis revealed a variant of unknown significance of c.454-13A > G in MLH1. Therefore, we performed reverse transcription-PCR using mRNA extracted from the patient's lymphocytes and detected a heterozygous gene allele indicating splicing abnormalities that complex splicing, with exon 5 followed by only the first codon (ACG) of exon 6 and leading to exon 7 of the MLH1. Two years later, this mutation was corrected to "likely pathogenic". For Lynch syndrome in which mismatch repair protein expression is undetectable by immunohistochemistry, reverse transcription-PCR may be useful to identify an intronic variant of unknown significance as the likely pathogenic variant.
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Affiliation(s)
- Toshiya Nishikubo
- Division of Neonatal Intensive Care, Maternal, Fetal and Neonatal Medical Center, Nara Medical University Hospital, Kashihara, Japan
- Division of Genetic Counseling, Nara Medical University Hospital, Kashihara, Japan
| | - Kaoru Masui
- Division of Genetic Counseling, Nara Medical University Hospital, Kashihara, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University Hospital, Kashihara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University Hospital, Kashihara, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University Hospital, Kashihara, Japan
| | - Kazuo Tamura
- Division of Medical Genetics, Master of Science, Graduate School of Science and Engineering Research, Kindai University, Higashiōsaka, Japan
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31
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Aogi K, Takeuchi H, Saeki T, Aiba K, Tamura K, Iino K, Imamura CK, Okita K, Kagami Y, Tanaka R, Nakagawa K, Fujii H, Boku N, Wada M, Akechi T, Iihara H, Ohtani S, Okuyama A, Ozawa K, Kim YI, Sasaki H, Shima Y, Takeda M, Nagasaki E, Nishidate T, Higashi T, Hirata K. Optimizing antiemetic treatment for chemotherapy-induced nausea and vomiting in Japan: Update summary of the 2015 Japan Society of Clinical Oncology Clinical Practice Guidelines for Antiemesis. Int J Clin Oncol 2021; 26:1-17. [PMID: 33161452 PMCID: PMC7788035 DOI: 10.1007/s10147-020-01818-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/16/2020] [Indexed: 01/07/2023]
Abstract
Patients with cancer should appropriately receive antiemetic therapies against chemotherapy-induced nausea and vomiting (CINV). Antiemetic guidelines play an important role in managing CINV. Accordingly, the first Japanese antiemetic guideline published in 2010 by the Japan Society of Clinical Oncology (JSCO) has considerably aided Japanese medical staff in providing antiemetic therapies across chemotherapy clinics. With the yearly advancements in antiemetic therapies, the Japanese antiemetic guidelines require revisions according to published evidence regarding antiemetic management worldwide. A revised version of the first antiemetic guideline that considered several upcoming evidences had been published online in 2014 (version 1.2), in which several updated descriptions were included. The 2015 JSCO clinical practice guideline for antiemesis (version 2.0) (in Japanese) has addressed clinical antiemetic concerns and includes four major revisions regarding (1) changes in emetogenic risk categorization for anti-cancer agents, (2) olanzapine usage as an antiemetic drug, (3) the steroid-sparing method, and (4) adverse drug reactions of antiemetic agents. We herein present an English update summary for the 2015 JSCO clinical practice guideline for antiemesis (version 2.0).
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Affiliation(s)
- Kenjiro Aogi
- Department of Breast Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hideki Takeuchi
- Department of Breast Oncology, Saitama Medical University, Saitama, Japan
- Department of Breast Surgical Oncology, Japan Organization of Occupational Health and Safety Yokohama Rosai Hospital, Yokohama, Japan
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Toshiaki Saeki
- Department of Breast Oncology, Saitama Medical University International Medical Center, Saitama, Japan.
| | - Keisuke Aiba
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Todachuo General Hospital, Saitama, Japan
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University Hospital, Fukuoka, Japan
| | - Keiko Iino
- Department of Adult Nursing, National College of Nursing, Tokyo, Japan
| | - Chiyo K Imamura
- Department of Clinical Pharmacokinetics and Pharmacodynamics, Keio University, Tokyo, Japan
- Advanced Cancer Translational Research Institute, Showa University, Tokyo, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Yoshikazu Kagami
- Division of Radiation Oncology, Department of Radiology, Showa University School of Medicine, Tokyo, Japan
| | - Ryuhei Tanaka
- Department of Pediatric Hematology and Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kazuhiko Nakagawa
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Hirofumi Fujii
- Department of Clinical Oncology, Jichi Medical University, Tochigi, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Makoto Wada
- Department of Psycho-Oncology and Palliative Medicine, Osaka International Cancer Institute, Osaka, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | | | - Shoichiro Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Ayako Okuyama
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Keiko Ozawa
- Department of Nursing, NTT Medical Center Tokyo, Tokyo, Japan
| | - Yong-Il Kim
- Department of Medical Oncology, Seirei Hamamatsu General Hospital, Sizuoka, Japan
- Department of Medical Oncology, Yodogawa Christian Hospital, Osaka, Japan
| | - Hidenori Sasaki
- Division of Medical Oncology, Hematology and Infectious Disease, Department of Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Ibaraki, Japan
| | - Masayuki Takeda
- Department of Medical Oncology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Eijiro Nagasaki
- Division of Clinical Oncology/Hematology, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan
- Todachuo General Hospital, Saitama, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Higashi
- Center for Cancer Control and Information Services, National Cancer Center, Tokyo, Japan
| | - Kouichi Hirata
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University Postgraduate School of Medicine, Sapporo, Hokkaido, Japan
- JR Sapporo Hospital, Sapporo, Hokkaido, Japan
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32
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Iwahashi N, Kirigaya J, Horii M, Abe T, Akiyama E, Okada K, Matsuzawa Y, Maejima N, Hibi K, Kosuge M, Ebina T, Tamura K, Kimura K. Clinical significance of late diastolic tissue doppler parameters after onset of STEMI: from the view point of the timing of the echocardipography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
The early transmitral flow velocity (E) divided by the early diastolic velocity of the mitral valve annulus (e') is referred to as the “E/e' ratio,” is useful even for ST elevation acute myocardial infarction (STEMI). However, the role of late diastolic velocity (a') which reveals the atrial function for STEMI is still unclear.
Objectives
We evaluated the clinical usefulness of tissue Doppler including atrial function for a first-time STEMI by long time follow up. Furthermore, we evaluated the meaning of each parameters by performing immediately after PCI or 2 weeks later.
Methods
We treated consecutive 571 first-time STEMI patients by immediate PCI within 12 hours after onset, and we examined 270 patients at immediately after PCI (GroupA, 65 years, 250 male) and 301 patients at 2 weeks after onset (GroupB, 64 years, 243 male). We examined trans mitral flow and TDI, then defined E/e' as LV filling pressure and A/a' as left atrial function. We followed them for a long time (>5 years). The primary end point (PE) was cardiac death or re-admission for heart failure (HF).
Results
We followed the patients in Group A for 10 years, Group B for 5 years. PE occurred in 64 patients in GroupA during 10 years, and 45 patients in GroupB during 5 years. We analyzed the univariate and multivariate Cox hazard analyses and we compared e' and a', E/e' and A/a' (Table). In GroupA, a' and A/a' were the independent predictors, on the other hand neither a' nor A/a' were the predictors in GroupB. E/e' was an independent predictor both in GroupA and B.
Conclusion
TDI parameters have different meanings by the timing of echocardiography after onset of a first-time STEMI. These results demonstrated that atrial dysfunction immediately after onset of STEMI suggests the poor prognosis after STEMI.
Cox Hazard Proportional Analysis
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Iwahashi
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - J Kirigaya
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - M Horii
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - T Abe
- Yokohama City University Hospital, Department of Medical Science and Cardio-Renal Medicine, Yokohama, Japan
| | - E Akiyama
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - K Okada
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - Y Matsuzawa
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - N Maejima
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - K Hibi
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - M Kosuge
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - T Ebina
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - K Tamura
- Yokohama City University Hospital, Department of Medical Science and Cardio-Renal Medicine, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
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Azuma M, Kato S, Kodama S, Hayakawa K, Kagimoto M, Iguchi K, Fukuoka M, Fukui K, Iwasawa T, Utsunomiya D, Kimura K, Tamura K. Relationship between cardiac magnetic resonance derived extracellular volume fraction and myocardial strain in patients with non-ischemic dilated cardiomyopathy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The feature tracking (FT) technique has been proposed as a robust method to evaluate the myocardial strain using conventional cine magnetic resonance imaging (MRI) of the left ventricle. Data is limited regarding the relationship between FT-derived myocardial strain and diffuse myocardial fibrosis evaluated by T1 mapping in patients with non-ischemic dilated cardiomyopathy (NIDCM).
Purpose
The aim of this study was to evaluate the correlation between extracellular volume (ECV) by T1 mapping and myocardial strain by FT in patients with NIDCM.
Methods
A total of sixty-four patients with NIDCM (62±12 years) and 15 controls (62±11 years) were studied. Using a 1.5T MR scanner, pre- and post- T1 mapping images of LV wall at mid-ventricular level was acquired to calculate ECV by modified Look-Locker inversion recovery (MOLLI) sequence. Radial strain (RS), circumferential strain (CS) and longitudinal strain (LS) was assessed by FT technique. ECV and myocardial strain were compared using a 6-segment model at mid-ventricular level.
Results
Compared to the controls, the NIDCM patients had a significantly higher ECV (0.30±0.02 vs. 0.24±0.01, p<0.001) and impaired myocardial strain (RS, 24.2±3.0 vs. 52.2±6.2, p<0.001; CS, −7.5±2.1 vs. −15.3±2.2, p<0.001; LS −10.4±3.5 vs. −20.2±4.7, p<0.001, respectively). Similar results were obtained when comparing all 6 myocardial segments (segment 7–12) (all p values <0.001). In a segment-based analysis, a significant positive correlation was found between the ECV and CS (r=0.26 to 0.41; all p values <0.05), a negative correlation was found between the ECV and RS (r=−0.31 to −0.41; all p values <0.05). In a patient-based analysis, there were significant positive correlations between the ECV and CS (r=0.45, p<0.001), ECV and LS from 2-chamber view (r=0.30, p=0.006), ECV and LS from 4-chamber view (r=0.37, p<0.001). There was a significant negative correlation between the ECV and RS (r=−0.43, p<0.001) (FIGURE)
Conclusions
In NIDCM patients, severity of myocardial fibrosis evaluated by T1 mapping is associated with impaired myocardial strain by FT technique.
Correlation between the ECV and strain
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Azuma
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - S Kato
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - S Kodama
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - K Hayakawa
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - M Kagimoto
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - K Iguchi
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - M Fukuoka
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - K Fukui
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - T Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Radiology, Yokohama, Japan
| | - D Utsunomiya
- Yokohama City University Hospital, Diagnostic Radiology, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Cardiology, Yokohama, Japan
| | - K Tamura
- Yokohama City University Hospital, Medical Science and Cardiorenal Medicine, Yokohama, Japan
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34
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Kirigaya H, Okada K, Hibi K, Akiyama E, Kimura Y, Matsuzawa Y, Iwahashi N, Maejima N, Kosuge M, Tamura K, Kimura K. Post-procedural quantitative flow ratio gradient and target lesion revascularization after drug-coated balloon or plain-old balloon angioplasty. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Balloon angioplasty, including drug-coated balloon (DCB), is an important option of percutaneous coronary interventions (PCI), even in the drug-eluting stent era. Although quantitative coronary angiography (QCA) has been frequently used to determine the optimal endpoint of balloon angioplasty, physiological assessment may add incremental prognostic values. Quantitative flow ratio (QFR) has evolved as a novel 3D QCA-based physiological index to estimate fractional flow reserve without hyperemia nor pressure guidewire, offering both anatomical and functional lesion assessments. This study aimed to characterize post-procedural anatomical and physiological indexes by QFR and to compare their prognostic impacts on long-term clinical outcomes.
Methods
This retrospective study included 98 patients with de novo (n=39) or in-stent restenosis (n=59) lesions who underwent PCI with DCB (n=69) or plain-old balloon angioplasty (POBA, n=29). All lesions were analyzed by QCA and QFR. QCA analysis measured lesion length, reference lumen diameter (RLD), minimum lumen diameter (MLD) and percent diameter stenosis (%DS) at pre- and post-procedures as anatomical indexes. QFR analysis measured post-procedural QFR of target vessel (QFR-vessel) and QFR-gradient (ΔQFR between proximal and distal segments of the lesion) as physiological indexes. Primary endpoint was target lesion revascularization (TLR) within 1-year post-procedure.
Results
Target lesion profiles were as follows: lesion length 26.3±16.6 mm, RLD 2.90±0.70 mm, MLD 0.94±0.32 mm and %DS 79.3±18.6%. At post-procedure, MLD, residual %DS, QFR-vessel and QFR-gradient of target lesions were 1.88±0.49 mm, 34.7±10.6%, 0.84±0.13 and 0.06±0.04, respectively. During 1 year post-procedure, TLR occurred in 19 (19%) patients. Patients with TLR showed smaller MLD (1.66±0.45 mm vs. 1.93±0.49 mm, p=0.028) and QFR-vessel (0.79±0.03 vs. 0.85±0.01, p=0.06), and greater residual %DS (42.7±11.3% vs. 32.8±9.5%, p=0.0002) and QFR-gradient (0.12±0.06 vs. 0.04±0.02, p<0.0001) at post-procedure compared with those without. In multivariate analysis including several clinical characteristics and anatomical indexes, QFR-gradient at post-procedure was independently associated with TLR within 1-year, demonstrating higher prognostic value compared with post-procedural MLD and residual %DS (Figure). The receiver-operating characteristics curve analysis identified the best cut-off value of QFR-gradient as 0.08 for predicting 1-year TLR after balloon angioplasty, irrespective of balloon type (DCB or POBA) (Figure 1).
Conclusions
Post-procedural QFR-gradient within the lesion was an independent and stronger predictor of subsequent TLR, compared with anatomical indexes. Further studies are warranted to investigate whether QFR guidance to optimize PCI procedure could improve clinical outcomes in patients with balloon angioplasty.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Kirigaya
- Yokohama City University Medical Center, Yokohama, Japan
| | - K Okada
- Yokohama City University Medical Center, Yokohama, Japan
| | - K Hibi
- Yokohama City University Medical Center, Yokohama, Japan
| | - E Akiyama
- Yokohama City University Medical Center, Yokohama, Japan
| | - Y Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Y Matsuzawa
- Yokohama City University Medical Center, Yokohama, Japan
| | - N Iwahashi
- Yokohama City University Medical Center, Yokohama, Japan
| | - N Maejima
- Yokohama City University Medical Center, Yokohama, Japan
| | - M Kosuge
- Yokohama City University Medical Center, Yokohama, Japan
| | - K Tamura
- Yokohama City University Hospital, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
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35
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Konishi M, Kagiyama N, Saito H, Saito K, Ogasahara Y, Maekawa E, Kitai T, Momomura S, Tamura K, Kimura K, Kamiya K, Matsue Y. Negative impact of skeletal muscle impairment in older patients with heart failure with reduced versus preserved ejection fraction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Reduced functional capacity is an important phenotype of heart failure (HF), even though it may be considered multifactorial, especially in HF with preserved ejection fraction (HFpEF). Impairment in skeletal muscle may be one of extra-cardiac factors for reduced functional capacity and subsequent poor outcome.
Purpose
We sought to investigate the impact of the impairment in skeletal muscle, defined by the cut-offs proposed by the international consensus, on functional capacity and clinical outcome, in HF patients with preserved and reduced EF (HFrEF).
Methods
This is a multicenter prospective study including 1317 consecutive older (≥65 years) hospitalized patients with HF [HFpEF (ejection fraction ≥45%, n=675, 82±7 years, 46.4% male) and HFrEF (ejection fraction <45%, n=642, 78±8 years, 68.4% male)].
Results
HFrEF patients were more likely to have low skeletal muscle mass measured by bioelectrical impedance analysis (30.9% vs 22.1%, p=0.003) whereas less likely to have low muscle strength (handgrip strength; 62.9% vs 73.8%, p<0.001) than HFpEF, resulting in similar prevalence of sarcopenia between the two groups (21.6% vs 18.1%, p=0.19). In HFrEF, presence of sarcopenia was an independent predictor of reduced functional capacity assessed by a 6-minute walk distance (standardized beta=−0.093, p=0.039 in multivariate linear regression analysis) and 1-year mortality (adjusted hazard ratio (aHR) and 95% CI; 2.14 (1.22–3.70), p=0.009 in multivariate Cox-regression analysis). In patients with HFpEF, sarcopenia could predict mortality (aHR and 95% CI; 2.23 (1.23–3.91), p=0.009), though its association with reduced functional capacity was not significant after multivariate adjustment (standardized beta=−0.059, p=0.20). Kaplan-Meier survival curves in HFpEF and HFrEF are shown (Figure).
Conclusion(s)
In older patients with HF, sarcopenia was similarly contributed to mortality in HFpEF and HFrEF whereas its influence on functional capacity was pronounced in HFrEF.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Japan Heart Foundation Research Grant
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Affiliation(s)
- M Konishi
- Yokohama City University Hospital, Yokohama, Japan
| | - N Kagiyama
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - H Saito
- Kameda Medical Center, Kamogawa, Japan
| | - K Saito
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Y Ogasahara
- The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - E Maekawa
- Kitasato University School of Medicine, Sagamihara, Japan
| | - T Kitai
- Kobe City Medical Center General Hospital, Kobe, Japan
| | - S Momomura
- Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - K Tamura
- Yokohama City University Hospital, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - K Kamiya
- Kitasato University School of Medicine, Sagamihara, Japan
| | - Y Matsue
- Juntendo University School of Medicine, Tokyo, Japan
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36
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Azuma M, Kato S, Kodama S, Hayakawa K, Kagimoto M, Iguchi K, Fukuoka M, Fukui K, Iwasawa T, Utsunomiya D, Kimura K, Tamura K. Extracellular volume fraction by T1 mapping predicts omprovement of left ventricular ejection fraction after catheter ablation in patients with non-ischemic cardiomyopathy and atrial fibrillation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial has shown that the catheter ablation (CA) for atrial fibrillation (AF) significantly reduced the risk of death and hospitalization for heart failure in patients with non-ischemic dilated cardiomyopathy (NIDCM) and AF (N Engl J Med 2018; 378:417–27). In addition, the Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction (CAMERA-MRI) study demonstrated that the absence of myocardial fibrosis on late gadolinium enhanced (LGE) magnetic resonance imaging (MRI) is associated with improvement of left ventricular systolic function after CA in NIDCM patients with AF (J Am Coll Cardiol 2017; 70:1949–61). Extracellular volume fraction (ECV) by T1 mapping has emerges as a non-invasive mean to quantify diffuse myocardial fibrosis.
Purpose
The aim of this study was to compare the predictive value of LGE-MRI and ECV by T1 mapping for the prediction of improvement of LVEF after CA in NIDCM patients.
Methods
A total of twenty-eight patients with NIDCM and AF (age: 67±10 years; 25 (89%) male; LVEF: 34.1±8.8%) were studied. Using a 1.5T MR scanner and 32 channel cardiac coils, cine MRI, LGE-MRI, pre- and post- T1 mapping images of LV wall at mid-ventricular level (modified Look-Locker inversion recovery sequence) were acquired. Myocardial fibrosis on LGE was defined as area with >5SD signal intensity of normal myocardium. ECV from six segments of mid ventricular level were averaged for each patient. All patients underwent CA for AF, and the improvement of LVEF before and after CA were evaluated by echocardiography.
Results
All patients restored sinus rhythm after CA at the time of echocardiography. The mean LVEF was 34.1±8.8% before CA and 49.1±12.0% after CA (p<0.001), resulting an improvement of 15.0±11.8%. Significant correlation was found between improvements in LVEF and amount of fibrosis on LGE-MRI (r=−0.40, p=0.034), improvement of LVEF and ECV (r=−0.55, p=0.008). In the ROC analysis, ECV had a higher discriminative ability for the improvement of LVEF after CA compared with amount of fibrosis on LGE-MRI (AUC 0.885 vs 0.650) (Figure).
Conclusions
In NIDCM patients with AF, ECV by T1 mapping had better predictive ability for improvement of LVEF after CA in comparison to LGE-MRI.
ROC curves of ECV and LGE-MRI
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Azuma
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - S Kato
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - S Kodama
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - K Hayakawa
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - M Kagimoto
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - K Iguchi
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - M Fukuoka
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - K Fukui
- Kanagawa Cardiovascular and Respiratory Center, Cardiology, Yokohama, Japan
| | - T Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Radiology, Yokohama, Japan
| | - D Utsunomiya
- Yokohama City University Hospital, Diagnostic Radiology, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Cardiology, Yokohama, Japan
| | - K Tamura
- Yokohama City University Hospital, Medical Science and Cardiorenal Medicine, Yokohama, Japan
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Mori H, Maeda A, Akashi Y, Ako J, Ikari Y, Ebina T, Sato N, Tamura K, Namiki A, Fukui K, Michishita I, Kimura K, Suzuki H. Atrial Fibrillation is related with higher in-hospital morality in acute myocardial infarction (AMI) patients from K-ACTIVE registry. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The prognostic significance of atrial fibrillation (AF) on in-hospital mortality in acute myocardial infarction (AMI) patients is not fully understood in Japanese patients.
Methods
To elucidate the clinical significance of AF on in-hospital mortality in AMI patients, we analyzed the Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardio Vacular rEgistry), which spans October 2016 to December 2019.
Results
A total of 3482 patients included 336 patients with AF and 3146 patients with sinus rhythm. Table 1 shows patient baseline characteristics. Patients with AF were significantly older than those with sinus rhythm (75 vs 67, P<0.0001). Prevalence of hypertension and hemodialysis were significantly greater in patients with AF than patients with sinus rhythm while prevalence of dyslipidemia and smoking were significantly less in patients with AF than patients with sinus rhythm. Table 2 shows characteristics of AMI. There were no significant difference in prevalence of STEMI, area of MI, Peak CK/CK-MB and prevalence of multivessel disease. However, patients with AF showed lower systolic blood pressure, faster heart rate, worse Killip category, greater prevalence of OHCA. Need of mechanical support including IABP/ECMO were greater in patients with AF than patients with sinus rhythm. In-hospital mortality was significantly higher in patients with AF than in patients with sinus rhythm (Figure, 10.4% versus 5.2%, P=0.0005). This trend didn't change even after adjustment with age and sex (Odds ratio 1.6 95% confidence interval 1.1–2.4, P=0.02).
Conclusion
AF was associated with higher in-hospital mortality in Japanese AMI patients.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was supported by JSPS KAKENHI Grant Number JP15K09101.
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Affiliation(s)
- H Mori
- Fujigaoka Hospital, Yokohama, Japan
| | - A Maeda
- Fujigaoka Hospital, Yokohama, Japan
| | - Y Akashi
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - J Ako
- Kitasato University Hospital, Sagamihara, Japan
| | - Y Ikari
- Tokai University Hospital, Isehara, Japan
| | - T Ebina
- Yokohama City University Medical Center, Yokohama, Japan
| | - N Sato
- Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - K Tamura
- Yokohama City University Hospital, Yokohama, Japan
| | - A Namiki
- Kanto Rosai Hospital, Kawasaki, Japan
| | - K Fukui
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | - K Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - H Suzuki
- Fujigaoka Hospital, Yokohama, Japan
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38
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Iwahashi N, Kirigaya J, Horii M, Hanajima Y, Abe T, Akiyama E, Okada K, Matsuzawa Y, Maejima N, Hibi K, Kosuge M, Ebina T, Tamura K, Kimura K. Serial echocardiographical assessment for urgent control of rapid atrial fibrillation in acute heart failure. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Doppler echocardiography is a well-recognized technique for noninvasive evaluation; however, little is known about its efficacy in patients with rapid atrial fibrillation (AF) accompanied by acute decompensated heart failure (ADHF). The aim of this study was to explore the usefulness of serial echocardiographical assessment for rapid AF patients with ADHF.
Patients
A total of 110 ADHF patients with reduced ejection fraction (HFrEF) and rapid AF who were admitted to the CCU unit and received landiolol treatmentto decrease the heart rate (HR) to <110 bpm and change HR (ΔHR) of >20% within 24 hours were enrolled.
Interventions
Immediately after admission, the patients (n=110) received landiolol, and its dose was increased to the maximum; then, we repeatedly performed echocardiography. Among them, 39 patients were monitored using invasive right heart catheterization (RHC) simultaneously with echocardiography.
Measurements and main results
There were significant relationships between Doppler and RHC parameters through the landiolol treatment (Figure, baseline–max HR treatment). We observed for the major adverse events (MAE) during initial hospitalization, which included cardiac death, HF prolongation (required intravenous treatment at 30 days), and worsening renal function (WRF). MAE occurred in 44 patients, and logistic regression analyses showed that the mean left atrial pressure (mLAP)-Doppler (odds ratio = 1.132, 95% confidence interval [CI]: 1.05–1.23, p=0.0004) and stroke volume (SV)-Doppler (odds ratio = 0.93, 95% confidence interval [CI]: 0.89–0.97, p=0.001) at 24 hours were the significant predictors for MAE, and multivariate analysis showed that mLAP-Doppler was the strongest predictor (odds ratio = 1.16, 95% CI: 0.107–1.27, p=0.0005) (Table).
Conclusions
During the control of the rapid AF in HFrEF patients withADHF, echocardiography was useful to assess their hemodynamic condition, even at bedside.
Doppler for rapid AF of ADHF
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- N Iwahashi
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - J Kirigaya
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - M Horii
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - Y Hanajima
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - T Abe
- Yokohama City University Medical Center, Division of emergency medicine, Yokohama, Japan
| | - E Akiyama
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - K Okada
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - Y Matsuzawa
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - N Maejima
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - K Hibi
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - M Kosuge
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - T Ebina
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
| | - K Tamura
- Yokohama City University Hospital, Department of Medical Science and Cardio-Renal Medicine, Yokohama, Japan
| | - K Kimura
- Yokohama City University Medical Center, Division of Cardiology, Yokohama, Japan
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39
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Satou R, Matsuzawa Y, Akiyama E, Konishi M, Yoshii T, Okada K, Maejima N, Iwahashi N, Hibi K, Kosuge M, Ebina T, Tamura K, Kimura K. Low-density lipoprotein cholesterol levels on admission and long-term outcomes in statin-naive patients with acute coronary syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Dyslipidemia, especially an increase in the low-density lipoprotein cholesterol (LDL-C) has been established as one of the most important risk factors for atherosclerotic cardiovascular diseases. In contrast, some recent studies have shown that the low LDL-C level was associated with short-term poor prognosis in patients with cardiovascular disease, and this is so-called “cholesterol paradox”. However, there is few data evaluating the effects on long-term outcome of “cholesterol paradox” in patients with acute coronary syndrome (ACS).
Purpose
The purpose of this study was to examine whether the low LDL-C level on admission affect long-term prognosis in patients with ACS.
Methods
A total of 434 ACS patients who survived to hospital discharge were enrolled in this study. All patients were statin-naïve on admission, and were received statin therapy after hospitalization. Patients were divided into the low LDL-C (≤114 mg/dl) and high LDL-C (>114 mg/dl) groups using the first tertile of the LDL-C level on admission. The primary endpoint was composite outcomes of all-cause death, myocardial infarction, ischemic stroke, hospitalization for congestive heart failure and unplanned revascularization.
Results
During a median follow-up period of 5.5 years, primary endpoint occurred in 117 patients. Overall, event-free rates differed significantly between the low and high LDL-C groups, demonstrating the lower event-free rate in patients with the low LDL-C group (38.9% in low LDL-C group versus 20.7% in high LDL-C group, p=0.0002; Figure). Even after adjustment for age, sex, body mass index, and various classical risk factors, the low LDL-C group was significantly at higher risk for primary composite outcomes compared to the high LDL-C group (adjusted hazard ratio 1.65, 95%-confidence interval 1.10–2.49, p=0.02).
Conclusion
In patients with ACS, the low LDL-C level on admission was significantly associated with long-term worse prognosis, regardless of statin therapy at discharge. In ACS patients with low LDL-C level, it might be necessary for elucidating the residual risk for secondary adverse event to improve their prognosis.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- R Satou
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - Y Matsuzawa
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - E Akiyama
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - M Konishi
- Yokohama City University, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - T Yoshii
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - K Okada
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - N Maejima
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - N Iwahashi
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - K Hibi
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - M Kosuge
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - T Ebina
- Yokohama City University Medical Center, division of cardiology, Yokohama, Japan
| | - K Tamura
- Yokohama City University, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
| | - K Kimura
- Yokohama City University, Department of Medical Science and Cardiorenal Medicine, Yokohama, Japan
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40
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Im SA, Cortes J, Lipatov O, Goncalves A, Lee KS, Schmid P, Tamura K, Testa L, Witzel I, Ohtani S, Zambelli S, Harbeck N, Andre F, Dent R, Lin J, Karantza V, Mejia J, Winer E. 44O Pembrolizumab (pembro) vs chemotherapy (chemo) for previously treated metastatic triple-negative breast cancer (mTNBC): KEYNOTE-119 Asia-Pacific subpopulation. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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41
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Hirayama Y, Yoshida Y, Mori M, Tamura K. Effects of the publication of Clinical Guidelines for the Management of Chemotherapy-Induced Peripheral Neuropathy on the Administration Preferences of Oncology Specialists: Japanese Association of Supportive Care in Cancer. Jpn J Clin Oncol 2020; 50:897-902. [PMID: 32424420 DOI: 10.1093/jjco/hyaa056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/09/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE We conducted a questionnaire survey of oncology specialists to investigate the frequency of administration of different drugs for the management of chemotherapy-induced peripheral neuropathy in Japan in 2015. Our group published Clinical Guidelines for the Management of Chemotherapy-Induced Peripheral Neuropathy in 2017 (CIPN-GL2017). In these guidelines, we recommended duloxetine only. To verify the effect of the publication of the CIPN-GL2017, we conducted a questionnaire survey in 2019. METHODS In 2015 and again in 2019, we investigated the use of vitamin B12, antiepileptic agents, duloxetine, antidepressants other than duloxetine, non-steroidal anti-inflammatory drugs, opioids and the Kampo compound (goshajinkigan) in a questionnaire employing a three-point scale wherein A implies routine or prophylactic administration, B implies occasional administration and C implies infrequent administration. RESULTS We sent the questionnaires via email to 971 diplomates of the Subspecialty Board of Japanese Society of Medical Oncology in 2015 and 1239 diplomates in 2019. The administration ratio (A + B) of duloxetine for numbness and pain was 46.8 and 31.7%, respectively, in 2015 and 68.9% (P < 0.01) and 73.1% (P < 0.01) in 2019. In response to the question regarding awareness of the CIPN-GL2017, 53.2% of respondents to the 2019 questionnaire were aware of the CIPN-GL2017. Among the respondents with an awareness of the CIPN-GL2017, the prescription rate of duloxetine (78.3%) for pain was significantly higher than that among respondents without any awareness (67.4%). CONCLUSIONS It is possible that the publication of CIPN-GL2017 influenced administration preferences of oncology specialists.
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Affiliation(s)
- Yasuo Hirayama
- Department of Hematology Oncology, Higashi Sapporo Hospital, Sapporo, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Fukuoka University, Fukuoka, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Kazuo Tamura
- General Medical Research Center, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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42
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Kimura SI, Kanda Y, Iino M, Fukuda T, Sakaida E, Oyake T, Yamaguchi H, Fujiwara SI, Jo Y, Okamoto A, Fujita H, Takamatsu Y, Saburi Y, Matsumura I, Yamanouchi J, Shiratori S, Gotoh M, Nakamura S, Tamura K. Efficacy and safety of micafungin in empiric and D-index-guided early antifungal therapy for febrile neutropenia; A subgroup analysis of the CEDMIC trial. Int J Infect Dis 2020; 100:292-297. [PMID: 32891738 DOI: 10.1016/j.ijid.2020.08.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The D-index is defined as the area over the neutrophil curve during neutropenia. The CEDMIC trial confirmed the noninferiority of D-index-guided early antifungal therapy (DET) using micafungin to empirical antifungal therapy (EAT). In this study, we evaluated the efficacy and safety of micafungin in these settings. METHODS From the CEDMIC trial, we extracted 67 and 113 patients who received micafungin in the DET and EAT groups, respectively. Treatment success was defined as the fulfilment of all components of a five-part composite end point. Fever resolution was evaluated at seven days after the completion of therapy. RESULTS The proportion of high-risk treatments including induction chemotherapy for acute leukemia and allogeneic hematopoietic stem cell transplantation was significantly higher in the DET group than in the EAT group (82.1% vs. 52.2%). The efficacy of micafungin was 68.7% (95%CI: 56.2-79.4) and 79.6% (71.0-86.6) in the DET and EAT groups, respectively. When we focused on high-risk treatments, the efficacy was 69.1% (55.2-80.9%) and 78.0% (65.3-87.7%), respectively (P = 0.30). There was no significant difference in any of the 5 components between the two groups. CONCLUSIONS The efficacy of micafungin in patients undergoing high-risk treatment was not strongly impaired in DET compared to that in EAT.
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Affiliation(s)
- Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Japan; Division of Hematology, Department of Medicine, Jichi Medical University, Japan.
| | - Masaki Iino
- Department of Medical Oncology, Yamanashi Prefectural Central Hospital, Japan
| | - Takahiro Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Japan
| | - Emiko Sakaida
- Department of Hematology, Chiba University Hospital, Japan
| | - Tatsuo Oyake
- Division of Hematology and Oncology, Department of Internal Medicine, Iwate Medical University School of Medicine, Japan
| | | | | | - Yumi Jo
- Department of Oncology and Hematology / Infection Control Division, Shimane University Hospital, Japan
| | - Akinao Okamoto
- Department of Hematology, Fujita Health University School of Medicine, Japan
| | - Hiroyuki Fujita
- Department of Hematology, Saiseikai Yokohama Nanbu Hospital, Japan
| | - Yasushi Takamatsu
- Division of Medical Oncology, Hematology and Infectious Diseases, Department of Internal Medicine, Fukuoka University Hospital, Japan
| | - Yoshio Saburi
- Department of Hematology, Oita Prefectural Hospital, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Japan
| | - Jun Yamanouchi
- Departments of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Japan
| | - Souichi Shiratori
- Department of Hematology, Hokkaido University, Faculty of Medicine, Japan
| | - Moritaka Gotoh
- Department of Hematology, Tokyo Medical University, Japan
| | - Shingen Nakamura
- Department of Community Medicine and Medical Science, Tokushima University Graduate School of Biomedical Sciences, Japan
| | - Kazuo Tamura
- General Medical Research Center, Fukuoka University, Japan
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43
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Frenel JS, Kim JW, Berton-Rigaud D, Asher R, Vidal L, Pautier P, Ledermann J, Penson R, Oza A, Korach J, Huzarski T, Pignata S, Colombo N, Park-Simon TW, Tamura K, Sonke G, Freimund A, Lee C, Pujade-Lauraine E. 813MO Efficacy of subsequent chemotherapy for patients with BRCA1/2 mutated platinum-sensitive recurrent epithelial ovarian cancer (EOC) progressing on olaparib vs placebo: The SOLO2/ENGOT Ov-21 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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44
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Tamura K, Takahashi S, Mukohara T, Tanioka M, Yasojima H, Ono M, Naito Y, Shimoi T, Otani Y, Kobayashi K, Kogawa T, Suzuki T, Takase T, Matsunaga R, Masuda N. 346P Phase I study of the liposomal formulation of eribulin (E7389-LF): Results from the HER2-negative breast cancer expansion. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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45
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Kudo M, Morimoto M, Moriguchi M, Izumi N, Takayama T, Yoshiji H, Hino K, Oikawa T, Chiba T, Motomura K, Kato J, Yasuchika K, Ido A, Sato T, Nakashima D, Ueshima K, Ikeda M, Okusaka T, Tamura K, Furuse J. A randomized, double-blind, placebo-controlled, phase 3 study of tivantinib in Japanese patients with MET-high hepatocellular carcinoma. Cancer Sci 2020; 111:3759-3769. [PMID: 32716114 PMCID: PMC7541009 DOI: 10.1111/cas.14582] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 05/28/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 12/17/2022] Open
Abstract
A previous randomized phase 2 study of hepatocellular carcinoma revealed that the c‐Met inhibitor tivantinib as second‐line treatment significantly prolonged progression‐free survival in a subpopulation whose tumor samples highly expressed c‐Met (MET‐high). Accordingly, this phase 3 study was conducted to evaluate the efficacy of tivantinib as a second‐line treatment for Japanese patients with MET‐high hepatocellular carcinoma. This randomized, double‐blind, placebo‐controlled study was conducted at 60 centers in Japan. Hepatocellular carcinoma patients with one prior sorafenib treatment and those with MET‐high tumor samples were eligible for inclusion. Registered patients were randomly assigned to either the tivantinib or placebo group at a 2:1 ratio and were treated with twice‐a‐day oral tivantinib (120 mg bid) or placebo until the discontinuation criteria were met. The primary endpoint was progression‐free survival while the secondary endpoints included overall survival and safety. Between January 2014 and June 2016, 386 patients provided consent, and 195 patients were randomized to the tivantinib (n = 134) or placebo (n = 61) group. Median progression‐free survival was 2.8 (95% confidence interval: 2.7‐2.9) and 2.3 (1.5‐2.8) mo in the tivantinib and placebo groups, respectively (hazard ratio = 0.74, 95% confidence interval: 0.52‐1.04, P = .082). Median overall survival was 10.3 (95% confidence interval: 8.1‐11.6) and 8.5 (6.2‐11.4) mo in the tivantinib and placebo group, respectively (hazard ratio = 0.82, 95% confidence interval: 0.58‐1.15). The most common tivantinib‐related grade ≥3 adverse events were neutropenia (31.6%), leukocytopenia (24.8%), and anemia (12.0%). This study did not confirm the significant efficacy of tivantinib as a second‐line treatment for Japanese patients with MET‐high hepatocellular carcinoma. (NCT02029157).
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Affiliation(s)
- Masatoshi Kudo
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Manabu Morimoto
- Department of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Michihisa Moriguchi
- Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Namiki Izumi
- Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Nara, Japan
| | - Keisuke Hino
- Department of Hepatology and Pancreatology, Kawasaki Medical School, Okayama, Japan
| | - Takayoshi Oikawa
- Department of Internal Medicine, Division of Hepatology, Iwate Medical University, Iwate, Japan
| | - Tetsuhiro Chiba
- Department of Gastroenterology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenta Motomura
- Department of Hepatology, Aso Iizuka Hospital, Fukuoka, Japan
| | - Junko Kato
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kentaro Yasuchika
- Department of Surgery, Division of Hepatobiliary Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Akio Ido
- Department of Gastroenterology, Kagoshima University Medical and Dental Hospital, Kagoshima, Japan
| | - Takashi Sato
- R&D Division, Kyowa Kirin Co., Ltd, Tokyo, Japan
| | | | - Kazuomi Ueshima
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuo Tamura
- General Medical Research Center, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Junji Furuse
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, Tokyo, Japan
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46
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Tanaka T, Tanaka M, Furusawa H, Kamada Y, Sagara Y, Anan K, Miyara K, Kai Y, Uga T, Tamura K, Mitsuyama S. Pilot Study of Irinotecan and S-1 (IRIS) for Advanced and Metastatic Breast Cancer. Anticancer Res 2020; 40:4779-4785. [PMID: 32727805 DOI: 10.21873/anticanres.14480] [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: 05/23/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Irinotecan is rarely used on the metastatic breast cancer (MBC) setting. S-1 is an oral mixture of tegafur, gimeracil and oteracil. We conducted this pilot study to assess efficacy and safty of chemotherapy with combined irinotecan and S-1 (IRIS). PATIENTS AND METHODS Irinotecan was given intravenously at 80 mg/m2 on days 1 and 8 and S-1 was given orally at 80-120 mg/day depending on body surface area for 2 weeks, repeating the cycle every 3 weeks. RESULTS Twenty-two patients were enrolled in the study. Median age was 50.5 years (range=26-72). Nineteen patients were evaluable for response. Median overall survival and progression-free survival were 672 days (95% CI=420-967) and 166 days (95% CI=76-814), respectively. CONCLUSION The IRIS regimen has an acceptable safety profile and modest efficacy against MBC in patients previously heavily treated with chemotherapy. This regimen has potential to treat MBC.
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Affiliation(s)
- Toshihiro Tanaka
- Division of Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Maki Tanaka
- Department of Surgery, JCHO Kurume General Hospital, Fukuoka, Japan
| | - Hidemi Furusawa
- Department of Breast Surgical Oncology, Breastopia Namba Hospital, Miyazaki, Japan
| | | | | | - Keisei Anan
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
| | | | - Yuichirou Kai
- Department of Surgery, Ueo Breast Surgery Clinic, Oita, Japan
| | - Tatsuya Uga
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuo Tamura
- Division of Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Fukuoka University, Fukuoka, Japan
| | - Shoshu Mitsuyama
- Department of Surgery, Kitakyushu Municipal Medical Center, Fukuoka, Japan
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47
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Tamura K, Miyake H, Setou M. Exploration of urinary lipid biomarkers in patients with clear cell renal cell carcinoma. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33583-7] [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: 11/30/2022] Open
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48
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Matsushita Y, Watanabe H, Tamura K, Motoyama D, Miyake H. Prognostic significance of time to castration resistance in patients with metastatic castration-sensitive prostate cancer. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33175-x] [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: 11/16/2022] Open
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49
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Motoyama D, Matsushita Y, Watanabe H, Tamura K, Ito T, Sugiyama T, Otsuka A, Miyake H. Significant impact of three-dimensional volumetry of perinephric fat on the console time during robot-assisted partial nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33084-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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50
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Narikawa M, Kiyokuni M, Kino T, Taguchi Y, Yano H, Hosoda J, Matsumoto K, Sugano T, Ishigami T, Ishikawa T, Tamura K, Kimura K. P1050General anesthesia improved rate of first-pass pulmonary vein isolation by radiofrequency ablation in patients with atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.139] [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: 11/12/2022] Open
Abstract
Abstract
Background
Pulmonary vein isolation (PVI) with radiofrequency ablation (RFA) is one of the important procedures for atrial fibrillation (AF). Attaining the stability of RFA, respiratory management and pain control during the procedure are required.
Purpose
We compared the characteristic parameters and procedural outcomes between general anesthesia and moderate (conscious) sedation in patients with AF performed RFA.
Methods
We performed a retrospective, 2-center observational study to compare the general anesthesia with moderate sedation during RFA on AF from January 2018 until December 2018. In general anesthesia group, we administrated propofol and muscle relaxants under mechanical ventilation. In moderate sedation group, we administrated dexmedetomidine and/or propofol with analgesic drug. Procedural time of AF ablation, first-pass PVI (pulmonary vein isolation after completing the right or left circle) were assessed.
Results
A total of 98 patients with mean age 66 ± 11 years were enrolled (80 males, 81%). Of these, 19 patients were performed RFA under general anesthesia and 79 patients were performed under moderate sedation. Age, gender, BMI, medications before admission and CHADs2 score (general anesthesia:1.9 ± 1.2 vs moderate sedation:1.5 ± 1.1, p = 0.14), left atrium diameter (40.2 ± 6.2 vs 40.6 ± 6.8 mm, p = 0.81) and proportion of paroxysmal AF (47.4 vs 54.4%, p = 0.61) were similar between two groups. Our study found catheter RFA with general anesthesia to be associated with reduced procedural time (161 ± 29 vs 241 ± 58 minutes, p < 0.01) and improved the rate of first-pass PVI (left pulmonary vein: 84.2 vs 59.5%, p = 0.06 and right pulmonary vein: 84.2 vs 58.2%, p =0.04).
Conclusions
RFA under general anesthesia improved first-pass PVI (quality of PVI) and shortened procedural time. General anesthesia may attribute to attaining the catheter and patient stability during RFA for PVI.
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Affiliation(s)
- M Narikawa
- Yokohama City University Hospital, Yokohama, Japan
| | - M Kiyokuni
- Yokohama City University Hospital, Yokohama, Japan
| | - T Kino
- Yokohama City University Hospital, Yokohama, Japan
| | - Y Taguchi
- Yokohama City University Hospital, Yokohama, Japan
| | - H Yano
- Gyotoku General Hospital, Cardiology, Ichikawa, Japan
| | - J Hosoda
- Yokohama City University Hospital, Yokohama, Japan
| | - K Matsumoto
- Yokohama City University Hospital, Yokohama, Japan
| | - T Sugano
- Yokohama City University Hospital, Yokohama, Japan
| | - T Ishigami
- Yokohama City University Hospital, Yokohama, Japan
| | - T Ishikawa
- Yokohama City University Hospital, Yokohama, Japan
| | - K Tamura
- Yokohama City University Hospital, Yokohama, Japan
| | - K Kimura
- Yokohama City University Hospital, Yokohama, Japan
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