Ryotaro Tomida, Tomoya Fukawa, Yoshito Kusuhara, Keisuke Hashimoto, Marika Atagi, Fumiya Kadoriku, Testuhiro Yano, Mitsuki Nishiyama, Kyotaro Fukuta, Saki Kobayashi, Ryoei Minato, Keito Shiozaki, Kei Daizumoto, Yutaro Sasaki, Tadanori Hosokawa, Kazuyoshi Izumi, Iku Ninomiya, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Takushi Naroda, Masahito Yamanaka, Kenjiro Okamoto and Junya Furukawa : Perioperative outcomes after Robot-assisted partial nephrectomy for very small (2cm) versus larger small (>2-4cm) renal tumors: a multi-institutional propensity score-matched study., Journal of Robotic Surgery, 20, 1, 2026.
(Summary)
The detection of incidentally identified small renal masses has increased, prompting greater use of nephron-sparing procedures. Robot-assisted partial nephrectomy (RAPN) is established for tumors4cm; however, evidence directly comparing its use for very small tumors (2cm) and slightly larger lesions (>2-4cm) is limited, particularly in Asian populations. We evaluated how tumor size affects perioperative outcomes, renal function preservation, and oncological safety in RAPN. The data of 649 Japanese patients who underwent RAPN for clinically localized renal cell carcinoma were retrospectively analyzed. Patients were grouped according to maximal tumor diameter (2cm or >2-4cm). Propensity score matching was performed to mitigate disparities in patient backgrounds including tumor complexity and location. Outcomes assessed included operative and console times, warm ischemia time, estimated blood loss (EBL), postoperative complications, trifecta and pentafecta achievement, renal functional preservation, and recurrence-free survival (RFS). After matching, 193 patient pairs were included. Tumors2cm were associated with significantly shorter operative and console times, lower warm ischemia, reduced EBL, fewer major complications, and higher trifecta achievement, compared with tumors>2-4cm. Renal function preservation was comparable between groups. Oncological outcomes were excellent in both cohorts, with 5-year RFS of 98.2% and 98.0% for tumors2cm and >2-4cm, respectively. RAPN for tumors2cm offers superior perioperative outcomes without compromising oncological control, compared with that for tumors>2-4cm. These findings support RAPN as a safe and effective nephron-sparing approach for managing incidentally detected sub-2cm renal tumors.
Saki Kobayashi, Yutaro Sasaki, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Tomoya Fukawa, Yasuyo Yamamoto and Junya Furukawa : Renal Pelvic Hematoma Following Robot-Assisted Pyeloplasty: Two Case Reports, Asian Journal of Endoscopic Surgery, 19, 1, e70234, 2026.
(Summary)
Renal pelvic hematoma is an uncommon but important complication after robot-assisted pyeloplasty (RAP), with few reports in the literature. Here, we report two cases of renal pelvic hematoma following RAP: A 9-year-old girl (Case 1) and a 25-year-old man (Case 2), both diagnosed with left ureteropelvic junction obstruction. Both underwent transperitoneal Anderson-Hynes pyeloplasty using 5-0 absorbable monofilament sutures. Postoperative imaging revealed renal pelvic hematoma in each case. Both patients remained hemodynamically stable and were managed conservatively. In Case 1, the hematoma and urine were aspirated through a 6 Fr ureteral catheter, whereas in Case 2, symptoms resolved spontaneously. Follow-up imaging demonstrated preserved renal function and improvement of hydronephrosis in both cases. Renal pelvic hematoma after RAP is rare but can be managed conservatively in stable patients. Careful intraoperative hemostasis and awareness of this complication are essential to ensure favorable outcomes.
Hideo Fukuhara, Shingo Nishimura, Keita Kobayashi, Kenichi Nishimura, Yoichiro Tohi, Ryu Shigehisa, Atsushi Takamoto, Ryutaro Shimizu, Ryotaro Tomida, Kohei Ogawa, Satoshi Katayama, Shinkuro Yamamoto, Kensuke Bekku, Noriyoshi Miura, Takuma Kato, Shuichi Morizane, Koichiro Wada, Junya Furukawa, Koji Shiraishi and Keiji Inoue : Prognostic nutritional index predicts the prognostic impact of avelumab maintenance therapy in patients with advanced urothelial carcinoma: results from the Chu-shikoku Japan Urological Consortium., Japanese Journal of Clinical Oncology, 2025.
(Summary)
Avelumab maintenance therapy is the standard treatment for locally advanced or metastatic urothelial carcinoma (mUC) demonstrating a response to platinum-based first-line therapy. Prognostic markers are necessary to predict the prognostic efficacy of avelumab therapy. This retrospective study investigated prognostic markers to optimize the efficacy of avelumab maintenance therapy.This retrospective cohort study enrolled a total of 91 patients diagnosed with locally advanced or mUC and who received avelumab maintenance therapy between February 2021 and September 2024. The impacts of neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), hemoglobin (Hb) level, and Creactive protein (CRP) level on overall survival (OS) were evaluated using Kaplan-Meier method and Cox proportional hazards model.The patients with pretreatment PNI40.2 [hazard ratio (HR) 0.15; 95% confidence interval (CI), 0.04-0.57] and pretreatment Hb10.4g/dl (HR 3.05; 95% CI, 1.53-6.09) were significantly associated with longer OS. In univariate analysis, significant prognostic factors for OS were identified as the number of cycles of avelumab 11 (P=.042), pretreatment Hb level10.4g/dl (P=.015), and pretreatment PNI40.2 (P=.002). The multivariate Cox regression analysis demonstrated that pretreatment PNI40.2 (HR 0.22; 95% CI: 0.56-0.86, P=.03) was identified as a significant prognostic factor for OS.Pretreatment low PNI was associated with poor survival outcome in avelumab maintenance therapy. This finding provides support for the potential role of PNI as a prognostic factor of avelumab maintenance therapy.
Hiroki Hagimoto, Shinichi Sakamoto, Kodai Sato, Kazuyoshi Nakamura, Hiroki Kito, Satoshi Fukasawa, Daichi Hino, Yusuke Shiraishi, Kohei Hashimoto, Yuto Matsushita, Shintaro Narita, Jun Miki, Takuma Kato, Ryuji Matsumoto, Toshihiro Saito, Ryotaro Tomida, Takahiro Kimura, Hiroshi Kitamura, Tomohiko Ichikawa and Yoshiyuki Matsui : Impact of Age on Treatment Patterns and Outcomes in Patients With Non-Metastatic Castration-Resistant Prostate Cancer, International Journal of Urology, 2025.
(Summary)
To evaluate the impact of age on treatment patterns and outcomes in patients with non-metastatic castration-resistant prostate cancer (nmCRPC). We conducted a retrospective multicenter analysis of 428 patients with nmCRPC from 25 tertiary centers (2002-2022). Patients were divided into two age groups: < 80 and ≥ 80 years. The outcomes included cancer-specific survival (CSS), overall survival (OS), and progression-free survival (PFS). Among 428 patients (median follow-up, 32.5 months), performance status (PS) 0 was more frequent in < 80 vs. ≥ 80 years (78% vs. 58%, p < 0.001). Use of first-line androgen receptor signaling inhibitors (ARSIs) was similar (58% vs. 59%, p = 0.83) among all, whereas any-line docetaxel use was less common in patients aged ≥ 80 years (33% vs. 9% for < 80 vs. ≥ 80, p < 0.001). Five-year CSS was 76.5% vs. 63.7% (p = 0.002) and five-year OS 73.8% vs. 59.9% (p = 0.006) for < 80 vs. ≥ 80 years, respectively. Time-to-treatment failure was shorter in patients aged ≥ 80 years (p = 0.04). Maintaining PS and managing ARSI-related adverse events are essential in older patients with nmCRPC and may preserve their eligibility for chemotherapy and improve their prognosis.
(Keyword)
aged 80 and over / androgen receptor signaling inhibitors / castration-resistant / docetaxel / prostatic neoplasms
Yutaro Sasaki, Satoshi Katayama, Yoichiro Tohi, Keita Kobayashi, Kenichi Nishimura, Shinkuro Yamamoto, Heima Niigawa, Taisuke Jo, Kei Daizumoto, Hirohito Naito, Ryotaro Tomida, Shingo Nishimura, Takuma Kato, Kensuke Bekku, Noriyoshi Miura, Tomoya Fukawa, Koji Shiraishi, Keiji Inoue and Junya Furukawa : Needlestick Injury During Urological Surgery: A 15-Year Review From a Multi-Institutional Study in the Chugoku-Shikoku Japan Urological Consortium, International Journal of Urology, 32, 12, 1873-1877, 2025.
(Summary)
Needlestick injuries (NSIs) are a major occupational hazard for healthcare workers and remain a concern during surgery. However, data specific to urologic surgery are limited. This multicenter retrospective study analyzed NSIs across seven Japanese institutions to clarify their characteristics and propose preventive strategies. We reviewed 63 590 urologic surgeries performed between April 2009 and March 2024 at seven university hospitals. Forty-six NSI cases were identified, of which 44 with complete data were analyzed. Collected variables included procedure type, surgeon experience, injury details, and infection status. Bleeding severity was classified as superficial (controlled by spontaneous hemostasis or light compression only) or moderate (requiring strong compression or additional hemostatic procedures such as sealing or suturing). The overall incidence of NSIs was 0.06% (range, 0.01%-0.24%). Suture needles were responsible for 75.0% of cases, and 61.4% occurred during wound closure, of which 92.6% involved suture needles. NSIs during wound closure were significantly more common in robot-assisted/laparoscopic procedures than in open/other procedures (88.9% vs. 42.3%, p = 0.005). Injuries predominantly affected the first to third digits (77.3%). Moderate bleeding was observed more often in dominant-hand injuries, although the difference did not reach statistical significance (31.3% vs. 10.7%, p = 0.102). NSIs in urologic surgery most often occur during wound closure and involve suture needles, particularly in robot-assisted and laparoscopic procedures. The first to third digits are most frequently affected, and dominant-hand injuries tend to cause more bleeding. Preventive measures-including safer suturing techniques, double gloving, and finger protection-are warranted to reduce the risk.
(Keyword)
needlestick injury / robot-assisted surgery / urological surgery
Kamei Yushi, Ryotaro Tomida, Takayoshi Shinya, Kei Daizumoto, Junya Furukawa, Yoshimi Bando, Hisanori Uehara, Koichi Tsuneyama and Masafumi Harada : A case of incidental adrenal capillary hemangioma after a partial nephrectomy for renal clear cell carcinoma, Radiology Case Reports, 20, 11, 5710-5714, 2025.
(Summary)
Adrenal capillary hemangiomas are an extremely rare tumor type, and no previous studies have described their features using dynamic contrast-enhanced computed tomography. We report the case of a 65-year-old male patient with a history of right partial nephrectomy for renal clear cell carcinoma. During follow-up, computed tomography scans revealed growth of a right adrenal nodule. On contrast-enhanced computed tomography, the adrenal tumor showed peripheral nodular and progressive central enhancements in the early and delayed phases, respectively. No evidence of metastasis to other organs appeared on computed tomography, and hormone levels showed no elevation in the blood test results. Histopathological examination of the resected adrenal tumor specimen confirmed the presence of clusters of thin-walled vessels, leading to a diagnosis of adrenal capillary hemangioma. This case suggests that adrenal capillary hemangiomas can present imaging findings similar to those previously reported for cavernous adrenal, other adrenal, and capillary hemangiomas originating from other organs.
Naoki Fujita, Yuto Matsushita, Takahiro Kojima, Yukari Bando, Takahiro Osawa, Tomokazu Sazuka, Keisuke Goto, Kazuyuki Numakura, Kazutoshi Yamana, Shuya Kandori, Yoshihide Kawasaki, Takuma Kato, Makito Miyake, Kazutoshi Fujita, Kosuke Ueda, Hajime Tanaka, Ryotaro Tomida, Hiroshi Kitamura, Hideaki Miyake and Shingo Hakakeyama : Impact of Impaired Renal Function on the Efficacy and Safety of Second-Line Tyrosine Kinase Inhibitor Therapy After First-Line Immuno-Oncology Combination Therapy in Metastatic Renal Cell Carcinoma: A Japanese Multicenter Retrospective Study, International Journal of Urology, 32, 10, 1506-1517, 2025.
(Summary)
To evaluate the effects of renal impairment at the time of second-line tyrosine kinase inhibitor (TKI) therapy initiation and rapid renal function decline during first-line immuno-oncology (IO) combination therapy on metastatic renal cell carcinoma (mRCC) patients treated with second-line TKIs. This multicenter retrospective study included 243 mRCC patients treated with first-line IO combination therapy, followed by second-line TKI therapy. Patients were divided into three groups using the estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) at the time of second-line TKI therapy initiation: eGFR ≥ 60, 30 ≤ eGFR < 60, and eGFR < 30. The eGFR slope during first-line IO combination therapy was calculated using eGFR measurements when initiating first-line and second-line therapies. Multivariable Cox proportional hazards regression analyses were performed to evaluate the effects of renal impairment and eGFR slope on progression-free survival (PFS) and overall survival (OS). The incidence rates of any grade and grade ≥ 3 adverse events were not significantly different among the three groups. Univariable analyses indicated that eGFR slope was not significantly associated with PFS or OS. Multivariable analyses suggested that moderate (30 ≤ eGFR < 60 mL/min/1.73 m2) and severe (eGFR < 30 mL/min/1.73 m2) renal impairment had no effects on shorter PFS, whereas severe renal impairment was independently and significantly associated with shorter OS. TKIs can be safely used as a second-line treatment after first-line IO combination therapy in mRCC patients with renal impairment without sacrificing oncological outcomes, except for in patients with severe renal impairment.
Yutaro Sasaki, Kyotaro Fukuta, Tetsuhiro Yano, Mitsuki Nishiyama, Saki Kobayashi, Ryoei Minato, Kei Daizumoto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto and Junya Furukawa : Vas Guide: a novel device for looping blood vessels in robot-assisted surgery., Surgical Endoscopy, 39, 7, 4447-4454, 2025.
(Summary)
Looping blood vessels in robot-assisted surgery remains challenging because of limitations in instrument articulation, joint length, and the lack of tactile feedback. To address this critical issue, we developed the Vas Guide, a novel device, for safe blood vessel handling. This study aims to establish the efficacy, safety, and durability of the Vas Guide.The Vas Guide is a flat, curved stainless-steel strip with blunt, rounded ends and a hole near the distal end. After sufficient dissection of the posterior surface of the target blood vessel, the Vas Guide with a vessel loop tied to the distal end was passed around the blood vessel in a single step using a suturing-like motion, thereby enabling secure vessel management. It is reusable and has a unit price of approximately $600. We analyzed 83 patients undergoing robot-assisted partial nephrectomy or nephroureterectomy at Tokushima University Hospital: 39 in the Vas Guide group and 44 in the conventional group. Outcomes including looping time, looping-related complication rates, such as collisions between instruments and bleeding, and additional instrument usage were recorded. The National Aeronautics and Space Administration task load index (NASA-TLX) scores were assessed.The patients' characteristics were comparable between the two groups. The Vas Guide group demonstrated significantly better outcomes, including faster looping times (31 vs. 90 s, p < 0.001), fewer looping-related complications (0% vs. 30%, p < 0.001), no additional instrument usage (0% vs. 50%, p < 0.001), and better NASA-TLX scores (26.5 vs. 75.7, p < 0.001). The Vas Guide showed no usability issues, with only minor surface scratches and a slight radius change (8.60 mm to 8.69 mm).This reusable device combines high efficacy, safety, and durability and can be implemented at a relatively low cost.
Yoichiro Tohi, Keita Kobayashi, Kei Daizumoto, Yohei Sekino, Hideo Fukuhara, Heima Niigawa, Satoshi Katayama, Ryutaro Shimizu, Atsushi Takamoto, Kenichi Nishimura, Taichi Nagami, Yushi Hayashida, Hiromi Hirama, Koji Shiraishi, Ryotaro Tomida, Kohei Kobatake, Keiji Inoue, Yoshiyuki Miyaji, Kensuke Bekku, Shuichi Morizane, Noriyoshi Miura, Koichiro Wada, Mikio Sugimoto, Keiji Inoue, Shinkuro Yamamoto, Koji Shiraishi, Yoshiyuki Miyaji, Nobuyuki Hinata, Junya Furukawa, Motoo Araki, Tatsushi Kawada, Atsushi Takenaka, Takashi Saika, Koichiro Wada, Yoichiro Tohi, Takuma Kato, Hirohito Naito, Hideo Fukuhara, Keita Kobayashi, Shin Ohira, Kei Daizumoto, Yutaro Sasaki, Ryotaro Tomida, Satoshi Katayama, Ryutaro Shimizu, Kenichi Nishimura, Ryuta Watanabe, Taichi Nagami, Atsushi Takamoto, Heima Niigawa, Yohei Sekino, Kohei Kobatake and Mikio Sugimoto : Real-world clinical usage and efficacy of apalutamide in men with nonmetastatic castration-resistant prostate cancer: A multi-institutional study in the CsJUC, Japanese Journal of Clinical Oncology, 55, 6, 643-649, 2025.
(Summary)
To evaluate the real-world clinical usage and effectiveness of apalutamide in men with nonmetastatic castration-resistant prostate cancer (nmCRPC). We retrospectively reviewed the data of 186 men who received apalutamide across 17 institutions. The primary outcomes were the clinical usage of apalutamide for nmCRPC: prior usage of other androgen receptor signaling inhibitors (ARSIs), prior radical treatment, and the distribution of the prostate-specific antigen (PSA) doubling time (PSA-DT) at the initial administration of apalutamide. The secondary outcomes were the efficacy of apalutamide: PSA response (50% or 90% decline), progression-free survival, and skin-adverse events (AEs). We identified 75 patients with nmCRPC. A total of 31 (41.3%) patients received prior treatment with other ARSIs. A total of 42 men (56%) did not receive any prior radical treatment. The PSA-DT was <3.0, 3.0-5.9, 6.0-10, and > 10 months in 34.7%, 40%, 14.7%, and 10.6% of the patients, respectively. Patients receiving prior treatment with other ARSIs showed a significantly lower PSA response (PSA 50% decline, 88.4% vs. 18.8%; PSA 90% decline, 60.5% vs. 6.2%, P < .001, respectively) and significantly shorter progression-free survival (median: 37 months vs. 4 months; log-rank P < .001) than those without prior ARSI treatment, although cancer status did not differ between the groups. Skin-AEs were observed in 42.7%. This real-world study revealed that apalutamide was used for the treatment after other ARSIs in >40% of patients with nmCRPC and showed limited efficacy in this context, although the effectiveness of apalutamide without prior other ARSI treatment was comparable with that reported in clinical trial results.
(Keyword)
apalutamide / nonmetastatic castration-resistant prostate cancer / prostate cancer / prostate-specific antigen response / PSA-doubling time
Effectiveness and safety of second-line tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma (mRCC) for whom first-line immuno-oncology (I-O) combination therapy was discontinued because of adverse events (AEs) remain to be determined. Clinicopathological data were retrospectively collected from 34 institutions between August 2018 and January 2022 for 243 patients with mRCC who received second-line TKIs after first-line I-O combination therapy. Two patients who requested discontinuation of first-line I-O combination therapy were excluded. Oncological outcomes and safety were compared between patients who discontinued first-line I-O combination therapy because of progressive disease (Group PD) and AEs (Group AE). First- and second-line overall survival (OS) were defined as the time from the start of first- and second-line therapy to death, respectively. Propensity score matching was applied to adjust prognostic factors between the 2 groups. There were 179 patients in Group PD and 62 patients in Group AE. Objective response rate and disease control rate were similar between the 2 groups. Progression-free survival (PFS), second-line OS, and first-line OS were significantly longer in Group AE than in Group PD (median 13.6 months vs. 8.5 months, P = 0.005; median not reached [NR] vs. 19.5 months, P = .005; median NR vs. 30.8 months, P = .012, respectively). After propensity score matching, PFS and second-line OS were still significantly longer and first-line OS tended to be longer in Group AE than in Group PD. There were no significant differences in the occurrence of AEs of any grade, including severe grades of 3 or greater, between the 2 groups. Second-line TKIs are safe and at least as effective in patients with mRCC who discontinued first-line I-O combination therapy because of AEs as they are in patients who discontinued because of PD.
Yoshihiko Tasaki, Shuzo Hamamoto, Shimpei Yamashita, Junya Furukawa, Kazutoshi Fujita, Ryotaro Tomida, Makito Miyake, Noriyuki Ito, Hideto Iwamoto, Yoshihisa Mimura, Yosuke Sugiyama, Rei Unno, Atsushi Okada, Takahiro Yasui and Yoko Furukawa-Hibi : Eosinophil is a predictor of severe immune-related adverse events induced by ipilimumab plus nivolumab therapy in patients with renal cell carcinoma: a retrospective multicenter cohort study., Frontiers in Immunology, 15, 1483956, 2025.
(Summary)
Immune-related adverse events (irAEs) induced by immune checkpoint inhibitors are difficult to predict and can lead to severe events. Although it is important to develop strategies for the early detection of severe irAEs, there is a lack of evidence on irAEs associated with ipilimumab plus nivolumab therapy for metastatic renal cell carcinoma (RCC). Therefore, this study aimed to investigate the association between eosinophil and severe irAEs in patients receiving ipilimumab plus nivolumab therapy for RCC. In this retrospective study, 161 patients receiving ipilimumab plus nivolumab therapy for RCC were divided into three groups based on whether they experienced <grade 2 irAEs (non-severe irAE group), grade 3 irAEs (severe irAE group), or not (non-irAE group). We examined the proportion of eosinophils before and 2 weeks after treatment (baseline and 2-week samples, respectively). Although the eosinophil in the baseline samples did not differ between the severe irAE and non-irAE groups (2.8% vs. 2.5%, P = 0.75), regarding the 2-week samples, the eosinophil was significantly higher in the severe irAE group (mean, 6.6% vs. 3.3%; P < 0.05). Multivariate analysis showed that an eosinophil of 3.0% was a risk factor for severe irAEs (odds ratio, 6.01). Median progression-free survival (mPFS), mPFS from the start of ipilimumab plus nivolumab therapy to second-line therapy (mPFS2), and median overall survival (mOS) were the shortest in the non-irAE group. Although the mPFS did not differ between the severe and non-severe irAE groups (9.2 vs 14.2 months, P = 0.45), notably, mPFS2 and mOS in the former group tended to be shorter than those in the latter group (mPFS2: 29.2 vs not reached, P = 0.10; mOS: 36.9 vs 52.3 months, P = 0.06). An increased eosinophil 2 weeks after ipilimumab plus nivolumab therapy may be a predictor of severe irAEs, which are associated with poor prognoses, compared with non-severe irAEs among patients with RCC. We provide a novel rationale for the importance of monitoring eosinophil counts for the early detection of severe irAEs.
Yutaro Sasaki, Saki Kobayashi, Kei Daizumoto, Fumiya Kadoriku, Marika Atagi, Tetsuhiro Yano, Mitsuki Nishiyama, Ryoei Minato, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Tomoya Fukawa, Yasuyo Yamamoto and Junya Furukawa : Use of the Assistent Guide Facilitates Ureteral Stent Placement in Robot-Assisted Pyeloplasty, Asian Journal of Endoscopic Surgery, 18, 1, e70178, 2025.
(Summary)
In robot-assisted pyeloplasty, intraoperative placement of a double-J ureteral stent (DJ stent) is an essential step to ensure ureteral patency and anastomotic healing. However, the procedure can be technically demanding because of limited tactile feedback and the need for precise coordination between the console surgeon (CS) and the patient-side surgeon (PSS). To address these challenges, we applied the Assistent guide (UMIHIRA Co. Ltd., Kyoto, Japan), originally developed for robot-assisted intracorporeal ileal conduit diversion. The device is a stainless-steel instrument with a blunt tip and side hole, accommodating all stent sizes and insertable through a 5-mm trocar. During RAPP, the PSS advances the guide through the trocar to the ureteral anastomosis, the CS inserts the guidewire under direct vision, and the PSS advances the DJ stent antegrade along the guidewire. The CS provides countertraction to stabilize the ureter. Since August 2022, six patients underwent RAPP using this technique. Stent placement was successful in all cases without complications such as stent damage, malpositioning, or ureteral injury. The PSS reported smooth handling and reliable torque transmission compared with conventional methods. The Assistent guide costs approximately ¥80 000 per device and is reusable. Although limited by sample size and single-institution experience, this technique provides a practical solution to a technically challenging step in RAPP. Further multi-institutional evaluation is warranted to confirm safety, efficacy, and broader applicability.
(Keyword)
Assistent guide / medical device development / robot-assisted pyeloplasty / ureteral stent placement
Tokiyoshi Tanegashima, Masaki Shiota, Naoki Terada, Toshihiro Saito, Akira Yokomizo, Naoki Kohei, Takayuki Goto, Sadafumi Kawamura, Yasuhiro Hashimoto, Atsushi Takahashi, Takahiro Kimura, Ken-Ichi Tabata, Ryotaro Tomida, Kohei Hashimoto, Toshihiko Sakurai, Toru Shimazui, Shinichi Sakamoto, Manabu Kamiyama, Nobumichi Tanaka, Koji Mitsuzuka, Takuma Kato, Shintaro Narita, Hiroaki Yasumoto, Shogo Teraoka, Masashi Kato, Takahiro Osawa, Yoshiyuki Nagumo, Hiroaki Matsumoto, Hideki Enokida, Takayuki Sugiyama, Kentaro Kuroiwa, Hiroshi Kitamura, Toshiyuki Kamoto and Masatoshi Eto : Improved prognosis of de novo metastatic prostate cancer after an introduction of life-prolonging agents for castration-resistant prostate cancer., International Journal of Clinical Oncology, 30, 3, 551-558, 2024.
(Summary)
In Japan, since 2014, new treatments such as androgen receptor signaling inhibitors and cabazitaxel have become applicable for metastatic castration-resistant prostate cancer (mCRPC), leading to dramatic changes in treatment options.This study aims to evaluate the impact of recent advancements in treatment options on the overall survival (OS) of patients diagnosed with de novo metastatic castration-sensitive prostate cancer (mCSPC) in Japan.A retrospective analysis was conducted on 2450 Japanese men diagnosed with de novo mCSPC between 2008 and 2018. Patients were stratified into two groups based on the period of diagnosis: an earlier period (2008-2013) and a later period (2014-2018). OS was compared between earlier and later periods using Kaplan-Meier analysis in total and propensity score matched subpopulation as well as risk-stratified subgroups.Patients diagnosed in the later period exhibited significantly improved OS compared to those diagnosed in the earlier period. The risk score, calculated based on ISUP grade group, LDH levels, and ALP levels, was a poor prognostic factor. In the later period, compared to the earlier period, there was no improvement in OS in the favorable-risk group, but a significant improvement was observed in the poor-risk group.It was suggested that the introduction of novel androgen receptor signaling inhibitors and chemotherapy treatment regimens since 2014 has led to improved survival outcomes for patients with de novo mCSPC, particularly those with poor-risk profiles. The findings highlight the impact of recent advancements in treatment on the prognosis of patients with metastatic prostate cancer in Japan.
(Keyword)
Humans / Male / Prostatic Neoplasms, Castration-Resistant / Aged / Retrospective Studies / Prognosis / Middle Aged / Aged, 80 and over / Japan / Neoplasm Metastasis / Androgen Receptor Antagonists / Taxoids / Kaplan-Meier Estimate
Nivolumab plus ipilimumab (NIVO+IPI) has a long-term response rate of 30% for patients with metastatic renal cell carcinoma (mRCC). However, 20% of patients develop primary resistant disease (PRD) to NIVO+IPI and show poor survival outcomes. In this study, we aimed to evaluate the effect of PRD as a second-line treatment in patients with mRCC. The data used in this multi-institutional, retrospective cohort were collected between August 2015 and January 2023. In total, 189 patients with mRCC were treated with NIVO+IPI and then with a vascular endothelial growth factor receptor-tyrosine kinase inhibitor. Associations between PRD and progression-free survival of second-line treatment (PFS), progression-free survival 2 (PFS2), and overall survival (OS) were analyzed. The median age at NIVO+IPI initiation was 67 years in the male-dominant population (n = 140, 74.1%), and most patients had clear cell histology (n = 140, 74.1%). PRD was recorded in 42 (22.2%) of 189 patients during NIVO+IPI therapy. Patients who experienced PRD showed poor PFS (hazard ratio [HR], 1.788; 95% confidence interval [CI], 1.176-2.718; p = 0.007), PFS2 (HR, 4.127; 95% CI, 2.649-6.431; p < 0.001), and OS (HR, 3.330; 95% CI, 2.040-5.437; p < 0.001). Before starting second-line therapy, patients with PRD tended to have a poor performance status compared with non-PRD patients and a higher IMDC risk. Second-line drug therapy was not associated with treatment outcomes in patients with PRD. PRD in patients with mRCC receiving NIVO+IPI as first-line treatment was associated with poor clinical course, even with second-line therapy.
Yutaro Sasaki, Yasuyo Yamamoto, Kyotaro Fukuta, Kazuyoshi Izumi, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka and Junya Furukawa : Cutaneous ureterostomy following robot-assisted radical cystectomy: a multicenter comparative study of transperitoneal versus retroperitoneal techniques., World Journal of Urology, 42, 1, 591, 2024.
(Summary)
Compared with r-CUS, t-CUS was associated with a shorter operative time and lower incidence of perioperative complications, including gastrointestinal complications. We believe that t-CUS can be performed safely and effectively.
Yutaro Sasaki, Narushi Yokota, Shuhei Nozaki, Satoshi Harada, Tetsuhiro Yano, Mitsuki Nishiyama, Saki Kobayashi, Ryoei Minato, Kei Daizumoto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Kazuya Kanda, Hiroomi Kanayama and Junya Furukawa : Robot-assisted nephroureterectomy using the GelPoint Platform with a focus on optimizing the port position and specimen retrieval., Asian Journal of Endoscopic Surgery, 17, 4, e13386, 2024.
(Summary)
One of the factors that makes robot-assisted nephroureterectomy difficult is that the optimal port position differs between nephrectomy and bladder cuff excision. In addition, how best to retrieve the specimen after resection while minimizing the size of the wound is a challenge in robot-assisted surgery. To solve these problems, we designed a surgical technique for robot-assisted nephroureterectomy using the GelPoint Platform with a focus on port position optimization and specimen retrieval. This study describes the surgical technique of GelPoint robot-assisted nephroureterectomy and reports our initial experience with this technique. Between January 2023 and May 2024, seven patients underwent robot-assisted nephroureterectomy using the GelPoint Platform and 11 underwent conventional robot-assisted nephroureterectomy. We compared the patients' characteristics and surgical outcomes between the two groups. Compared with the conventional robot-assisted nephroureterectomy group, the median operative time tended to be shorter in the GelPoint robot-assisted nephroureterectomy group (280 vs. 357 min, respectively; p = .135). The maximum incision length tended to be longer in the GelPoint robot-assisted nephroureterectomy group (7.0 vs. 6.0 cm, respectively; p = .078). The incidence of 30-day complications was similar between the two groups (28.5% vs. 18.2%, respectively; p = 1.000). No complications were associated with the use of the GelPoint Platform. The surgical outcomes of GelPoint robot-assisted nephroureterectomy are comparable to those of conventional robot-assisted nephroureterectomy, and it can be performed safely and effectively. GelPoint robot-assisted nephroureterectomy can be considered a feasible alternative for selected patients with upper tract urothelial carcinoma.
Yutaro Sasaki, Kyotaro Fukuta, Fumiya Kadoriku, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto and Junya Furukawa : Retroperitoneal cutaneous ureterostomy following radical cystectomy: A multicenter comparative study of robotic versus open surgery., International Journal of Urology, 31, 12, 1408-1413, 2024.
(Summary)
The aim of this study was to evaluate the differences in perioperative outcomes of cutaneous ureterostomy (CUS) between open surgery (open radical cystectomy, ORC) and robot-assisted surgery (robot-assisted radical cystectomy, RARC), including the stent-free rate, readmission rates due to urinary tract infection (UTI), and changes in renal function. Between 2005 and 2023, a total of 37 patients underwent CUS following ORC, while 24 patients underwent CUS following RARC. Perioperative outcomes were compared between these two groups. The patients in the RARC group were significantly older (p = 0.007) and had a significantly higher proportion of high-risk cases with ASA-PS 3 (p = 0.002). In addition, RARC was associated with a significantly lower estimated blood loss (p < 0.001) and a reduced transfusion rate (p = 0.003). Postoperative complication rates and the stent-free rate were comparable between the ORC and RARC groups. Throughout a median follow-up period of 2.6 years, rates of readmission due to UTI did not differ significantly between the two groups. Moreover, there were no differences in the change in estimated glomerular filtration rate before and after surgery and the 3-year survival rates were similar across both groups. CUS following RARC appears to offer a safer alternative compared with CUS following ORC, and the stent-free rates are comparable. The significantly lower estimated blood loss and transfusion rate associated with RARC are particularly favorable for elderly patients, those who are frail, and individuals with multiple comorbidities.
Shuzo Hamamoto, Yoshihiko Tasaki, Shimpei Yamashita, Junya Furukawa, Kazutoshi Fujita, Ryotaro Tomida, Makito Miyake, Noriyuki Ito, Hideto Iwamoto, Yosuke Sugiyama, Kazumi Taguchi and Takahiro Yasui : External validation of hemoglobin and neutrophil levels as predictors of the effectiveness of ipilimumab plus nivolumab for treating renal cell carcinoma., Frontiers in Oncology, 14, 1400041, 2024.
(Summary)
Pretreatment hemoglobin and neutrophil levels were previously reported to be important indicators for predicting the effectiveness of ipilimumab plus nivolumab (IPI + NIVO) therapy for renal cell carcinoma (RCC). Therefore, we aimed to validate this in a large external cohort. In total, 172 patients with RCC who underwent IPI + NIVO treatment at a multicenter setting were divided into three groups according to their pretreatment hemoglobin and neutrophil levels (group 1: non-anemia; group 2: anemia and low-neutrophil; and group 3: anemia and high-neutrophil). Group 1 showed better survival than groups 2 and 3 (overall survival: 52.3 vs. 21.4 vs. 9.4 months, respectively; progression-free survival: 12.1 vs. 7.0 vs. 3.4 months, respectively). In this large cohort, we validated our earlier observation that hemoglobin and neutrophil levels can be reliable predictors of the effectiveness of IPI + NIVO in advanced RCC. Thus, our approach may aid in selecting the optimal first-line therapy for RCC.
Tokiyoshi Tanegashima, Masaki Shiota, Takahiro Kimura, Dai Takamatsu, Yoshiyuki Matsui, Akira Yokomizo, Ryoichi Saito, Shuichi Morizane, Makito Miyake, Masakazu Tsutsumi, Yoshiyuki Yamamoto, Kojiro Tashiro, Ryotaro Tomida, Kohei Edamura, Shintaro Narita, Takahiro Yamaguchi, Takashi Kasahara, Kohei Hashimoto, Masashi Kato, Takayuki Yoshino, Shusuke Akamatsu, Akihiro Matsukawa, Tomoyuki Kaneko, Ryuji Matsumoto, Akira Joraku, Manabu Kato, Toshihiro Saito, Takuma Kato, Shuichi Tatarano, Shinichi Sakamoto, Hidenori Kanno, Naoki Terada, Naotaka Nishiyama, Hiroshi Kitamura and Masatoshi Eto : Prognosis based on postoperative PSA levels and treatment in prostate cancer with lymph node involvement., International Journal of Clinical Oncology, 29, 10, 1586-1593, 2024.
(Summary)
The therapeutic role of pelvic lymph node dissection (PLND) during radical prostatectomy (RP) for prostate cancer is not established. In clinical practice, PLND is primarily performed in cases of high-risk prostate cancer. The detection of lymph node metastasis plays a crucial role in determining the need for subsequent treatments. This study aims to evaluate the prognosis of prostate cancer patients with lymph node involvement (LNI) by stratifying them based on postoperative prostate-specific antigen (PSA) levels to identify biomarkers that can guide postoperative treatment strategies.Analysis was conducted on 383 patients, selected from 572 initially eligible, who underwent RP with LNI across 33 Japanese Urological Oncology Group institutions from 2006 to 2019. Patients were grouped according to postoperative PSA levels and salvage treatments received. Follow-up focused on castration resistance-free survival (CRFS), metastasis-free survival (MFS), and overall survival (OS).In the persistent PSA group (PSA ≥ 0.1 ng/mL), CRFS and MFS were significantly shorter compared to the non-persistent PSA group (PSA < 0.1 ng/mL), and there was a tendency for shorter OS. In the persistent PSA group, patients with postoperative PSA values above the median (PSA ≥ 0.52 ng/mL) showed shorter CRFS and MFS. Furthermore, in the PSA ≥ 0.52 group, androgen deprivation therapy (ADT) plus radiotherapy (RT) combination had prolonged CRFS and MFS compared with ADT alone.This study provides valuable insights into stratifying patients based on postoperative PSA levels to tailor postoperative treatment strategies, potentially improving the prognosis of prostate cancer patients with LNI.
A multicenter study of nonmetastatic castration-resistant prostate cancer (nmCRPC) was conducted to identify the optimal cut-off value of prostate-specific antigen (PSA) doubling time (PSADT) that correlated with the prognosis in Japanese nmCRPC. Of the 515 patients diagnosed and treated for nmCRPC at 25 participating Japanese Urological Oncology Group centers, 450 patients with complete clinical information were included. The prognostic values of clinical factors were evaluated with respect to prostate specific antigen progression-free (PFS), cancer-specific survival (CSS), and overall survival (OS). The optimal cutoff value of PSADT was identified using survival tree analysis by Python. The Median PSA and PSADT at diagnosis of nmCRPC were 3.3 ng/ml, and 5.2 months, respectively. Patients treated with novel hormonal therapy (NHT) showed significantly longer PFS (HR: hazard ratio 0.38, p < 0.0001) and PFS2 (HR 0.45, p < 0.0001) than those treated with vintage nonsteroidal antiandrogen agent (Vintage). The survival tree identified 4.65 months as the most prognostic PSADT cutoff point. Among the clinical and pathological factors PSADT of < 4.65 months remained an independent prognostic factor for OS (HR 2.96, p = 0.0003) and CSS (HR 3.66, p < 0.0001). Current data represented optimal cut-off of PSADT 4.65 months for a Japanese nmCRPC.
(Keyword)
Humans / Male / Prostate-Specific Antigen / Prostatic Neoplasms, Castration-Resistant / Aged / Middle Aged / Japan / Prognosis / Aged, 80 and over / East Asian People
Yutaro Sasaki, Yoshito Kusuhara, Takuro Oyama, Mitsuki Nishiyama, Saki Kobayashi, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Hiroomi Kanayama and Junya Furukawa : Radical prostatectomy using the Hinotori robot-assisted surgical system: Docking-free design may contribute to reduction in postoperative pain., The International Journal of Medical Robotics + Computer Assisted Surgery : MRCAS, 20, 3, e2648, 2024.
(Summary)
The docking-free design of the Japanese Hinotori surgical robotic system allows the robotic arm to avoid trocar grasping, thereby minimising excessive abdominal wall stress. The aim of this study was to evaluate the safety and efficacy of robotic-assisted radical prostatectomy (RARP) using the Hinotori system and to explore the potential contribution of its docking-free design to postoperative pain reduction. This study reviewed the clinical records of 94 patients who underwent RARP: 48 patients in the Hinotori group and 46 in the da Vinci Xi group. Hinotori group had significantly longer operative and console times (p = 0.030 and p = 0.029, respectively). Perioperative complications and oncologic outcomes did not differ between the two groups. On postoperative day 4, the rate of decline from the maximum visual analogue scale score was marginally significant in the Hinotori group (p = 0.062). The docking-free design may contribute to reducing postoperative pain.
Ryotaro Tomida, Tomoya Fukawa, Yoshito Kusuhara, Keisuke Hashimoto, Keito Shiozaki, Kazuyoshi Izumi, Iku Ninomiya, Fumiya Kadoriku, Hirofumi Izaki, Takushi Naroda, Kenjiro Okamoto, Yasuo Kawanishi, Hiro-omi Kanayama and Masayuki Takahashi : Robot-assisted partial nephrectomy in younger versus older adults with renal cell carcinoma: a propensity score-matched analysis., World Journal of Urology, 42, 1, 326, 2024.
(Summary)
Our study aimed to compare the surgical outcomes of robot-assisted partial nephrectomy (RAPN) between younger and older patients after adjusting for their background differences. We particularly assessed RAPN outcomes and safety in older patients.We retrospectively evaluated 559 patients clinically diagnosed with T1 renal cell carcinoma (RCC) and treated with RAPN between 2013 and 2022 at five institutions in Japan. The patients were classified into two groups according to their age during surgery (younger group: < 75 years, older group: ≥ 75 years). Propensity score matching (PSM) was performed to adjust for the differences in the backgrounds between younger and older patients, and surgical outcomes were compared.Among the 559 patients, 422 (75.5%) and 137 (24.5%) were classified into the younger and older groups, respectively; 204 and 102 patients from the younger and older groups were matched according to PSM, respectively. Subsequently, patient characteristics other than age were not significantly different between the two groups. In the matched cohort, the older group had more patients with major complications (younger, 3.0%; older, 8.8%; P = 0.045).Surgical outcomes of RAPN in older patients with RCC were comparable with those in younger patients, although older patients experiencedsignificantly more complications than younger patients. These results suggest the need for further detailed preoperative evaluation and appropriate postoperative management in older patients receiving RAPN.
Ryotaro Tomida, Masayuki Takahashi, Yuto Matsushita, Takahiro Kojima, Kazutoshi Yamana, Shuya Kandori, Yukari Bando, Naotaka Nishiyama, Shimpei Yamashita, Hisanori Taniguchi, Keisuke Monji, Ryo Ishiyama, Shuichi Tatarano, Kimihiko Masui, Ayumu Matsuda, Tomoyuki Kaneko, Takanobu Motoshima, Yusuke Shiraishi, Satoru Kira, Takaya Murashima, Hiroaki Hara, Masafumi Matsumura, Hiroshi Kitamura, Hideaki Miyake and Junya Furukawa : Comparison of Cabozantinib and Axitinib as Second-line Therapy After Nivolumab Plus Ipilimumab in Patients With Metastatic Clear Cell Renal Cell Carcinoma: A Comparative Analysis of Retrospective Real-world Data., Clinical Genitourinary Cancer, 22, 3, 102094, 2024.
(Summary)
To date, no studies have compared the treatment outcomes of second-line therapies in patients with metastatic clear cell renal cell carcinoma (ccRCC). This study retrospectively evaluated the efficacy of cabozantinib and axitinib as second-line treatments in patients with metastatic ccRCC who previously received immune-oncology combination therapy. Patients with metastatic ccRCC treated with cabozantinib and axitinib as second-line therapy after nivolumab-ipilimumab treatment were identified among 243 patients with RCC treated between August 1, 2018 and January 31, 2022 at 34 institutions belonging to the Japanese Urological Oncology Group. Patients were assessed for treatment outcomes, including progression-free survival (PFS), overall survival, objective response rate (ORR), and incidence rate of treatment-related adverse events (AEs). Forty-eight patients treated with cabozantinib and 60 treated with axitinib as second-line therapy after nivolumab-ipilimumab treatment for metastatic ccRCC were identified. The median PFS (95% confidence interval) was 11.0 months (9.0-16.0) with cabozantinib and 9.5 months (6.0-13.0) with axitinib. The ORRs were 37.5% (cabozantinib) and 38.3% (axitinib). The rates of any-grade AEs and grade 3 AEs were 79.2% (cabozantinib) versus 63.3% (axitinib; P = .091) and 35.4% (cabozantinib) versus 23.3% (axitinib; P = .202), respectively. In the poor-risk group, PFS was longer in the cabozantinib group than in the axitinib group (P = .033). The efficacy and safety of cabozantinib and axitinib were comparable. In the poor-risk group, cabozantinib was more effective than axitinib. These findings provide valuable insights into the selection of second-line treatment options after nivolumab-ipilimumab treatment in patients with metastatic ccRCC.
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Keito Shiozaki, Kei Daizumoto, Yoshiteru Ueno, Kosuke Seto, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi and Junya Furukawa : Robot-assisted intracorporeal ileal conduit urinary diversion: A two-center comparative study of Bricker versus Wallace ureteroileal anastomosis, Asian Journal of Endoscopic Surgery, 17, 2, e13307, 2024.
(Summary)
This study was performed to evaluate the differences in the perioperative results, renal function, and incidence of hydronephrosis over time between the use of Bricker anastomosis and Wallace anastomosis for robot-assisted intracorporeal ileal conduit urinary diversion (RICIC). Fifty-five patients who underwent RICIC at two institutions were evaluated (Bricker, n = 23; Wallace, n = 32). We investigated changes in estimated glomerular filtration rate and hydronephrosis before surgery and at 3, 6, and 12 months after surgery. The patients in the Bricker group were significantly older than those in the Wallace group. The urinary diversion time was significantly longer in the Bricker group. No significant difference in postoperative renal function was observed. Additionally, no significant difference was observed in the incidence of postoperative hydronephrosis. However, the incidence of right hydronephrosis tended to be high overall, especially in the Wallace group. No patients in either group required repair surgery or ureteral stent placement. In patients undergoing RICIC, there was no difference in postoperative renal function or the incidence of hydronephrosis between Wallace and Bricker anastomosis. Symptomatic hydronephrosis was not observed in either group. The present study showed that each method was equally effective and safe.
Yutaro Sasaki, Kazuyoshi Izumi, Kyotaro Fukuta, Fumiya Kadoriku, Yuichiro Atagi, Kei Daizumoto, Keito Shiozaki, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Kenjiro Okamoto, Masahito Yamanaka and Junya Furukawa : Impact of lymph node dissection on surgical and oncological outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer: a multicenter retrospective study, Journal of Robotic Surgery, 18, 1, 141, 2024.
(Summary)
This study was performed to clarify the therapeutic and diagnostic roles of lymph node dissection (LND) by examining the impact of LND and lymph node yield (LNY) on oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC). Between 2014 and 2021, 216 patients underwent LND during RARC at Tokushima University Hospital and affiliated hospitals. Among the 216 patients, we compared 115 patients with an LNY of ≥ 20 and 101 with an LNY of < 20 to investigate the impact of LNY on surgical and oncological outcomes. Furthermore, we investigated the impact of LNY and the extent of LND on oncological outcomes by dividing the extent of LND into two groups (standard and extended). The 3-year rates of overall survival (OS) (p = 0.256), cancer-specific survival (CSS) (p = 0.791), and recurrence-free survival (RFS) (p = 0.953) did not differ between the two groups divided by the LNY. A higher LNY was associated with a significantly higher lymph node positivity rate (p = 0.020). The incidence of LND-related major complications was not significantly different between the two groups (p = 0.910). The 3-year survival rates did not differ between the two groups divided by the extent of LND: OS (p = 0.366), CSS (p = 0.814), and RFS (p = 0.689). The LNY and extent of LND were not associated with oncological outcomes in patients undergoing LND during RARC, whereas a higher LNY was associated with lymph node positivity. In the era of adjuvant therapy with immune checkpoint inhibitors, LND during RARC has an important diagnostic role in the detection of pathological node positivity.
Nobutaka Nishimura, Makito Miyake, Kota Iida, Tatsuki Miyamoto, Ryotaro Tomida, Kazuyuki Numakura, Junichi Inokuchi, Takahiro Yoneyama, Eijiro Okajima, Shugo Yajima, Hitoshi Masuda, Naoki Terada, Rikiya Taoka, Takashi Kobayashi, Takahiro Kojima, Yoshiyuki Matsui, Naotaka Nishiyama, Hiroshi Kitamura, Hiroyuki Nishiyama and Kiyohide Fujimoto : Treatment patterns and prognosis in patients with Bacillus Calmette-Guérin-exposed high-risk non-muscle invasive bladder cancer: a real-world data analysis., World Journal of Urology, 42, 1, 2024.
(Summary)
The International Bladder Cancer Group designated the subgroup that is resistant to Bacillus Calmette-Guérin (BCG) but does not meet the criteria for BCG-unresponsive NMIBC as "BCG-exposed high-risk NMIBC" to guide optimal trial design. We aimed to investigate the treatment patterns and prognoses of patients with BCG-exposed NMIBC.We conducted a retrospective chart review of 3283 patients who received intravesical BCG therapy for NMIBC at 14 participating institutions between January 2000 and December 2019. Patients meeting the criteria for BCG-exposed and BCG-unresponsive NMIBC, as defined by the Food and Drug Administration and International Bladder Cancer Group, were selected. To compare treatment patterns and outcomes, high-risk recurrence occurring more than 24 months after the last dose of BCG was defined as "BCG-treated NMIBC." In addition, we compared prognoses between BCG rechallenge and early cystectomy in patients with BCG-exposed NMIBC.Of 3283 patients, 108 (3.3%), 150 (4.6%), and 391 (11.9%) were classified as having BCG-exposed, unresponsive, and treated NMIBC, respectively. BCG-exposed NMIBC demonstrated intermediate survival curves for intravesical recurrence-free and progression-free survival, falling between those of BCG-unresponsive and treated NMIBC. Among patients with BCG-exposed NMIBC, 48 (44.4%) received BCG rechallenge, which was the most commonly performed treatment, and 19 (17.6%) underwent early cystectomy. No significant differences were observed between BCG rechallenge and early cystectomy in patients with BCG-exposed NMIBC.The newly proposed definition of BCG-exposed NMIBC may serve as a valuable disease subgroup for distinguishing significant gray areas, except in cases of BCG-unresponsive NMIBC.
This study aimed to create a prognostic model to predict disease recurrence among patients with lymph node involvement but no prostate-specific antigen (PSA) persistence and to explore its clinical utility.The study analyzed patients with lymph node involvement after pelvic lymph node dissection with radical prostatectomy in whom no PSA persistence was observed between 2006 and 2019 at 33 institutions. Prognostic factors for recurrence-free survival (RFS) were analyzed by the Cox proportional hazards model.Among 231 patients, 127 experienced disease recurrence. The factors prognostic for RFS were PSA level at diagnosis (≥ 20 vs. < 20 ng/mL: hazard ratio [HR], 1.66; 95% confidence interval [CI], 1.09-2.52; P = 0.017), International Society of Urological Pathology grade group at radical prostatectomy (RP) specimen (group ≥ 4 vs. ≤ 3: HR, 1.63; 95% CI 1.12-2.37; P = 0.010), pathologic T-stage (pT3b/4 vs. pT2/3a: HR, 1.70; 95% CI 1.20-2.42; P = 0.0031), and surgical margin status (positive vs. negative: HR, 1.60; 95% CI 1.13-2.28; P = 0.0086). The prognostic model using four parameters were associated with RFS and metastasis-free survival.The prognostic model in combination with postoperative PSA value and number of lymph nodes is clinically useful for discussing treatment choice with patients.
Hiroshi Kikuchi, Takashige Abe, Makito Miyake, Haruka Miyata, Ryuji Matsumoto, Takahiro Osawa, Nobutaka Nishimura, Kiyohide Fujimoto, Junichi Inokuchi, Takahiro Yoneyama, Ryotaro Tomida, Kazuyuki Numakura, Yuto Matsushita, Kazumasa Matsumoto, Takuma Sato, Rikiya Taoka, Takashi Kobayashi, Takahiro Kojima, Yoshiyuki Matsui, Naotaka Nishiyama, Hiroshi Kitamura, Hiroyuki Nishiyama and Nobuo Shinohara : The impact of second transurethral resection on survival outcomes in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin therapy., Japanese Journal of Clinical Oncology, 54, 2, 192-200, 2024.
(Summary)
Several guidelines recommended that second transurethral resection should be performed in patients with diagnosis of high-risk non-muscle-invasive bladder cancer. However, therapeutic benefits of second transurethral resection before bacillus Calmette-Guérin intravesical instillation were conflicting amongst previous studies. We investigated the prognostic impact of second transurethral resection before bacillus Calmette-Guérin instillation in high-risk non-muscle-invasive bladder cancer patients.This retrospective study included 3104 non-muscle-invasive bladder cancer patients who received bacillus Calmette-Guérin instillations between 2000 and 2019 at 31 collaborative institutions. Univariate and multivariate Cox proportional hazards models were used to assess the risk factors of intravesical recurrence, disease progression, cancer-specific mortality and overall mortality.In the entire population, patients undergoing second transurethral resection (33%, 1026/3104) had a lower risk of intravesical recurrence on univariate analysis (hazard ratio 0.85, 95% confidence interval 0.73-0.98, P = 0.027), although it did not remain significant on multivariate analysis (hazard ratio 0.90, 95% confidence interval 0.76-1.07, P = 0.24). Subgroup analysis revealed that, in pT1 patients (n = 1487), second transurethral resection was significantly correlated with a lower risk of intravesical recurrence on multivariate analysis (hazard ratio 0.80, 95% confidence interval 0.64-1.00, P = 0.048), but lower risks of disease progression (hazard ratio 0.75, 95% confidence interval 0.56-1.00, P = 0.049), cancer-specific mortality (hazard ratio 0.54, 95% confidence interval 0.35-0.85, P = 0.007) and overall mortality (hazard ratio 0.73, 95% confidence interval 0.55-0.97, P = 0.027) on univariate analysis.Second transurethral resection confers accurate pathological staging and could be used to safely select good candidates for intravesical bacillus Calmette-Guérin instillation. We further confirm that second transurethral resection could confer an oncological benefit in pT1 bladder cancer patients treated by bacillus Calmette-Guérin instillation, and so strongly recommend second transurethral resection in this patient population.
This study aimed to assess the prognostic outcomes in mRCC patients receiving second-line TKI following first-line IO combination therapy.This study retrospectively included 243 mRCC patients receiving second-line TKI after first-line IO combination therapy: nivolumab plus ipilimumab (n = 189, IO-IO group) and either pembrolizumab plus axitinib or avelumab plus axitinib (n = 54, IO-TKI group). Oncological outcomes between the two groups were compared, and prognostication systems were developed for these patients.In the IO-IO and IO-TKI groups, the objective response rates to second-line TKI were 34.4% and 25.9% (p = 0.26), the median PFS periods were 9.7 and 7.1 months (p = 0.79), and the median OS periods after the introduction of second-line TKI were 23.1 and 33.5 months (p = 0.93), respectively. Among the several factors examined, non-CCRCC, high CRP, and low albumin levels were identified as independent predictors of both poor PFS and OS by multivariate analyses. It was possible to precisely classify the patients into 3 risk groups regarding both PFS and OS according to the positive numbers of the independent prognostic factors. Furthermore, the c-indices of this study were superior to those of previous systems as follows: 0.75, 0.64, and 0.61 for PFS prediction and 0.76, 0.70, and 0.65 for OS prediction by the present, IMDC, and MSKCC systems, respectively.There were no significant differences in the prognostic outcomes after introducing second-line TKI between the IO-IO and IO-TKI groups, and the histopathology, CRP and albumin levels had independent impacts on the prognosis in mRCC patients receiving second-line TKI, irrespective of first-line IO combination therapies.
Yutaro Sasaki, Masayuki Takahashi, Keito Shiozaki, Katsuhito Hori, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Koichi Tomita, Koichi Sairyo and Hiroomi Kanayama : The importance of laparoscopic surgery for young urologists remains unwavering even in the era of robot assisted surgery, Asian Journal of Endoscopic Surgery, 17, 1, e13254, 2023.
(Summary)
Robot-assisted surgery (RAS) cannot be achieved without the performance of laparoscopic surgical techniques by a patient-side surgeon (PSS). In many medical institutions in Japan, young urologists often take on the role of a PSS. Participating in RAS as a PSS provides a good opportunity to acquire not only the knowledge necessary for surgery, but also skills in laparoscopic surgical techniques. Learning laparoscopic surgery as a PSS may contribute to improving the quality of RAS. Furthermore, it will lead to skill improvement as an operator in laparoscopic surgery. However, notably, opportunities for young urologists to perform laparoscopic surgery are decreasing in the current era of RAS. Under these circumstances, we believe that cadaver surgical training will become increasingly important in the future. We believe that performance of cadaver surgical training will contribute to increased motivation, enhance the understanding of surgical procedures, and facilitate the acquisition of surgical techniques.
Yoichiro Tohi, Takuma Kato, Keita Kobayashi, Kei Daizumoto, Hideo Fukuhara, Shin Ohira, Satoshi Katayama, Ryutaro Shimizu, Atsushi Takamoto, Kenichi Nishimura, Kenichiro Ikeda, Taichi Nagami, Yushi Hayashida, Hiromi Hirama, Hirohito Naito, Ryotaro Tomida, Yutaro Sasaki, Shinkuro Yamamoto, Shinjiro Shimizu and Mikio Sugimoto : Real-world prostate-specific antigen response and progression to castration-resistant prostate cancer among men with metastatic castration-sensitive prostate cancer treated with apalutamide: a multi-institutional study in the Chu-shikoku Japan Urological Consortium., Japanese Journal of Clinical Oncology, 54, 2, 167-174, 2023.
(Summary)
Japanese men receiving apalutamide often experience skin-adverse events (AEs), possibly requiring treatment interruption or dose reduction. However, concerns have arisen regarding the impact of these adjustments on the efficacy of apalutamide. Our study evaluated the efficacy, safety, and persistence of apalutamide in men with metastatic castration-sensitive prostate cancer (mCSPC). We retrospectively reviewed the medical records of 108 men with mCSPC from 14 Japanese institutions. The primary outcomes were the efficacy of apalutamide: prostate-specific antigen (PSA) response (50%, 90% and < 0.2 decline) and progression to castration-resistant prostate cancer (CRPC). The secondary outcomes were the skin-AE and compliance of apalutamide. PSA50%, PSA90% and PSA < 0.2 declines were observed in 89.8, 84.3 and 65.7%, and the median time to CRPC progression was not reached. PSA < 0.2 decline and an initial full dose of apalutamide were significantly associated with a longer time to CRPC. The most common AE was skin-AE (50.9%), and there was no association between the occurrence of skin-AE and the time to CRPC (P = 0.72). The median apalutamide persistence was 29 months, which was longer in the initial full dose recipients than in the reduced dose recipients. The dosage is reduced in about 60% of patients within the first year of treatment in the initial full dose recipients. Our findings indicate the effectiveness of apalutamide in Japanese men with mCSPC, despite a substantial portion requiring dose reduction within a year among the initial full dose recipients.
(Keyword)
male / Humans / Prostate-Specific Antigen / Prostatic Neoplasms, Castration-Resistant / Japan / Retrospective Studies / Castration / Thiohydantoins
Positive core ratios observed on prostate biopsy correlated with higher recurrence rates after LDR-BT. This indicates that the proportion of positive cores in the biopsy may be an important factor in predicting the likelihood of recurrence, especially for patients with GG3 PCa.
Yutaro Sasaki, Kei Daizumoto, Kyotaro Fukuta, Keito Shiozaki, Mitsuki Nishiyama, Seiya Utsunomiya, Saki Kobayashi, Kosuke Seto, Yoshiteru Ueno, Ryotaro Tomida, Yoshito Kusuhara, Tomoya Fukawa, Ryoichi Nakanishi, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki and Masayuki Takahashi : Lymph node dissection during radical cystectomy for bladder cancer: A two-center comparative study of robotic versus open surgery., Asian Journal of Endoscopic Surgery, 16, 4, 724-730, 2023.
(Summary)
This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC). From October 2003 to December 2021, 122 patients underwent LND during RARC and 103 patients underwent LND during ORC at Tokushima University Hospital and Tokushima Prefectural Central Hospital. We investigated the safety and efficacy of LND during RARC by comparing the surgical and oncological outcomes between the two groups. The patients were significantly older in the RARC than the ORC group. The operative time was significantly shorter and the estimated blood loss was significantly lower in the RARC than the ORC group. Although the lymph node yield was significantly higher in the RARC than the ORC group, there was no significant difference in lymph node positivity between the groups. There was no significant difference in the incidence of local recurrence or distant metastasis between the two groups. The 5-year survival rates (overall survival, cancer-specific survival, and recurrence-free survival) were not different between the RARC and ORC groups. This study suggests that the surgical and oncological safety and efficacy of LND during RARC are greater than those of LND during ORC. We believe that LND during RARC is a higher-quality procedure than LND during ORC.
Masayuki Takahashi, Kei Daizumoto, Tomoya Fukawa, Yayoi Fukuhara, Yoshimi Bando, Minoru Kowada, Tsogt-Ochir Dondoo, Yutaro Sasaki, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hisanori Uehara and Hiroomi Kanayama : Insulin receptor expression to predict resistance to axitinib and elucidation of the underlying molecular mechanism in metastatic renal cell carcinoma., British Journal of Cancer, 129, 3, 521-530, 2023.
(Summary)
Decreased INSR in RCC could be a biomarker to predict axitinib resistance. Regarding the resistant mechanism, vascular endothelial cells with decreased INSR in RCC may secrete interferon-β and induce PD-L1.
Katsuhito Hori, Yutaro Sasaki, Keito Shiozaki, Fumiya Kadoriku, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto, Masayuki Takahashi, Yoshihiro Tsuruo and Hiroomi Kanayama : Efficacy of fresh-frozen cadaveric surgical training for arteriovenous fistula in vascular access., The Journal of Vascular Access, 2023.
(Summary)
CST for AVF creation is useful for surgical education because it enables learning of surgical techniques that are almost equivalent to those in living bodies. In addition, this study suggested that CST not only contributes to the improvement of surgical skills of young surgeons but also promotes the reduction of anxiety and stress about AVF creation.
Masayuki Takahashi, Kei Daizumoto, Yutaro Sasaki, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Yasuyo Yamamoto and Omi Hiro Kanayama : THE NEXT TEN YEARS OF SYSTEMIC THERAPY FOR METASTATIC RENAL CELL CARCINOMA, The Nishinihon Journal of Urology, 85, 4, 145-152, 2023.
(Keyword)
metastatic renal cell carcinoma / new drugs / systemic therapy
Megumi Tsuda, Tomoya Fukawa, Yasuyo Yamamoto, Kei Daizumoto, Yutaro Sasaki, Yoshiteru Ueno, Ryotaro Tomida, Yoshito Kusuhara, Kunihisa Yamaguchi, Masayuki Takahashi and Hiro-omi Kanayama : Impact of early urinary catheter removal on successful voiding and physical function in stroke patients., The Journal of Medical Investigation : JMI, 70, 3.4, 436-442, 2023.
(Summary)
The aim of the present study was to identify factors related to the success of trial without catheter (TWOC) in patients with stroke and to examine the effect of the timing of urinary catheter removal on the course of stroke. Patients who were admitted to the Stroke Care Unit of our institution between March 2018 and October 2021 were included. To identify factors related to success of TWOC, a multivariate analysis was performed on the patient's condition at admission and catheter indwelling time. The patients were divided into two groups by the timing of catheter removal, and we assessed the relationship between the timing of catheter removal successful TWOC and recovery of physical function. A total of 118 patients were included. The presence of comorbidities and scores of severity and function at admission were not predictors of successful voiding. The time to achieve voiding sussess was significantly shorter in the early catheter removal group than in the later group (p<0.005). Interestingly, the early group also showed better improvements in physical function. Early removal of catheters may lead to early recovery of bladder function, improvement of physical function, and lower risk of complications in patients with stroke. J. Med. Invest. 70 : 436-442, August, 2023.
Yoshiteru Ueno, Tomoharu Fukumori, Yoshito Kusuhara, Tomoya Fukawa, Megumi Tsuda, Kei Daizumoto, Yutaro Sasaki, Ryotaro Tomida, Yasuyo Yamamoto, Kunihisa Yamaguchi, Chisato Tonoiso, Akiko Kubo, Takashi Kawanaka, Shunsuke Furutani, Hitoshi Ikushima, Masayuki Takahashi and Hiro-omi Kanayama : Prostate-specific Antigen Levels Following Brachytherapy Impact Late Biochemical Recurrence in Japanese Patients With Localized Prostate Cancer., In Vivo, 37, 2, 738-746, 2023.
(Summary)
PSA levels at 5 years post-treatment were associated with long-term recurrence of localized prostate cancer, which can help alleviate patient anxiety concerning prostate cancer recurrence if PSA levels remain low at 5 years after LDR-BT.
(Keyword)
male / Humans / Prostate-Specific Antigen / Brachytherapy / Cohort Studies / East Asian People / Prostatic Neoplasms
Fumiya Kadoriku, Yutaro Sasaki, Kyotaro Fukuta, Yuichiro Atagi, Keito Shiozaki, Kei Daizumoto, Ryotaro Tomida, Yoshiteru Ueno, Megumi Tsuda, Yoshito Kusuhara, Tomoya Fukawa, Yutaka Yanagihara, Kunihisa Yamaguchi, Yasuyo Yamamoto, Hirofumi Izaki, Masayuki Takahashi, Sadamu Yamashi, Masaharu Kan and Hiroomi Kanayama : A propensity score matching study on robot-assisted radical cystectomy for older patients: comparison of intracorporeal ileal conduit and cutaneous ureterostomy., BMC Urology, 22, 1, 2022.
(Summary)
In older patients, the ICIC group showed non-inferior surgical and oncological outcomes compared with the CUS group. Urinary diversion following RARC in older patients should be carefully selected by considering not only the age but also the general condition (including comorbidities) of the patient.
Hikari Otsuka, Yuki Kita, Katsuhiro Ito, Takeshi Sano, Junichi Inokuchi, Ryotaro Tomida, Atsushi Takahashi, Kazumasa Matsumoto, Ryoma Kurahashi, Yu Ozaki, Masayuki Uegaki, Satoru Maruyama, Shoichiro Mukai, Masakazu Tsutsumi, Takashi Kawahara, Takehiko Segawa, Hiroshi Kitamura, Satoshi Morita and Takashi Kobayashi : Immune-related adverse events in urothelial cancer patients: Adjustment for immortal time bias., Cancer Science, 113, 11, 3912-3921, 2022.
(Summary)
To investigate the association between the onset, severity, and type of immune-related adverse events (irAEs) and the efficacy of pembrolizumab in patients with platinum-pretreated advanced urothelial carcinoma (UC), we retrospectively collected clinical datasets of 755 patients and conducted landmark analysis. Patients who survived for fewer than 3 months were excluded from the evaluation to reduce the immortal time bias. In total, 620 patients were evaluated, of whom 220 patients (35.5%) experienced grade ≥2 irAEs, including 134 patients with grade 2 irAEs and 86 with grade ≥3 irAEs. Propensity score matching extracted 198 patients with and without grade ≥2 irAEs. The onset of grade ≥2 irAEs was associated with longer median progression-free survival (PFS) (8.3 months vs. 4.5 months, p = 0.003) and overall survival (OS) (20.4 months vs. 14.3 months, p = 0.031) and a higher objective response rate (ORR) (44.8% vs. 30.2%, p = 0.004). Patients with grade 2 irAEs had significantly better oncological outcomes (PFS, OS, and ORR) than grade ≤1 and ≥3 irAEs. Patients with grade ≥3 irAEs had worse outcomes than grade 2 irAEs. Endocrine and skin irAEs were related with better survival outcomes, and the rate of severities was lower in these categories. In conclusion, the occurrence of irAEs, particularly low-grade irAEs, was predictive of pembrolizumab efficacy in patients with platinum-pretreated advanced UC.
The treatment for lymph node involvement (LNI) after radical prostatectomy (RP) has not been established. This study aimed to reveal the outcomes of various management strategies among patients with LNI after RP. Retrospectively, 561 patients with LNI after pelvic lymph node dissection (PLND) with RP treated between 2006 and 2019 at 33 institutions participating in the Japanese Urological Oncology Group were investigated. Metastasis-free survival (MFS) was the primary outcome. Patients were stratified by prostate-specific antigen (PSA) persistence after RP. Cox regression models were used to analyze the relationships between clinicopathological characteristics and survival. Survival analyses were conducted using the Kaplan-Meier method and log-rank test with or without propensity score matching. Prognoses, including MFS and overall survival, were prominently inferior among patients with persistent PSA compared with those without persistent PSA. In multivariate analysis, androgen deprivation therapy (ADT) plus radiotherapy (RT) was associated with better MFS than ADT alone among patients with persistent PSA (hazard ratio = 0.37; 95% confidence interval = 0.15-0.93; p = 0.034). Similarly, MFS and overall survival were significantly better for ADT plus RT than for ADT alone among patients with persistent PSA after propensity score matching. This study indicated that PSA persistence in LNI prostate cancer increased the risk of poor prognoses, and intensive treatment featuring the addition of RT to ADT might improve survival.
Ryotaro Tomida, Makito Miyake, Ryoei Minato, Yuichiro Sawada, Masafumi Matsumura, Kota Iida, Shunta Hori, Shinji Fukui, Chikara Ohyama, Hideaki Miyake, Fumiya Hongo, Rikiya Taoka, Takashi Kobayashi, Takahiro Kojima, Yoshiyuki Matsui, Naotaka Nishiyama, Hiroshi Kitamura, Hiroyuki Nishiyama, Kiyohide Fujimoto and Katsuyoshi Hashine : Impact of carcinoma in situ on the outcome of intravesical Bacillus Calmette-Guérin therapy for non-muscle-invasive bladder cancer: a comparative analysis of large real-world data., International Journal of Clinical Oncology, 27, 5, 958-968, 2022.
(Summary)
This study investigated the clinical impact of carcinoma in situ (CIS) in intravesical Bacillus Calmette-Guérin (BCG) therapy for patients with non-muscle-invasive bladder cancer (NMIBC).This study retrospectively evaluated 3035 patients who were diagnosed with NMIBC and treated by intravesical BCG therapy between 2000 and 2019 at 31 institutions. Patients were divided into six groups according to the presence of CIS as follows: low-grade Ta without concomitant CIS, high-grade Ta without concomitant CIS, high-grade Ta with concomitant CIS, high-grade T1 without concomitant CIS, high-grade T1 with concomitant CIS, and pure CIS (without any papillary lesion). The endpoints were recurrence- and progression-free survival after the initiation of BCG therapy. We analyzed to identify factors associated with recurrence and progression.At a median follow-up of 44.4 months, recurrence and progression were observed in 955 (31.5%) and 316 (10.4%) patients, respectively. Comparison of six groups using univariate and multivariate analysis showed no significant association of CIS. However, CIS in the prostatic urethra was an independent factors associated with progression.Concomitant CIS did not show a significant impact in the analysis of Ta and T1 tumors which were treated using intravesical BCG. Concomitant CIS in the prostatic urethra was associated with high risk of progression. Alternative treatment approaches such as radical cystectomy should be considered for patients with NMIBC who have a risk of progression.
To determine the effect of combined androgen blockade with a first-generation anti-androgen on the prognoses of metastatic hormone-sensitive prostate cancer patients stratified by tumor burden. We retrospectively analyzed the cases of metastatic hormone-sensitive prostate cancer patients who were treated with androgen deprivation therapy in 2008-2017 at 30 institutions in Japan. To compare the overall survival and progression-free survival rates of the patients treated with castration monotherapy and combined androgen blockade, we carried out a Cox proportional hazards regression analysis using both inverse probability of treatment weighting and instrumental variables methods. High-burden disease was defined as the presence of four or more bone metastases and/or visceral metastasis. Of 2048 patients, 702 (34.3%) and 1346 (65.7%) patients were classified as the low- and high-burden groups, respectively. In each group, >80% of the patients were treated with combined androgen blockade. Although there was no significant between-group difference in the overall survival according to the androgen deprivation therapy method, in the high-burden group the progression-free survival of the combined androgen blockade-treated patients was significantly better than that of patients treated with castration monotherapy: inverse probability of treatment weighting method, hazard ratio 0.49, 95% confidence interval 0.34-0.71; instrumental variables method, hazard ratio 0.80, 95% confidence interval 0.60-0.98. In the high-burden group, combined androgen blockade with a first-generation anti-androgen resulted in superior progression-free survival compared with castration monotherapy. For well-selected metastatic hormone-sensitive prostate cancer patients, the use of combined androgen blockade might still have some suitable scenarios.
Osuke Arai, Shunsuke Iuchi, Ryotaro Tomida, Masafumi Matsumura and Katuyoshi Hashine : [PROSTATE-SPECIFIC ANTIGEN LEVEL AT 6 MONTHS AFTER RADICAL PROSTATECTOMY ENABLES STRATIFICATION OF FOLLOW-UP PERIODS IN THE CANCER REGIONAL ALLIANCES CRITICAL PATH]., The Japanese Journal of Urology, 113, 1, 16-21, 2022.
(Summary)
(Objectives)Factors related to prostate-specific antigen (PSA) recurrence, including PSA at 6 months after radical prostatectomy, were evaluated to determine if the postoperative follow-up period in the cancer regional alliances critical path could be individualized using a coordinated path. (Patients and methods)Among 352 patients who underwent laparoscopic radical prostatectomy at our hospital from May 2009 to June 2015, 331 who did not undergo preoperative hormone therapy were examined retrospectively. Cases with PSA < 0.01 ng/mL at 6 months after surgery (group A, n=209) were compared with those with PSA > 0.01 ng/mL at the same time point (group B, n=122). (Results)PSA recurrence was significantly higher in group B (n=21 (10.0%) vs. n=70 (57.4%), p< 0.001) and the time to recurrence was significantly shorter (44 vs.12.5 months, p< 0.001). In multivariate analysis within group A, the Gleason Grade Group (GGG) and extraprostatic extension in surgical specimens were predictors of PSA recurrence. In group A, all cases (n=30) of GGG1 in surgical specimens had no extraprostatic extension and no PSA recurrence. There were 90 cases of surgical specimens with GGG2 and no extracapsular infiltration, and only 4 of these cases had recurrence (4.4%). (Conclusion)The results of the study indicate that follow-up interval stratification is possible using the PSA level at 6 months after radical prostatectomy, GGG and extraprostatic extension in the surgical specimen.
Nobutaka Nishimura, Makito Miyake, Kota Iida, Tatsuki Miyamoto, Ryotaro Tomida, Kazuyuki Numakura, Junichi Inokuchi, Takahiro Yoneyama, Yoshiaki Matsumura, Shugo Yajima, Hitoshi Masuda, Naoki Terada, Rikiya Taoka, Takashi Kobayashi, Takahiro Kojima, Yoshiyuki Matsui, Naotaka Nishiyama, Hiroshi Kitamura, Hiroyuki Nishiyama and Kiyohide Fujimoto : Prognostication in Japanese patients with bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer undergoing early radical cystectomy., International Journal of Urology, 29, 3, 242-249, 2021.
(Summary)
The US Food and Drug Administration recently defined the clinical term "bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer" as a disease state resistant to adequate bacillus Calmette-Guérin therapy. There is a significant lack of prognostication for this disease even in patients who have undergone early radical cystectomy. This study aimed to identify the clinical outcomes and prognostic factors in Japanese patients with bacillus Calmette-Guérin-unresponsive non-muscle-invasive bladder cancer who underwent early radical cystectomy.Data from a large-scale multicenter retrospective study included 2879 patients with highest-risk or high-risk non-muscle-invasive bladder cancer who received intravesical bacillus Calmette-Guérin induction therapy between January 2000 and December 2019. A total of 141 patients (4.3%) met the criteria for bacillus Calmette-Guérin-unresponsive disease, of whom 47 (33.3%) underwent early radical cystectomy. Prognostic factors for three clinical endpoints, namely, unresectable lesion-free survival, cancer-specific survival, and overall survival, were identified.The highest-risk status at induction bacillus Calmette-Guérin was associated with short unresectable lesion-free survival (hazard ratio 7.85; P < 0.05), cancer-specific survival (hazard ratio 12.24; P < 0.05), and overall survival (hazard ratio 9.25; P < 0.01). Moreover, extravesical tumors (pathological T3 or T4) on the radical cystectomy specimens were associated with poor prognosis and were found at a higher rate in patients with the highest-risk status at induction bacillus Calmette-Guérin than in those with high-risk status (35.7% vs 21.2%).The highest-risk status among the pre-bacillus Calmette-Guérin factors was associated with upstaging to extravesical tumors and poor prognosis despite early radical cystectomy procedures. Appropriate decision-making and the correct timing of radical cystectomy are vital to avoid treatment delays and improve outcomes.
Minoru Kato, Takashi Kobayashi, Yoshiyuki Matsui, Katsuhiro Ito, Kensuke Hikami, Takeshi Yamada, Kosuke Ogawa, Kenji Nakamura, Naoto Sassa, Akira Yokomizo, Takashige Abe, Kazunari Tsuchihashi, Shuichi Tatarano, Junichi Inokuchi, Ryotaro Tomida, Maki Fujiwara, Atsushi Takahashi, Kazumasa Matsumoto, Kosuke Shimizu, Hiromasa Araki, Ryoma Kurahashi, Yu Ozaki, Yu Tashiro, Masayuki Uegaki, Takahiro Kojima, Junji Uchida, Osamu Ogawa, Hiroyuki Nishiyama and Hiroshi Kitamura : Impact of the objective response to and number of cycles of platinum-based first-line chemotherapy for metastatic urothelial carcinoma on overall survival of patients treated with pembrolizumab., International Journal of Urology, 28, 12, 1261-1267, 2021.
(Summary)
To investigate the impact of the number of cycles and objective response to chemotherapy on overall survival in patients with metastatic urothelial carcinoma treated with pembrolizumab.This multicenter, retrospective study included 755 patients from 59 institutions with advanced, chemoresistant urothelial carcinoma who received pembrolizumab. The associations of the overall survival with the number of cycles and best objective response were investigated using Cox multiple regression analysis.Overall, 391 patients received standard first-line chemotherapy and pembrolizumab as a second-line treatment, and were included in the final analysis. Of the 391 patients, 185 received less than four cycles, 134 received four to six cycles and 72 received more than six cycles of first-line chemotherapy. An objective response (complete or partial response) to chemotherapy was observed in 145 patients (37.1%). Univariate analysis showed that the overall survival of patients who received more than six cycles or responded to chemotherapy (complete or partial response) was significantly longer than that of patients who received less than four cycles or did not respond to chemotherapy (stable or progressive disease). At multivariate levels, no correlations were observed between overall survival and the number of cycles of or the response to chemotherapy.Therapeutic benefit of pembrolizumab can be expected irrespective of the objective response to and number of cycles of platinum-based first-line chemotherapy.
The metastatic burden is a critical factor for decision-making in the treatment of metastatic hormone-sensitive prostate cancer (HSPC). This study aimed to develop and validate a novel risk model for survival in patients with de novo low- and high-burden metastatic HSPC. The retrospective observational study included men with de novo metastatic prostate cancer who were treated with primary androgen-deprivation therapy at 30 institutions across Japan between 2008 and 2017. We created a risk model for overall survival (OS) in the discovery cohort (n = 1449) stratified by the metastatic burden (low vs high) and validated its predictive ability in a separate cohort (n = 951). Based on multivariate analyses, lower hemoglobin levels, higher Gleason grades, and higher clinical T-stage were associated with poor OS in low-burden disease. Meanwhile, lower hemoglobin levels, higher Gleason grade group, liver metastasis, and higher extent of disease scores in bone were associated with poor OS in patients with high-burden disease. In the discovery and validation cohorts, the risk model using the aforementioned parameters exhibited excellent discriminatory ability for progression-free survival and OS. The predictive ability of this risk model was superior to that of previous risk models. Our novel metastatic burden-stratified risk model exhibited excellent predictive ability for OS, and it is expected to have several clinical uses, such as precise prognostic estimation.
To assess the impact of histological variants on survival and response to treatment with pembrolizumab in patients with chemo-resistant urothelial carcinoma (UC). The medical records of 755 patients with advanced UC who received pembrolizumab were reviewed retrospectively. Patients were classified into pure UC (PUC) and each variant. Best overall response (BOR) and overall survival (OS) were compared between the groups using a propensity score matching (PSM). Overall, 147 (19.5%) patients harboured any histological variant UC (VUC). After PSM, there were no significant differences in the objective response rate (ORR, 24.5% vs 17.3%, P = 0.098) or disease control rate (DCR, 36.7% vs 30.2%, P = 0.195) when comparing patients with any VUC and PUC. Furthermore, any VUC, as compared with PUC, was associated with a similar risk of death (hazard ratio [HR] 0.90, 95% confidence interval [CI] 0.68-1.20; P = 0.482). Squamous VUC, which was the most frequent variant in the cohort, had a comparable ORR, DCR and OS as compared with PUC or non-squamous VUC. The patients with sarcomatoid VUC (n = 19) had significantly better ORR (36.8%, P = 0.031), DCR (52.6%, P = 0.032), and OS (HR 0.37, 95% CI 0.15-0.90; P = 0.023) compared to patients with PUC. The presence of variant histology did not seem to affect BOR or OS after pembrolizumab administration in patients with chemo-resistant UC. The patients with sarcomatoid VUC achieved favourable responses and survival rates compared to PUC.
Yoichiro Tohi, Takuma Kato, Akira Yokomizo, Koji Mitsuzuka, Ryotaro Tomida, Junichi Inokuchi, Ryuji Matsumoto, Toshihiro Saito, Hiroshi Sasaki, Koji Inoue, Hidefumi Kinoshita, Hiroshi Fukuhara, Satoru Maruyama, Shinichi Sakamoto, Toshiki Tanikawa, Shin Egawa, Haruhiko Ichikura, Takashige Abe, Masaki Nakamura, Yoshiyuki Kakehi and Mikio Sugimoto : Impact of health-related quality of life on repeat protocol biopsy compliance on active surveillance for favorable prostate cancer: results from a prospective cohort in the PRIAS-JAPAN study., Urologic Oncology: Seminars and Original Investigations, 40, 2, 56.e9-56.e15, 2021.
(Summary)
This study aimed to evaluate how health-related quality of life (HRQOL) is related to repeat protocol biopsy compliance.We conducted a retrospective analysis using data from a prospective cohort in the Prostate Cancer Research International: Active Surveillance (PRIAS)-JAPAN study between January 2010 and August 2019. We used the Short Form 8 Health Survey (SF-8), as patient-reported outcomes, to assess HRQOL at AS enrollment and the first year of the protocol. The physical component summary (PCS) and mental component summary (MCS) were calculated from SF-8 questionnaires. The primary outcome was the evaluation of the association of HRQOL at enrollment on the first repeat biopsy compliance. The secondary outcome was the comparison of SF-8 scores during AS, stratified by repeat protocol biopsy compliance.Of 805 patients who proceeded to the first year of the protocol, the non-compliance rate was 15% (121 patients). In the adjusted model, lower MCS at enrollment was significantly associated with the first repeat protocol biopsy non-compliance (odds ratio [OR], 2.134; 95% confidence interval [CI], 1.031-4.42; P = 0.041) but not in lower PCS (OR, 0.667; 95% CI, 0.294-1.514; P = 0.333). All subscales of SF-8 were lower in the non-compliance group than in the compliance group at any point. MCS in the non-compliance group improved over time from the time of AS enrollment (2.34 increased, P = 0.152).Our data suggest that lower MCS at AS enrollment using patient-reported outcomes was negatively associated with the first repeat protocol biopsy compliance. Our study may support the availability of a simple questionnaire to extract non-compliance.
(Keyword)
Aged / Biopsy / Humans / Japan / Male / Middle Aged / Prospective Studies / Prostatic Neoplasms / Quality of Life / Retrospective Studies / Watchful Waiting
Katsuhiro Ito, Takashi Kobayashi, Takahiro Kojima, Kensuke Hikami, Takeshi Yamada, Kosuke Ogawa, Kenji Nakamura, Naoto Sassa, Akira Yokomizo, Takashige Abe, Kazunari Tsuchihashi, Shuichi Tatarano, Junichi Inokuchi, Ryotaro Tomida, Maki Fujiwara, Atsushi Takahashi, Kazumasa Matsumoto, Kosuke Shimizu, Hiromasa Araki, Ryoma Kurahashi, Yu Osaki, Yu Tashiro, Masayuki Uegaki, Osamu Ogawa, Hiroshi Kitamura and Hiroyuki Nishiyama : Pembrolizumab for treating advanced urothelial carcinoma in patients with impaired performance status: Analysis of a Japanese nationwide cohort., Cancer Medicine, 10, 10, 3188-3196, 2021.
(Summary)
The benefits of pembrolizumab in patients with advanced urothelial carcinoma (UC) and impaired performance status (PS) remain unknown. This study assessed the safety and efficacy of pembrolizumab in patients with platinum-refractory UC and Eastern Cooperative Oncology Group PS ≥2 to identify which subgroups may benefit from this drug.This retrospective nationwide cohort study collected clinicopathological information for 755 patients from 59 institutions. The overall response rate (ORR) and overall survival (OS) were compared among the patients with PS 0-1, 2, and 3-4. Multivariate analysis was conducted to identify factors predicting OS in patients with PS ≥2.The numbers of patients with PS 0-1, 2, and 3-4 were 602, 98, and 55, respectively; the ORRs in these groups were 29.5, 15.3, and 9.1%, respectively, and the median OS times were 14.3, 3.1, and 2.4 months, respectively. In multivariate Cox regression analysis, a neutrophil-lymphocyte ratio (NLR) ≥3.5 (hazard ratio [HR] = 1.897) and liver metastasis (HR = 2.072) were associated with OS in the PS ≥2 subgroup. The median OS of patients with PS ≥2 without either risk factor was 6.8 months, compared with 3.1 months for patients with one risk factor and 2.3 months for patients with both risk factors.PS ≥2 portended worse ORR and OS than PS ≤1 despite a comparable safety profile. Among the patients with impaired PS, patients with NLR <3.5 and no liver metastasis may most greatly benefit from pembrolizumab therapy.
To explore possible solutions to overcome chronic Bacillus Calmette-Guérin (BCG) shortage affecting seriously the management of non-muscle invasive bladder cancer (NMIBC) in Europe and throughout the world, we investigated whether non-maintenance eight-dose induction BCG (iBCG) was comparable to six-dose iBCG plus maintenance BCG (mBCG).This observational study evaluated 2669 patients with high- or highest-risk NMIBC who treated with iBCG with or without mBCG during 2000-2019. The patients were classified into five groups according to treatment pattern: 874 (33%) received non-maintenance six-dose iBCG (Group A), 405 (15%) received six-dose iBCG plus mBCG (Group B), 1189 (44%) received non-maintenance seven-/eight-dose iBCG (Group C), 60 (2.2%) received seven-/eight-dose iBCG plus mBCG, and 141 (5.3%) received only ≤5-dose iBCG. Recurrence-free survival (RFS), progression-free survival, and cancer-specific survival were estimated and compared using Kaplan-Meier analysis and the log-rank test, respectively. Propensity score-based one-to-one matching was performed using a multivariable logistic regression model based on covariates to obtain balanced groups. To eliminate possible immortal bias, 6-, 12-, 18-, and 24-month conditional landmark analyses of RFS were performed.RFS comparison confirmed that mBCG yielded significant benefit following six-dose iBCG (Group B) in recurrence risk reduction compared to iBCG alone (groups A and C) before (P < 0.001 and P = 0.0016, respectively) and after propensity score matching (P = 0.001 and P = 0.0074, respectively). Propensity score-matched sequential landmark analyses revealed no significant differences between groups B and C at 12, 18, and 24 months, whereas landmark analyses at 6 and 12 months showed a benefit of mBCG following six-dose iBCG compared to non-maintenance six-dose iBCG (P = 0.0055 and P = 0.032, respectively). There were no significant differences in the risks of progression and cancer-specific death in all comparisons of the matched cohorts.Although non-maintenance eight-dose iBCG was inferior to six-dose iBCG plus mBCG, the former might be an alternative remedy in the BCG shortage era. To overcome this challenge, further investigation is warranted to confirm the real clinical value of non-maintenance eight-dose iBCG.
Metastatic burden is a critical factor for therapy decision-making in metastatic hormone-sensitive prostate cancer. The present study aimed to identify prognostic factors in men with high- or low-metastatic burden treated with primary androgen-deprivation therapy. The study included 2450 men with de novo metastatic prostate cancer who were treated with primary androgen-deprivation therapy at 30 institutions across Japan between 2008 and 2017. We investigated the prognostic value of various clinicopathological parameters for progression-free survival (PFS) and overall survival (OS) in patients stratified by low- or high-metastatic burden. Among the 2450 men, 841 (34.3%) and 1609 (65.7%) were classified as having low- and high-metastatic burden, respectively. Median PFS of the low- and high-burden groups were 44.5 and 16.1 months, respectively, and the median OS was 103.2 and 62.7 months, respectively. Percentage of biopsy-positive core, biopsy Gleason grade group, T-stage, and N-stage were identified to be differentially prognostic. M1a was associated with worse PFS than was M1b in the low-burden group, whereas lung metastasis was associated with better PFS and OS than was M1b in the high-burden group. Differential prognostic factors were identified for patients with low- and high-burden metastatic prostate cancer. These results may assist in decision-making to select the optimal therapeutic strategies for patients with different metastatic burdens.
Naoki Terada, Takashi Mizowaki, Toshihiro Saito, Akira Yokomizo, Naoki Kohei, Ken-Ichi Tabata, Masaki Shiota, Atsushi Takahashi, Toru Shimazui, Takayuki Goto, Yasuhiro Hashimoto, Masato Fujii, Ryotaro Tomida, Toshihiko Sakurai, Kohei Hashimoto, Sadafumi Kawamura, Shogo Teraoka, Shinichi Sakamoto, Takahiro Kimura, Manabu Kamiyama, Shintaro Narita, Nobumichi Tanaka, Takuma Kato, Masashi Kato, Takahiro Osawa, Takahiro Kojima, Takahiro Inoue, Mikio Sugimoto, Hiroyuki Nishiyama and Toshiyuki Kamoto : Potential effectiveness of local radiotherapy for extending survival and reducing symptomatic local events in patients with de novo metastatic prostate cancer., BJUI Compass, 1, 5, 165-173, 2020.
(Summary)
To evaluate the association between the use of local radiotherapy (RT) with the survival of patients with de novo metastatic prostate cancer and symptomatic local events (SLEs).Patients were initially diagnosed with metastatic prostate cancer between 2008 and 2017 at 30 institutes in Japan. Prostate-specific antigen (PSA) progression-free survival (PSA-PFS) under initial androgen deprivation therapy and overall survival (OS) was compared between patients receiving local RT (RT group) and no RT (no-RT group) by multivariate Cox proportional hazard analyses. The occurrence rate of grade ≥2 SLEs was compared by multivariate logistic regression analyses. Propensity score matching (PSM) analyses were performed to compare PSA-PFS and OS of the groups in the high and low metastatic burden cohort.Two hundred and five (7%) of 2829 patients received RT before PSA progression. Median PSA-PFS and OS were significantly longer in the RT group than in the no-RT group and the difference was significant in multivariate analyses (HR = 0.44, 95% CI = 0.33-0.57 and HR = 0.40, 95% CI = 0.27-0.60, respectively). The occurrence rate of grade ≥2 SLEs was significantly lower in the RT group (2%) than the no-RT group (9%) and the difference was significant in multivariate analyses (HR = 0.28, 95% CI = 0.10-0.76). Using PSM analyses, PSA-PFS and OS remained significantly different (HR = 0.64, 95% CI = 0.46-0.89 and HR = 0.47, 95% CI = 0.30-0.72, respectively), between the RT (n = 182) and the no-RT (n = 182) groups. The difference in OS was significant in the high metastatic burden cohort (HR = 0.55, 95% CI = 0.37-0.81).Addition of local RT to standard treatment for de novo metastatic prostate cancer patients tends to have the potential to extend survival, even in patients with high metastatic burden, and to reduce SLEs.
The present study aimed to evaluate the efficacy of the real-world use of axitinib and to develop a prognostic model for stratifying patients who could derive long-term benefit from axitinib. This was a retrospective, descriptive study evaluating the efficacy of axitinib in patients with metastatic renal cell carcinoma that had been treated with 1 or 2 systemic antiangiogenic therapy regimens at 1 of 36 hospitals belonging to the Japan Urologic Oncology Group between January 2012 and February 2019. The primary outcome was overall survival (OS). Using a split-sample method, candidate variables that exhibited significant relationships with OS were chosen to create a model. The new model was validated using the rest of the cohort. In total, 485 patients were enrolled. The median OS was 34 months in the entire study population, whereas it was not reached, 27 months, and 14 months in the favorable, intermediate, and poor risk groups, respectively, according to the new risk classification model. The following 4 variables were included in the final risk model: the disease stage at diagnosis, number of metastatic sites at the start of axitinib therapy, serum albumin level, and neutrophil : lymphocyte ratio. The adjusted area under the curve values of the new model at 12, 36, and 60 months were 0.77, 0.82, and 0.82, respectively. The efficacy of axitinib in routine practice is comparable or even superior to that reported previously. The patients in the new model's favorable risk group might derive a long-term survival benefit from axitinib treatment.
Ryotaro Tomida, Ousuke Arai, Shunsuke Iuchi, Masafumi Matsumura and Katsuyoshi Hashine : [PATIENT-REPORTED OUTCOME AFTER ILEAL NEOBLADDER]., The Japanese Journal of Urology, 111, 4, 107-113, 2020.
(Summary)
(Objectives) Investigation of patient-reported outcome (PRO) after ileal neobladder for bladder cancer. (Patients and methods) Forty patients who underwent radical cystectomy and ileal neobladder between July 2007 and December 2017 were asked to complete a questionnaire. PRO was evaluated using the Medical Outcomes Study Short Form-8 (SF-8) for general health-related quality of life (QOL) and the Bladder Cancer Index and the Japanese version of the Functional Assessment of Cancer Therapy-Bladder for disease specific QOL. Patients were divided into two groups according to the postoperative period (early and late), and the differences in questionnaire results between the groups were evaluated. (Results) All scores on the SF-8 were over 50 points, exceeding the Japanese national standard of 50 points for all items. The physical and mental summary scores were also favorable. For disease-specific QOL, only daytime incontinence was significantly higher in the late group, with daytime incontinence two or more times per week at 42.1%, compared to 20.0% in the early group (P=0.0403). A comparison of daytime urinary incontinence in four groups during the postoperative period showed that urinary incontinence was least frequent among patients between 64 and 101 months after surgery; patients in this group were also the youngest in age at the time of surgery. (Conclusions) Cross-sectional analysis of PRO revealed that patients with ileal neobladder had good general health-related QOL after surgery, but urinary incontinence was a significant problem.
Katsuyoshi Hashine, Toshio Kakuda, Shunsuke Iuchi, Ryotaro Tomida and Masafumi Matsumura : Patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy., Japanese Journal of Clinical Oncology, 49, 11, 1037-1042, 2019.
(Summary)
To assess patient-reported outcomes after open radical prostatectomy, laparoscopic radical prostatectomy and permanent prostate brachytherapy.patient-reported outcomes were evaluated using Expanded Prostate Cancer Index Composite scores at baseline and 1, 3, 6, 12 and 36 months after treatment, respectively, using differences from baseline scores.Urinary function was the same in the three groups at baseline, but worse after surgery than after permanent prostate brachytherapy until 12 months, and similar after open radical prostatectomy and permanent prostate brachytherapy and better than after laparoscopic radical prostatectomy at 36 months. Urinary bother was significantly worse at 1 month after surgery, but better after open radical prostatectomy than after permanent prostate brachytherapy and laparoscopic radical prostatectomy at 3 months, after which symptoms improved gradually in all groups. Obstructive/irritative symptoms were worse after permanent prostate brachytherapy than after open radical prostatectomy at 36 months, and worse after laparoscopic radical prostatectomy until 6 months. Urinary incontinence was worse after surgery, particularly after 1 month. This symptom returned to the baseline level at 12 months after open radical prostatectomy, but recovery after laparoscopic radical prostatectomy was slower. Bowel function after permanent prostate brachytherapy was significantly worse than after surgery at 1 month and this continued until 6 months. Bowel bother was slightly worse at 3 and 6 months after permanent prostate brachytherapy compared to these time points after surgery.Urinary function and bother were worst after laparoscopic radical prostatectomy, especially in the early postoperative phase, whereas urinary obstructive/irritative symptom, bowel function and bother were worse after permanent prostate brachytherapy. These findings are useful and informative for the treatment of patients with prostate cancer.
Ryotaro Tomida, Kosuke Seto, Takuya Tsujioka, Hiroyuki Iio, Kenichi Nishimura, Kensuke Shinomori, Shiro Fujikata, Shuji Tanimoto, Kenjiro Okamoto, Sadamu Yamashi and Masaharu Kan : [FACTORS AFFECTING SHORT-TERM RENAL FUNCTION AFTER PARTIAL NEPHRECTOMY]., The Japanese Journal of Urology, 109, 1, 7-13, 2018.
(Summary)
(Objectives) Recently, partial nephrectomy has been recommended for patients with T1 renal cell carcinoma to preserve renal function. In this study, we retrospectively investigated the factors that affect renal function after laparoscopic or robotic partial nephrectomy using cold or warm ischemia. (Patients and methods) We reviewed 105 patients who underwent laparoscopic or robotic partial nephrectomy between March 2006 and July 2016. Patients who had a single kidney were excluded. Thirty-nine patients were managed with cold ischemia, and 66 were managed with warm ischemia. Renal function was assessed using the estimated glomerular filtration rate (eGFR) and glomerular filtration rate (GFR) categories of the stage of chronic kidney disease (CKD). (Results) In the cold and warm ischemia groups, the duration of ischemia was significantly correlated with deterioration of the eGFR at 12 months postoperatively, but the duration of ischemia was not significantly correlated with exacerbation of the GFR categories for the stage of CKD in multivariate analyses. (Conclusions) These results suggest that the ischemia time may not have an impact on prognosis. However, due to the lack of deaths from renal carcinoma or cardiovascular events postoperatively in this study, the influence of each factor on overall survival or cardiovascular events could not be evaluated. More investigations are necessary to discern the acceptable level of deterioration and the corresponding clinical implications for postoperative eGFR.
Junya Furukawa, Ryotaro Tomida, Kei Daizumoto, Yutaro Sasaki and Tomoya Fukawa : Advances in Adjuvant Therapy for Renal Cell Carcinoma: Perspectives on Risk Stratification and Treatment Outcomes., International Journal of Urology, 32, 7, 781-790, Mar. 2025.
(Summary)
Radical surgery is effective for localized renal cell carcinoma (RCC). However, recurrence occurs in up to 40% of patients, underscoring the need for adjuvant therapy to improve the prognosis. Historically, adjuvant treatments, including tyrosine kinase inhibitors, have shown limited success, failing to improve overall survival. The introduction of the immune checkpoint inhibitor pembrolizumab, as demonstrated in the KEYNOTE-564 trial, has revolutionized the field by showing significant overall survival benefits and prompting updates to RCC treatment guidelines. Accurate risk assessment is critical for identifying high-risk patients most likely to benefit from adjuvant therapy. Established risk models, such as the UCLA Integrated Staging System and the Leibovich score, incorporate clinical and pathological factors to stratify recurrence risk. Recent enhancements in these models have improved predictive accuracy, enabling better optimization of inclusion criteria for clinical trials targeting high-risk recurrence and the development of individualized surveillance protocols to refine patient selection for adjuvant treatment. This review examines the evolution of risk stratification models and adjuvant therapy for RCC, highlighting the potential of innovative biomarkers, such as liquid biopsies, to further enhance patient selection and optimize treatment outcomes. Ongoing clinical trials investigating new combinations of immune checkpoint inhibitors hold promise, and integrating accurate risk assessment with advanced immunotherapy will be key to improving postoperative survival rates for patients with RCC.
Yasuyo Yamamoto, Yutaro Sasaki, Ryotaro Tomida, Kei Daizumoto, Yoshito Kusuhara, Tomoya Fukawa, Kunihisa Yamaguchi, Masayuki Takahashi and Junya Furukawa : Total cystectomy for Interstitial Cystitis, The Japanese Journal of Urology,