1
|
Nakano J, Urabe F, Kiuchi Y, Takamizawa S, Suzuki H, Kawano S, Miyajima K, Fukuokaya W, Takahashi K, Iwatani K, Imai Y, Kayano S, Aikawa K, Yanagisawa T, Tashiro K, Yuen S, Sato S, Tsuzuki S, Miki J, Kimura T. The clinical impact of ureteroscopy for upper tract urothelial carcinoma: A multicenter study. Int J Urol 2024; 31:394-401. [PMID: 38151321 DOI: 10.1111/iju.15375] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND With the development of kidney-sparing surgery and neoadjuvant chemotherapy, ureteroscopic biopsy (URSBx) has become important for the management of upper tract urothelial carcinoma (UTUC). METHODS We retrospectively analyzed data from 744 patients with UTUC who underwent radical nephroureterectomy (RNU), stratified into no ureteroscopy (URS), URS alone, and URSBx groups. Intravesical recurrence-free survival (IVRFS) was examined using the Kaplan-Meier method. We conducted Cox regression analyses to identify risk factors for IVR. We investigated differences between clinical and pathological staging to assess the ability to predict the pathological tumor stage and grade of RNU specimens. RESULTS Kaplan-Meier curves and multivariate Cox regression revealed significantly more IVR and inferior IVRFS in patients who underwent URS and URSBx. Superficial, but not invasive, bladder cancer recurrence was more frequent in the URS and URSBx groups than in the no URS group. Clinical and pathological staging agreed for 55 (32.4%) patients. Downstaging occurred for 48 (28.2%) patients and clinical understaging occurred for 67 (39.4%) patients. Upstaging to muscle-invasive disease occurred for 39 (35.8%) of 109 patients with ≤cT1 disease. Clinical and pathological grading were similar for 72 (42.3%) patients. Downgrading occurred for 5 (2.9%) patients, and clinical undergrading occurred for 93 (54.7%) patients. CONCLUSION URS and URSBx instrumentation will be risk factors for superficial, but not invasive, bladder cancer recurrence. Clinical understaging/undergrading and upstaging to muscle-invasive disease occurred for a large proportion of patients with UTUC who underwent RNU. These data emphasize the challenges involved in accurate UTUC staging and grading.
Collapse
Affiliation(s)
- Juria Nakano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuria Kiuchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | | | - Hirotaka Suzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shota Kawano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Steffi Yuen
- Division of Urology, Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Uchida N, Urabe F, Suhara Y, Goto Y, Yoshihara K, Sadakane I, Yata Y, Kurawaki S, Miyajima K, Ishikawa M, Takahashi K, Iwatani K, Imai Y, Sakanaka K, Nakazono M, Hisakane A, Kurauchi T, Kayano S, Onuma H, Mori K, Aikawa K, Yanagisawa T, Tashiro K, Tsuzuki S, Miki J, Furuta A, Sato S, Takahashi H, Kimura T. Effect of a variant histology on the oncological outcomes of Japanese patients with upper tract urothelial carcinomas after radical nephroureterectomy: a multicenter retrospective study. Transl Androl Urol 2024; 13:414-422. [PMID: 38590954 PMCID: PMC10999016 DOI: 10.21037/tau-23-561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
Background An earlier systematic review and meta-analysis found that patients with a certain histological variant of upper tract urothelial carcinoma (UTUC) exhibited more advanced disease and poorer survival than those with pure UTUC. A difference in the clinicopathological UTUC characteristics of Caucasian and Japanese patients has been reported, but few studies have investigated the clinical impact of the variant histology in Japanese UTUC patients. Methods We retrospectively enrolled 824 Japanese patients with pTa-4N0-1M0 UTUCs who underwent radical nephroureterectomy without neoadjuvant chemotherapy. Subsequently, we explored the effects of the variant histology on disease aggressiveness and the oncological outcomes. We used Cox's proportional hazards models to identify significant predictors of oncological outcomes, specifically intravesical recurrence-free survival (IVRFS), recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Results Of the 824 UTUC patients, 32 (3.9%) exhibited a variant histology that correlated significantly with a higher pathological T stage and lymphovascular invasion (LVI). Univariate analysis revealed that the variant histology was an independent risk factor for suboptimal RFS, CSS, and OS. However, significance was lost on multivariate analyses. Conclusions The variant histology does not add to the prognostic information imparted by the pathological findings after radical nephroureterectomy, particularly in Japanese UTUC patients.
Collapse
Affiliation(s)
- Naoki Uchida
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yushi Suhara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuma Goto
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yoshihara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Ibuki Sadakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shiro Kurawaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Mimu Ishikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Hisakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kurauchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hajime Onuma
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Kashiwa Hospital, Chiba, Japan
| | - Akira Furuta
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
3
|
Kayano S, Yanagisawa T, Yata Y, Miyajima K, Hara S, Iwatani K, Sasahara T, Imai Y, Murakami M, Hata K, Yamamoto T, Kimura T. Impact of timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis associated with upper urinary tract stones: a propensity score-matched analysis. World J Urol 2024; 42:147. [PMID: 38478082 DOI: 10.1007/s00345-024-04871-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/08/2024] [Indexed: 03/26/2024] Open
Abstract
OBJECTIVE We aimed to assess the impact of the timing of urinary drainage on clinical outcomes in patients with obstructive pyelonephritis (OPN) associated with upper urinary tract (UUT) stones. METHODS We retrospectively evaluated the multicenter dataset of 240 patients with OPN associated with UUT stones who underwent urinary drainage. We divided the patients into two groups depending on the timing of urinary drainage; emergency drainage, defined as within 12 h from admission, and delayed drainage, defined as between 12 and 48 h from admission. The outcomes were the length of hospital stay, time to leukocyte normalization, and time to body temperature normalization. One-to-two propensity score matching (PSM) was applied to minimize the effect of confounders between the two groups. Subsequently, predictive patient factors for emergency drainage were analyzed using the logistic regression model. RESULTS Only the time from admission to normal body temperature was significantly shorter in the emergency drainage group when compared with the delayed drainage group (median: 2 vs. 3 days; p = 0.02), while there was no difference in time from drainage to body temperature normalization between the two groups. On multivariable analysis, high pretreatment C-reactive protein (CRP) was associated with implementing emergency drainage within 12 h. CONCLUSIONS The timing of urinary drainage was only associated with the duration of high fever, but it did not affect the postdrainage course. Emergency urinary drainage is more likely to be performed in severe patients, such as high pretreatment CRP.
Collapse
Affiliation(s)
- Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Ota Memorial Hospital, Gunma, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan.
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, JR Tokyo General Hospital, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| | - Shuhei Hara
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| | - Taishiro Sasahara
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Machida Municipal Hospital, Tokyo, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Fuji City General Hospital, Shizuoka, Japan
| | - Masaya Murakami
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Fuji City General Hospital, Shizuoka, Japan
| | - Kenichi Hata
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Atsugi City Hospital, Kanagawa, Japan
| | - Toshihiro Yamamoto
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
- Department of Urology, Tokyo-Kita Medical Center, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, 3-19-18, Nishi-Shimbashi, Minato-Ku, Tokyo, 105-8471, Japan
| |
Collapse
|
4
|
Suhara Y, Urabe F, Yoshihara K, Kurawaki S, Fukuokaya W, Iwatani K, Imai Y, Sakanaka K, Hisakane A, Kurauchi T, Kayano S, Onuma H, Mori K, Kimura S, Tashiro K, Tsuzuki S, Miki J, Sato S, Takahashi H, Kimura T. Prognostic significance of subclassifying pathological T3 upper tract urothelial carcinoma: Results from a multicenter cohort study. Int J Urol 2024; 31:125-132. [PMID: 37828777 DOI: 10.1111/iju.15321] [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: 07/18/2023] [Accepted: 09/26/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE The population with pathological T3 (pT3) upper tract urothelial carcinoma (UTUC) is heterogeneous, thereby making prognostication challenging. We assessed the clinical ramifications of subclassifying pT3 UTUC after nephroureterectomy. METHODS We conducted a retrospective analysis including 308 patients who underwent nephroureterectomy for pT3N0-1M0 UTUC. pT3 was subclassified into pT3a and pT3b based on invasion of the peripelvic and/or periureteral fat. Cox's proportional hazard models were utilized to determine the significant prognosticators of oncological outcomes, encompassing intravesical recurrence-free survival, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival. RESULTS Multivariate analysis elucidated that pT3b status, pathological N1 status, and lymphovascular invasion status were independent risk factors for an unfavorable RFS and CSS. Although the RFS and CSS of patients with pT3b UTUC were superior to those in patients with pT4 UTUC, no significant disparities were detected between patients with pT3a and pT2. CONCLUSION Our findings demonstrate that pT3 UTUC with peripelvic/periureteral fat invasion is independently associated with metastasis and cancer-specific death after nephroureterectomy. These findings provide patients and physicians with invaluable insight into the risk for disease progression in pT3 UTUC patients.
Collapse
Affiliation(s)
- Yushi Suhara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yoshihara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Shiro Kurawaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Wataru Fukuokaya
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Hisakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kurauchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hajime Onuma
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shoji Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Shun Sato
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
5
|
Kagawa H, Urabe F, Kiuchi Y, Katsumi K, Yamaguchi R, Suhara Y, Yoshihara K, Goto Y, Sadakane I, Yata Y, Saito S, Kurawaki S, Ajisaka S, Miyajima K, Takahashi K, Iwatani K, Imai Y, Sakanaka K, Nakazono M, Kurauchi T, Kayano S, Onuma H, Aikawa K, Yanagisawa T, Tashiro K, Tsuzuki S, Furuta A, Miki J, Kimura T. Real-world outcomes of adjuvant immunotherapy candidates with upper tract urothelial carcinoma: results of a multicenter cohort study. Int J Clin Oncol 2024; 29:55-63. [PMID: 37863996 DOI: 10.1007/s10147-023-02424-9] [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] [Received: 07/05/2023] [Accepted: 10/03/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Recent clinical trials have reported improved disease-free survival rates of patients with stage pT3-4/ypT2-4 or pN + upper tract urothelial carcinoma (UTUC) on adjuvant nivolumab therapy. However, the appropriateness of the patient selection criteria used in clinical practice remains uncertain. METHODS We retrospectively analyzed 895 patients who underwent nephroureterectomy to treat UTUC. The patients were divided into two groups: grade pT3-4 and/or pN + without neoadjuvant chemotherapy (NAC) or grade ypT2-4 and/or ypN + on NAC (adjuvant immunotherapy candidates) and others (not candidates for adjuvant immunotherapy). Kaplan-Meier curves were drawn to assess the oncological outcomes, including recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Cox proportional hazards models were used to identify significant prognostic factors for oncological outcomes. RESULTS The Kaplan-Meier curves revealed notably inferior RFS, CSS, and OS of patients who were candidates for adjuvant immunotherapy. Multivariate analysis revealed that pathological T and N grade and lymphovascular invasion (LVI) status were independent risk factors for poor RFS, CSS, and OS. CONCLUSION In total, 44.8% of patients were candidates for adjuvant immunotherapy. In addition to pathological T and N status, LVI was a significant predictor of survival, and may thus play a pivotal role in the selection of patients eligible for adjuvant immunotherapy.
Collapse
Affiliation(s)
- Hirokazu Kagawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan.
| | - Yuria Kiuchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Kota Katsumi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Ryotaro Yamaguchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yushi Suhara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yoshihara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Yuma Goto
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ibuki Sadakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shun Saito
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Shiro Kurawaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shino Ajisaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazuhiro Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kurauchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hajime Onuma
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Furuta
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
6
|
Takahashi K, Urabe F, Suhara Y, Nakano J, Yoshihara K, Goto Y, Sadakane I, Koike Y, Yata Y, Suzuki H, Kurawaki S, Miyajima K, Iwatani K, Imai Y, Sakanaka K, Nakazono M, Kurauchi T, Kayano S, Onuma H, Aikawa K, Yanagisawa T, Tashiro K, Tsuzuki S, Koike Y, Furuta A, Miki J, Kimura T. Comparison of neoadjuvant and adjuvant chemotherapy for upper tract urothelial carcinoma in real-world practice: a multicenter retrospective study. Jpn J Clin Oncol 2023; 53:1208-1214. [PMID: 37647644 DOI: 10.1093/jjco/hyad118] [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: 07/25/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Multiple studies have demonstrated the effectiveness of neoadjuvant chemotherapy and adjuvant chemotherapy in patients with upper tract urothelial carcinoma compared with surgery alone. However, no clinical trial has established the superiority of neoadjuvant chemotherapy or adjuvant chemotherapy in terms of perioperative outcomes. METHODS We conducted a retrospective analysis encompassing 164 upper tract urothelial carcinoma patients who underwent radical nephroureterectomy and received perioperative chemotherapy. Of these patients, 65 (39.6%) and 99 (60.4%) received neoadjuvant chemotherapy and adjuvant chemotherapy, respectively. Recurrence-free survival and cancer-specific survival were computed using the Kaplan-Meier method. Additionally, we conducted Cox regression analyses to evaluate the risk factors for recurrence-free survival and cancer-specific survival. RESULTS Pathological downstaging was seen in 37% of the neoadjuvant chemotherapy group. However, no pathological complete response was observed in this cohort. The Kaplan-Meier curves demonstrated significantly lower recurrence-free survival and cancer-specific survival in patients who received adjuvant chemotherapy. Multivariate Cox regression analysis revealed patients treated with adjuvant chemotherapy exhibited a marked association with inferior recurrence-free survival and cancer-specific survival. CONCLUSION Our study has suggested that neoadjuvant chemotherapy would be more effective in high-risk upper tract urothelial carcinoma patients compared with adjuvant chemotherapy.
Collapse
Affiliation(s)
- Kazuhiro Takahashi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fumihiko Urabe
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yushi Suhara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Juria Nakano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Yoshihara
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Yuma Goto
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Ibuki Sadakane
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuhei Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuji Yata
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hirotaka Suzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shiro Kurawaki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiichiro Miyajima
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kosuke Iwatani
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Yu Imai
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Keigo Sakanaka
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Minoru Nakazono
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takashi Kurauchi
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Sotaro Kayano
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hajime Onuma
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Aikawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Takafumi Yanagisawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Kojiro Tashiro
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei Katsushika Medical Center, Tokyo, Japan
| | - Shunsuke Tsuzuki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yusuke Koike
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Akira Furuta
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Jun Miki
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
7
|
Miki J, Yanagisawa T, Tsuzuki S, Mori K, Urabe F, Kayano S, Yorozu T, Sato S, Kimura T, Takahashi H, Kishimoto K, Egawa S. Anatomical localization and clinical impact of sentinel lymph nodes based on patterns of pelvic lymphatic drainage in clinically localized prostate cancer. Prostate 2018; 78:419-425. [PMID: 29368339 DOI: 10.1002/pros.23486] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/03/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Although sentinel lymph node in prostate has been generating renewed interest, its significance remains controversial due to inadequate evidence. METHODS We reviewed a prospective cohort of 50 consecutive patients with intermediate- to high-risk localized prostate cancer who had undergone laparoscopic radical prostatectomy. Sentinel lymph node biopsy by fluorescence detection using intraoperative imaging with indocyanine green and backup extended pelvic lymph node dissection were conducted prior to prostatectomy. Intraoperative and pathological findings were elaborated and compared for confirmation. RESULTS Sentinel lymph nodes were successfully identified in 47 patients (94%). A median of four sentinel lymph nodes was detected per patient. Lymph node metastasis was confirmed in six patients (12%), all of whom had positive sentinel lymph nodes. Three typical pathways of lymphatic drainage related to sentinel lymph nodes from the prostate were recognized. Ninety-one percent of the positive sentinel lymph nodes (10/11) were located at two predominant sites along these characteristic lymphatic pathways. One site was the junctional nodes, located at the junction between internal and external iliac vessels. The other was the distal internal iliac nodes, located along the inferior vesical artery. CONCLUSIONS Over 90% of positive sentinel lymph nodes were identified at two predominant sites. Priority should be given to the removal of these sentinel lymph nodes, which are located closer to the prostate, in pelvic lymph node dissection. Particular attention should be paid to identifying these nodes to reduce the possibility of overlooking lymph node metastasis.
Collapse
Affiliation(s)
- Jun Miki
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | | | - Shunsuke Tsuzuki
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Keiichiro Mori
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Fumihiko Urabe
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Sotaro Kayano
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Takashi Yorozu
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Shun Sato
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Pathology, Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Kishimoto
- Department of Urology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Shin Egawa
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
8
|
Sakuraba M, Miyamoto S, Nagamatsu S, Kayano S, Taji M, Kinoshita T, Kosuge T, Kimata Y. Hepatic artery reconstruction following ablative surgery for hepatobiliary and pancreatic malignancies. Eur J Surg Oncol 2012; 38:580-5. [PMID: 22521870 DOI: 10.1016/j.ejso.2012.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 03/21/2012] [Accepted: 04/02/2012] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Hepatic artery (HA) reconstruction is an important part of resective surgery for advanced hepatobiliary and pancreatic malignancies, but few reports have been published. To identify indications for HA reconstruction, we retrospectively analyzed our surgical procedures and outcomes. METHODS En-bloc resection of advanced hepatobiliary and pancreatic malignancies followed by HA reconstruction was performed in 35 patients. Patients ranged in age from 27 to 81 years and included 18 men and 17 women. The primary site of cancer included the bile duct in 22 patients, the pancreas in 7, and others in 6. Reconstruction of the HA was necessitated by HA resection due to direct cancer invasion in 29 patients and by accidental arterial injury during surgical procedure in 6 patients. RESULTS The HA was reconstructed with end-to-end anastomosis between hepatic arteries in 17 patients. Transposition of an intra-abdominal artery, such as the gastroepiploic artery, was required in 14 patients, and arterial grafting was required in 4 patients. Although the HA patency was achieved in 30 patients, 4 cases of arterial thrombosis and 1 case of arterial rupture developed postoperatively. The overall RFS time was analyzed in all patients, and mean and median RFS times were 18 and 9 months, respectively. CONCLUSION Although oncologic outcomes remain poor, HA resection and reconstruction can be performed in selected patients. We believe that the method of first choice for HA reconstruction is end-to-end anastomosis between HAs. A vascular autograft should be used only in selected cases.
Collapse
Affiliation(s)
- M Sakuraba
- Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa-shi, 277-8577 Chiba, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Ohdaira T, Nagai H, Kayano S, Kazuhito H. Antifogging effects of a socket-type device with the superhydrophilic, titanium dioxide-coated glass for the laparoscope. Surg Endosc 2006; 21:333-8. [PMID: 17219293 DOI: 10.1007/s00464-006-0795-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 05/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Lens fogging during laparoscopic surgery extensively deteriorates operative field visibility and may provoke serious complications. METHODS A simulation model study was conducted using a conventional laparoscope, a conventional laparoscope plus heating (100 degrees C, 10 s), a conventional laparoscope plus surfactant, and a conventional laparoscope plus both a titanium dioxide (TiO2)-coated glass (with > or = 15 h of preoperative ultraviolet irradiation) and a water supply. For each, the time from laparoscope insertion into the peritoneal cavity to fogging-induced interruption of surgery was measured. RESULTS The TiO2-coated glass had unique verified properties of exerting antifogging effects on the oil film after 15 or more hours of previous ultraviolet irradiation, and of inversely accelerating fogging after less than 15 h of previous ultraviolet irradiation. The clinical study showed later fogging with the TiO2-coated glass model, which successfully completed surgery without retraction of the laparoscope from the peritoneal cavity, as compared with the other models. CONCLUSION An antifogging device using superhydrophilic TiO2-coated glass was very effective in preventing fogging during laparoscopic surgery.
Collapse
Affiliation(s)
- T Ohdaira
- Department of General Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuki, Tochigi, 329-0498, Japan.
| | | | | | | |
Collapse
|
10
|
Nakatani N, Kayano S, Kikuzaki H, Sumino K, Katagiri K, Mitani T. Identification, quantitative determination, and antioxidative activities of chlorogenic acid isomers in prune (Prunus domestica L. ). J Agric Food Chem 2000; 48:5512-5516. [PMID: 11087511 DOI: 10.1021/jf000422s] [Citation(s) in RCA: 207] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Neochlorogenic acid (3-CQA) and cryptochlorogenic acid (4-CQA), isolated from prune (Prunus domestica L.), were identified by NMR and MS analyses. In addition, the quantity of chlorogenic acid isomers in prune were measured by HPLC. These isomers, 3-CQA, 4-CQA, and chlorogenic acid (5-CQA), were contained in the ratio 78.7:18. 4:3.9, respectively. 4-CQA was identified and quantified in prune for the first time, and relatively high amounts of this isomer were characteristic. Antioxidative activities of the chlorogenic acid isomers, such as scavenging activity on superoxide anion radicals and inhibitory effect against oxidation of methyl linoleate, were also evaluated. Each isomer showed antioxidative activities which were almost the same.
Collapse
Affiliation(s)
- N Nakatani
- Department of Food and Nutrition, Faculty of Human Life Science, Osaka City University, 3-138, Sugimoto 3, Sumiyoshi, Osaka 558-8585, Japan
| | | | | | | | | | | |
Collapse
|
11
|
Kayano S, Wilson DJ. Migration of pollutants in groundwater. VI. Flushing of DNAPL droplets/ganglia. Environ Monit Assess 1993; 25:193-212. [PMID: 24225801 DOI: 10.1007/bf00548021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/1992] [Indexed: 06/02/2023]
Abstract
Models for describing the flushing of DNAPL from contaminated aquifers are developed, and the dependence of the calculated cleanup times on the model parameters is explored. Diffusion transport from isolated DNAPL droplets, from low-permeability porous spherical domains containing distributed DNAPL droplets, and from low-permeability porous planar lamellae containing distributed DNAPL is analyzed, and the resulting expressions then coupled with the equations for advective transport of dissolved VOC by means of natural uniform flow and a system of injection and recovery wells generating a two-dimensional flow field. The models are readily run on currently available microcomputers. The results of computations with the models are consistent with the severe tailing and slow rates of remediation which are generally observed when DNAPLs are removed by flushing.
Collapse
Affiliation(s)
- S Kayano
- Departments of Chemistry and of Civil and Environmental Engineering, Vanderbilt University, 37235, Nashville, Tennessee, USA
| | | |
Collapse
|
12
|
Yamaagata S, Sato T, Oyama M, Kusuhara M, Kayano S, Kojima M. [A case of adult rheumatic fever with acute progressive mitral valve diseases]. Nihon Naika Gakkai Zasshi 1993; 82:115-6. [PMID: 8459157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|