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論文
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Hosogoe, Shogo ; Hatakeyama, Shingo ; Kusaka, Ayumu ; Hamano, Itsuto ; Tanaka, Yoshimi ; Hagiwara, kazuhisa ; Hirai, Hideaki ; Morohashi, Satoko ; Kijima, Hiroshi ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ohyama, Chikara
概要:
Background and Objective: A quantitative tumor response evaluation to molecular-targeting agents in advanced renal cell carcinoma (RCC) is debatable. We aimed to evaluate the relationship between radiologic tumor response and
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pathological response in patients with advanced RCC who underwent presurgical therapy. Results: Of 34 patients, 31 underwent scheduled radical nephrectomy. Presurgical therapy agents included axitinib (n = 26), everolimus (n = 3), sunitinib (n = 1), and axitinib followed by temsirolimus (n = 1). The major presurgical treatment-related adverse event was grade 2 or 3 hypertension (44%). The median radiologic tumor response by RECIST, Choi, and CMER were -19%, -24%, and -49%, respectively. Among the radiologic tumor response tests, CMER showed a higher association with tumor necrosis in surgical specimens than others. Ki67/MIB1 status was significantly decreased in surgical specimens than in biopsy specimens. The magnitude of the slope of the regression line associated with the tumor necrosis percentage was greater in CMER than in Choi and RECIST. Materials and Methods: Between March 2012 and December 2016, we prospectively enrolled 34 locally advanced and/or metastatic RCC who underwent presurgical molecular-targeting therapy followed by radical nephrectomy. Primary endpoint was comparison of radiologic tumor response among Response Evaluation Criteria in Solid Tumors (RECIST), Choi, and contrast media enhancement reduction (CMER). Secondary endpoint included pathological downstaging, treatment related adverse events, postoperative complications, Ki67/MIB1 status, and tumor necrosis. Conclusions: CMER may predict tumor response after presurgical moleculartargeting therapy. Larger prospective studies are needed to develop an optimal tumor response evaluation for molecular-targeting therapy.
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Hamano, Itsuto ; Hatakeyama, Shingo ; Iwamura, Hiromichi ; Fujita, Naoki ; Fukushi, Ken ; Narita, Takuma ; Hagiwara, kazuhisa ; Kusaka, Ayumu ; Hosogoe, Shogo ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Kawaguchi, Toshiaki ; Ohyama, Chikara
概要:
Objective: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncologic outcomes in muscle-invasive bladder cancer patients who underwent radical cystectomy. Methods: A total of 581 patients who underwent radical
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cystectomy at four medical centers between January 1995 and February 2017 were examined retrospectively. We investigated oncologic outcomes, including progression-free, cancer-specific, and overall survival (PFS, CSS, and OS, respectively) stratified by preoperative CKD status (pre-CKD vs. non-CKD). We performed a Cox proportional hazards regression analysis using inverse probability of treatment weighting (IPTW) to evaluate the impact of preoperative CKD on prognosis and developed the prognostic factor-based risk stratification nomogram. Results: Of the 581 patients, 215 (37%) were diagnosed with CKD before radical cystectomy. Before the background adjustment, PFS, CSS, and OS after radical cystectomy were significantly lower in the pre-CKD group compared to the non-CKD group. Background-adjusted IPTW analysis showed that preoperative CKD was significantly associated with poor PFS, CSS, and OS after radical cystectomy. The nomogram for predicting 5-year PFS and OS probability showed significant correlation with actual PFS and OS (c-index = 0.73 and 0.77, respectively). Conclusions: Muscle-invasive bladder cancer patients with preoperative CKD had a significantly lower survival probability than those without CKD.
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Kusaka, Ayumu ; Hatakeyama, Shingo ; Hosogoe, Shogo ; Hamano, Itsuto ; Iwamura, Hiromichi ; Fujita, Naoki ; Fukushi, Ken ; Narita, Takuma ; Hagiwara, kazuhisa ; Yamamoto, Hayato ; Tobisawa, Yuki ; Yoneyama, Tohru ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Koie, Takuya ; Ito, Hiroyuki ; Yoshikawa, Kazuaki ; Kawaguchi, Toshiaki ; Ohyama, Chikara
概要:
Background: The recurrence risk stratification and the cost effectiveness of oncological surveillance after radical cystectomy are not clear. We aimed to develop a risk stratification and a surveillance protocol with improved cost
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effectiveness after radical cystectomy. Results: Of 581 enrolled patients, 175 experienced disease recurrences. The pathology-based protocol presented significant differences in recurrence-free survival between normal-and high-risk patients, but the medical expense was high, especially in normal-risk (<= pT2pN0) patients. Cox regression analysis identified six factors associated with recurrence-free survival. Risk score-based 5-year follow-up was significantly more cost effective than the pathology-based protocol. Materials and Methods: We retrospectively evaluated 581 patients with radical cystectomy for muscle-invasive bladder cancer at 4 hospitals. Patients with routine oncological follow-up were stratified into normal-and high-risk groups by a pathology-based protocol utilizing pT, pN, lymphovascular invasion, and histology. Cost effectiveness of the pathology-based protocol was evaluated and a risk-score-based protocol was developed to optimize cost effectiveness. Risk-scores were calculated by summing risk factors independently associated with recurrence-free survival. Patients were stratified by low-, intermediate-, and high-risk score. Estimated cost per one recurrence detection by the pathology and by risk-scores were compared. Conclusions: Risk-score-stratified surveillance protocol has potential to reduce over-evaluation after radical cystectomy without adverse effects on medical cost.
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Narita, Takuma ; Hatakeyama, Shingo ; Koie, Takuya ; Hosogoe, Shogo ; Matsumoto, Teppei ; Soma, Osamu ; Yamamoto, Hayato ; Yoneyama, Tohru ; Tobisawa, Yuki ; Yoneyama, Takahiro ; Hashimoto, Yasuhiro ; Ohyama, Chikara
概要:
Background: Urinary tract obstruction and postoperative hydronephrosis are risk factor for renal function deterioration after orthotopic ileal neobladder construction. However, reports of relationship between transient hydronephrosis
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and renal function are limited. We assess the influence of postoperative transient hydronephrosis on renal function in patients with orthotopic ileal neobladder construction. Methods: Between January 2006 and June 2013, we performed radical cystectomy in 164 patients, and 101 received orthotopic ileal neobladder construction. This study included data available from 64 patients with 128 renal units who were enrolled retrospectively. The hydronephrosis grade of each renal unit scored 0-4. The patients were divided into 4 groups according to the grade of hydronephrosis: control, low, intermediate, and high. The grade of postoperative hydronephrosis was compared with renal function 1 month and 1 year after surgery. Results: There were no significant differences in renal function before surgery between groups. One month after surgery, the presence of hydronephrosis was significantly associated with decreased renal function. However, 1 year after urinary diversion hydronephrosis grades were improved significantly, and renal function was comparable between groups. Postoperative hydronephrosis at 1 month had no significant influence on renal function 1 year after ileal neobladder construction. Limitations include retrospective design, short follow-up periods, and a sample composition. Conclusions: The presence of transient hydronephrosis immediately after surgery may have limited influence on renal function 1 year after ileal neobladder construction.
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