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Yoshinobu Komai,
Noboru Numao,
Soichiro Yoshida,
Yoh Matsuoka,
Yasukazu Nakanishi,
Chikako Ishii,
Fumitaka Koga,
Kazutaka Saito,
Hitoshi Masuda,
Yasuhisa Fujii,
Satoru Kawakami,
Kazunori Kihara
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ABSTRACT: PURPOSE: We aimed to clarify the diagnostic ability of multiparametric magnetic resonance imaging (MP-MRI) to reveal anterior cancers missed by transrectal 12-core prostate biopsy (TR12PBx), based on the results of three-dimensional 26-core prostate biopsy (3D26PBx), a combination of TR12PBx and transperineal 14-core biopsy (TP14PBx) procedures. MATERIALS AND METHODS: The study population consisted of 324 patients who prospectively underwent prebiopsy MP-MRI and then 3D26PBx at a single institution. We defined TR12-negative cancer as cancer detected by TP14PBx but not by TR12PBx. We focused on cancers located in the anterior region. Any suspicious findings for malignancy in the region anterior to the urethra on MP-MRI were defined as anterior lesion on MP-MRI. Significant cancer was defined as biopsy GS ≥ 4+3 and/or percent positive core > 20% and/or maximum cancer length ≥ 5mm. The associations between anterior lesion on MP-MRI and TR12-negative cancer were investigated. RESULTS: The overall cancer detection rate by 3D26PBx was 39% (128/324), and of these 28% (36/128) were TR12-negative cancers. Anterior lesion on prebiopsy MP-MRI was identified in 20% (65/324) of the overall cohort. Of men with or without anterior lesion on MP-MRI, 40% (26/65) or 3.8% (10/259) had a TR12-negative cancer, respectively. Significant TR12-negative cancer was observed in 0.4% (1/259) of men without anterior lesion on MP-MRI. Prebiopsy MP-MRI presented anterior lesion in 92% (11/12) of significant TR12-negaitve cancers. CONCLUSIONS: Prebiopsy MP-MRI has a potential to efficiently select men who could have advantages by anterior samplings in addition to TR12PBx.
The Journal of urology 03/2013; · 4.02 Impact Factor
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Noboru Numao,
Soichiro Yoshida, Yoshinobu Komai,
Chikako Ishii,
Makoto Kagawa,
Toshiki Kijima,
Minato Yokoyama,
Junichiro Ishioka,
Yoh Matsuoka,
Fumitaka Koga,
Kazutaka Saito,
Hitoshi Masuda,
Yasuhisa Fujii,
Satoru Kawakami,
Kazunori Kihara
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ABSTRACT: PURPOSE: To evaluate the usefuleness of prebiopsy multiparametric MRI and clinical variables to reduce initial prostate biopsy MATERIALS AND METHODS: We prospectively evaluated 351 consecutive men with PSA levels between 2.5 and 20 ng/ml and/or DRE suspicious for clinically localized disease. All men underwent prebiopsy multiparametric MRI and an initial 14-29 core biopsy, including anterior samplings. Three definitions of significant cancer were defined based on Gleason score and cancer volume (percent positive core and/or maximum cancer length).Overall cohort was divided into low-risk (PSA <10 ng/ml and a normal DRE) and high-risk group (PSA ≥10 ng/ml and/or an abnormal DRE). Frequency of significant cancer was evaluated according to MRI and risk categories. Clinical variables as predictors for significant cancer were analyzed using logistic regression. Sensitivity, specificity, PPV and NPV of MRI with or without clinical variables for significant cancer were calculated. RESULTS: Frequency of significant cancer in men with negative or positive MRI was 9-13% or 43-50% in the low-risk, respectively and 47-51% or 68-71% in the high risk group, respectively. In men with negative MRI in the low-risk group, prostate volume was the only significant predictor of significant cancer. In the low-risk group, negative predictive value of a combination of positive MRI and lower prostate volume (< 33ml) for significant cancer was 93.7-97.5%. CONCLUSIONS: Prebiopsy multiparametric MRI along with prostate volume has a high performance to reduce initial prostate biopsies by discriminating between significant cancer and others in men with PSA <10 ng/ml and a normal DRE.
The Journal of urology 03/2013; · 4.02 Impact Factor
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ABSTRACT: Choriocarcinoma is an early metastasizing and highly invasive tumor and characterized as a high-level human chorionic gonadotropin-secreting tumor. It normally arises in the gestational trophoblast, gonads and much less frequently in the stomach. Primary gastric choriocarcinoma appears to have a poor prognosis; especially with liver metastasis, the survival period is expected to be <1 month. This unfavorable clinical outcome is partly due to the lack of defined chemotherapy against primary gastric choriocarcinoma. We herein report a case of a 68-year-old male primary gastric choriocarcinoma patient with advanced liver metastases in which germ cell tumor-based chemotherapy achieved a pathological complete response and 2-year disease-free survival.
Japanese Journal of Clinical Oncology 10/2012; · 1.78 Impact Factor
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Yoshinobu Komai,
Satoru Kawakami,
Noboru Numao,
Yasuhisa Fujii,
Kazutaka Saito,
Yuichi Kubo,
Fumitaka Koga,
Jiro Kumagai,
Shinya Yamamoto,
Junji Yonese,
Yuichi Ishikawa,
Iwao Fukui,
Kazunori Kihara
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ABSTRACT: Study Type - Prognosis (inception cohort) Level of Evidence 2 What's known on the subject? and What does the study add? The criteria used for selecting patients with prostate cancer for active surveillance (AS) are still not satisfactory due to the difficulty in predicting the significance of the prostate cancer. Urologists could predict insignificant prostate cancer by incorporating cumulative cancer length and biopsy Gleason score, derived from extended biopsy. The present study has added new criteria for predicting insignificant prostate cancer, which would lead to a better selection of candidates for AS. OBJECTIVE: • To develop extended biopsy based criteria for predicting insignificant cancer (IC) using extended biopsy findings. PATIENTS AND METHODS: • From 2000 to 2009, 1575 patients with prostate cancer were primarily treated by radical prostatectomy in two referral hospitals. • Of these, the study cohort comprised 499 patients with extended biopsy confirmed, clinically organ-confined (cT1-2N0M0) prostate cancer with PSA levels of <20 ng/mL. • Cancer information obtained through extended biopsy included cumulative cancer length (CCL) divided by the number of biopsy cores (CCL/core). RESULTS: • Pathological examination revealed 39 ICs (7.8%). All these ICs fell in a category of prostate cancer with clinical stage ≤T2a and 2005 International Society of Urological Pathology Consensus Conference (ISUP) modified biopsy Gleason score ≤7. • Accordingly, we analysed predictors of IC in a subset cohort of 370 patients in this category. A multivariate logistic regression analysis revealed that 2005 ISUP modified biopsy Gleason score and CCL/core were independently significant predictors of IC. • We determined a threshold value of CCL/core of 0.20 mm for predicting IC using receiver operating characteristic analysis. • Based on these findings, we developed simple extended biopsy based criteria for predicting IC as follows: (i) PSA level of <20 ng/mL; (ii) Clinical stage ≤T2a; (iii) 2005 ISUP modified biopsy Gleason score ≤6; (iv) CCL/core of <0.20 mm. • The specificity of the criteria was 91%, which was significantly higher than the value from a subset of criteria without item iv (P < 0.001). CONCLUSION: • We have developed extended biopsy based criteria for predicting IC incorporating the 2005 ISUP modified biopsy Gleason score and CCL/core.
BJU International 07/2012; · 2.84 Impact Factor
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ABSTRACT: Study Type - Prognosis (cohort) Level of Evidence 2a What's known on the subject? and What does the study add? C-reactive protein (CRP) level has been shown to be a significant prognostic factor for various malignancies, including urothelial carcinoma treated surgically. Apart from CRP level, several prognostic factors have been identified for advanced urothelial carcinoma patients receiving a second-line chemotherapy. CRP could also be a significant prognostic factor for advanced urothelial carcinoma patients receiving a second-line chemotherapy. CRP kinetics, the dynamic change of CRP concentration, has a strong impact on survival. Adding to the baseline CRP status at the start of treatment, the normalization of CRP during treatment is significantly associated with prognosis. The period with normalized CRP level was strongly correlated with survival period. Therefore, CRP could be a potential biomarker for advanced urothelial carcinoma patients. OBJECTIVE: • To assess the impact of C-reactive protein (CRP) kinetics, the effect of dynamic changes of CRP concentration on the survival of patients with locally advanced or metastatic urothelial carcinoma (UC) treated by single chemotherapeutic regimen including cisplatin was examined. PATIENTS AND METHODS: • Eighty patients with advanced UC, who failed treatment of advanced UC with the first-line chemotherapy or who received perioperative treatment of neoadjuvant or adjuvant settings, were treated with gemcitabine, etoposide and cisplatin (GEP) as second-line chemotherapy. • Patients were divided into three groups according to CRP kinetics based on baseline and nadir CRP concentrations. Patients whose baseline CRP levels were <5 mg/L, patients whose baseline CRP levels were ≥5 mg/L and normalized (<5 mg/L), and patients whose baseline CRP levels were ≥5 mg/L and never normalized were assigned to non-elevated, normalized and non-normalized CRP groups, respectively. • The prognostic impact of CRP kinetics and the correlation between normalized CRP period and overall survival period were determined. RESULTS: • In 46 (57%) of the 80 patients, CRP levels were elevated at the diagnosis of advanced UC. During treatment, after a median follow-up period of 12 months CRP levels were normalized in 24 (71%) of 34 patients, whereas CRP levels remained elevated in the remaining 10 patients. • Overall survival rates were significantly different between the non-elevated, normalized, and non-normalized CRP groups (P < 0.001), with 1-year survival rates of 72, 51 and 14%, respectively. On multivariate analysis including Eastern Cooperative Oncology Group performance status, visceral metastasis, number of metastatic sites, previous definitive surgery, anaemia, baseline and nadir CRP levels (mg/L), and CRP kinetics status, CRP kinetics was an independent and significant factor for overall survival. • The normalized CRP period was significantly correlated with the overall survival period in 52 patients who died. CONCLUSIONS: • CRP kinetics is significantly associated with the prognosis and survival period of patients with advanced UC treated by chemotherapy. • Although larger confirmatory studies are warranted to validate our results, CRP can potentially be a useful biomarker for patients with advanced UC.
BJU International 04/2012; · 2.84 Impact Factor
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Soichiro Yoshida,
Fumitaka Koga,
Shuichiro Kobayashi,
Chikako Ishii,
Hiroshi Tanaka,
Hajime Tanaka, Yoshinobu Komai,
Kazutaka Saito,
Hitoshi Masuda,
Yasuhisa Fujii,
Satoru Kawakami,
Kazunori Kihara
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ABSTRACT: In chemoradiation (CRT)-based bladder-sparing approaches for muscle invasive bladder cancer (MIBC), patients who respond favorably to induction CRT enjoy the benefits of bladder preservation, whereas nonresponders do not. Thus, accurate prediction of CRT sensitivity would optimize patient selection for bladder-sparing protocols. Diffusion-weighted MRI (DW-MRI) is a functional imaging technique that quantifies the diffusion of water molecules in a noninvasive manner. We investigated whether DW-MRI predicts CRT sensitivity of MIBC.
The study cohort consisted of 23 MIBC patients (cT2/T3 = 7/16) who underwent induction CRT consisting of radiotherapy to the small pelvis (40 Gy) with two cycles of cisplatin (20 mg/day for 5 days), followed by partial or radical cystectomy. All patients underwent DW-MRI before the initiation of treatment. Associations of apparent diffusion coefficient (ADC) values with CRT sensitivity were analyzed. The proliferative potential of MIBC was also assessed by analyzing the Ki-67 labeling index (LI) in pretherapeutic biopsy specimens.
Thirteen patients (57%) achieved pathologic complete response (pCR) to CRT. These CRT-sensitive MIBCs showed significantly lower ADC values (median, 0.63 × 10(-3) mm(2)/s; range, 0.43-0.77) than CRT-resistant (no pCR) MIBCs (median, 0.84 × 10(-3) mm(2)/s; range, 0.69-1.09; p = 0.0003). Multivariate analysis identified ADC value as the only significant and independent predictor of CRT sensitivity (p < 0.0001; odds ratio per 0.001 ×10(-3) mm(2)/s increase, 1.03; 95% confidence interval, 1.01-1.08). With a cutoff ADC value at 0.74 × 10(-3) mm(2)/s, sensitivity/specificity/accuracy in predicting CRT sensitivity was 92/90/91%. Ki-67 LI was significantly higher in CRT-sensitive MIBCs (p = 0.0005) and significantly and inversely correlated with ADC values (ρ = -0.67, p = 0.0007).
DW-MRI is a potential biomarker for predicting CRT sensitivity in MIBC. DW-MRI may be useful to optimize patient selection for CRT-based bladder-sparing approaches.
International journal of radiation oncology, biology, physics 03/2012; 83(1):e21-7. · 4.59 Impact Factor
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Shuichiro Kobayashi,
Fumitaka Koga,
Soichiro Yoshida,
Hitoshi Masuda,
Chikako Ishii,
Hiroshi Tanaka, Yoshinobu Komai,
Minato Yokoyama,
Kazutaka Saito,
Yasuhisa Fujii,
Satoru Kawakami,
Kazunori Kihara
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ABSTRACT: The diagnostic performance of diffusion-weighted magnetic resonance imaging (DW-MRI) in bladder cancer and the potential role of apparent diffusion coefficient (ADC) values in predicting pathological bladder cancer phenotypes associated with clinical aggressiveness were investigated.
One hundred and four bladder cancer patients underwent DW-MRI and T2-weighted magnetic resonance imaging (T2W-MRI) before transurethral resection. The image sets were reviewed by two independent radiologists. ADC values were measured in 121 eligible tumours.
In detecting patients with bladder cancer, DW-MRI exhibited high sensitivity equivalent to that of T2W-MRI (>90%). Interobserver agreement was excellent for DW-MRI (κ score, 0.88) though moderate for T2W-MRI (0.67). ADC values were significantly lower in high-grade (vs. low-grade, P < 0.0001) and high-stage (T2 vs. T1 vs. Ta, P < 0.0001) tumours. At a cut-off ADC value determined by partition analysis, clinically aggressive phenotypes including muscle-invasive bladder cancer (MIBC) and high-grade T1 disease were differentiated from less aggressive phenotypes with a sensitivity of 88%, a specificity of 85% and an accuracy of 87%.
DW-MRI exhibits high diagnostic performance in bladder cancer with excellent objectivity. The ADC value could potentially serve as a biomarker to predict clinical aggressiveness in bladder cancer.
European Radiology 06/2011; 21(10):2178-86. · 3.22 Impact Factor
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Yoshinobu Komai,
Yasuhisa Fujii,
Yasumasa Iimura,
Manabu Tatokoro,
Kazutaka Saito,
Yukihiro Otsuka,
Fumitaka Koga,
Chizuru Arisawa,
Satoru Kawakami,
Tetsuo Okuno,
Toshihiko Tsujii,
Yukio Kageyama,
Shinji Morimoto,
Tsuguhiro Toma,
Yotsuo Higashi,
Iwao Fukui,
Kazunori Kihara
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ABSTRACT: To evaluate the prognostic effect of age in patients with localized renal cell carcinoma (RCC) and investigate the incidence of Xp11 translocation RCC in young patients who developed recurrence.
From 1990 to 2007, 2403 Japanese patients underwent nephrectomy for presumed RCC at 9 institutions. Of those, 1143 patients had localized RCC (Stage pT1-2N0M0). Their clinical data were retrospectively reviewed. In the present study, 131 patients (11%) were considered young (≤45 years at diagnosis). In the young patients with recurrence, the nephrectomy specimens were immunostained with TFE3 to determine the incidence of Xp11 translocation RCC.
During the median follow-up of 47 months, 3 cancer deaths (2.2%) occurred among young patients and 51 (5.0%) among older patients. The 5-year cancer-specific survival (CSS) rate was significantly better for the younger patients than for the older patients (P = .049). Multivariate analysis showed that age was significantly associated with CSS, as were the pathologic T stage, tumor grade, and symptoms at diagnosis. The hazard ratio of young age was 0.31 (95% confidence interval 0.077-0.87). The recurrence-free survival curves revealed no difference between these 2 groups. Of the 74 patients with recurrence, the CSS after recurrence was significantly better in the younger patients than in the older patients (P = .0010). Of the 8 young patients with recurrence, 4 had Xp11 translocation RCC, and 3 survived for >5 years after recurrence.
Compared with the older patients, the young patients with RCC had similar recurrence-free survival rates but better CSS rates. This might have been because significant numbers of the young patients had Xp11 translocation RCC.
Urology 01/2011; 77(4):842-7. · 2.43 Impact Factor
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ABSTRACT: The aim of this study is to analyze the incidence of involvement of ipsilateral adrenal gland from renal cell carcinoma and assess the actual significance of ipsilateral adrenalectomy at nephrectomy.
From 1981 to 2007, 588 patients were diagnosed as having renal cell carcinoma pathologically at our institution. Of those patients, we retrospectively reviewed the clinicopathologic data in the 426 renal cell carcinoma patients who were eligible for evaluation. Of the 426 patients, 193 (AD group) and the remaining 233 (AS group) underwent radical or partial nephrectomy with or without adrenalectomy, respectively.
Five patients (2.6%) of AD group had adrenal involvement and all of them presented T4 and/or M1 disease. The three patients presented direct involvement of adrenal gland, while metastasis in the remaining 2. All the 5 patients had disease progression after surgery and 4 of them died of disease. The remaining one patient, in whom interferon showed a remarkable response, has been alive with disease for 31 months. The ipsilateral adrenal gland was abnormal on preoperative computed tomography (CT) in 8 patients (1.8%), of whom, 4 had adrenal involvement. One of the five adrenal involvements was overlooked by CT. Thus, in this study, CT showed 80% sensitivity, 98% specificity, 99% negative predictive value and 50% positive predictive value. The 18 patients (7.7%) in AS group later developed nodal and/or visceral metastasis, while no solitary ipsilateral adrenal recurrence was observed in this group.
Ipsilateral adrenal involvement from renal cell carcinoma is rare, especially after the adrenal-sparing surgery. It is concluded that concomitant adrenalectomy appears to give a very limited therapeutic benefit in this
Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 05/2010; 101(4):592-6.
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ABSTRACT: To present a novel technique to prevent inguinal hernias after radical retropubic prostatectomy (RRP). The incidence of inguinal hernia after RRP has been reported to occur in the range 12%-21%. Indirect hernias are more common than direct hernias after RRP.
A total of 569 Japanese patients with prostate cancer underwent antegrade RRP between January 2001 and February 2007. Since February 2006, 138 patients underwent procedures for concurrent inguinal hernia prevention at the time of RRP. For hernia prevention, the processus vaginalis was ligated close to the peritoneal cavity and transected. The remaining 431 patients who underwent the same RRP procedures without hernia prevention were considered control group. The incidence rates of postoperative inguinal hernia in the 2 groups were statistically compared.
An inguinal hernia developed postoperatively in 105 (24%) of the 431 control patients during follow-up of median 42 months. Hernia-free survival rates were 87%, 81%, and 77%, for 1-, 2-, and 3-year, respectively. By contrast, 2 of the 138 patients (1.4%) who underwent hernia prevention developed an inguinal hernia during follow-up of median 24 months. Hernia-free survival rates were both 99% for 1- and 2-year (P <.0001). The hernia prevention procedure added approximately 10 minutes to the surgery time. There were no significant complications associated with the hernia prevention procedure.
Our results suggest that this prophylactic measure is safe and effective to prevent post-RRP inguinal hernias. However, a longer follow-up period is needed to confirm the results.
Urology 11/2009; 75(3):713-7. · 2.43 Impact Factor
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ABSTRACT: The aim of this study was to assess the surgical outcome of high-grade prostate cancer (PCA) treated with antegrade radical prostatectomy with intended wide resection (aRP) and to establish the risk stratification.
A consecutive 77 Japanese patients with Gleason score 8-10 PCA were treated with aRP alone and excluding patients with persistently elevated prostate-specific antigen (PSA), prospectively observed without any treatment until PSA failure was confirmed. PSA failure-free, cancer-specific and overall survival curves were generated with Kaplan-Meier method and the difference between groups was assessed with log-rank test. Cox's proportional hazards model was used to elucidate predictors of PSA failure.
During a median follow-up of 6 years, PSA failure was observed in 41 (53%) of the 77 patients. Five- and 10-year PSA failure-free survival rates of the entire cohort were 44.6% and 40.1%, respectively. Both overall and cancer-specific survival rates of the entire cohort at 5 and 10 years were 96.8% and 87.9%, respectively. In a multivariate analysis, PSA (P = 0.008), specimen confinement (SC) (P = 0.006) and persistently elevated PSA after aRP were identified as significant and independent predictors of PSA failure. When stratifying patients into three risk groups according to PSA level and SC status, PSA failure-free survival rate in patients with PSA < 10 ng/ml and specimen-confined disease (SCD) was significantly better than that in those of any other groups.
Good prognosis can be expected in patients with high-grade PCA treated with aRP alone when PSA < 10 ng/ml and the tumor was removed as an SCD.
Japanese Journal of Clinical Oncology 04/2009; 39(6):387-93. · 1.78 Impact Factor
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Yoshinobu Komai,
Mutsunori Fujiwara,
Yasuhisa Fujii,
Hiroyuki Mukai,
Junji Yonese,
Satoru Kawakami,
Shinya Yamamoto,
Toshiro Migita,
Yuichi Ishikawa,
Morito Kurata,
Takuro Nakamura,
Iwao Fukui
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ABSTRACT: To determine the incidence of Xp11 translocation renal cell carcinoma (RCC) in adult patients using cytogenetics and immunohistochemstry.
Cytogenetic studies were prospectively done using tumor samples from 443 consecutive adult Japanese patients (ages 15-89 years) who underwent nephrectomy for RCC. TFE3 immunohistochemistry was done for cases in which cytogenetic results were not obtained. Clinicopathologic characteristics of Xp11 translocation RCC were examined.
Mitotic cells suitable for cytogenetic analysis were obtained in 244 tumor samples (55%); among these, we identified 4 cases (1.6%) of Xp11 translocation RCC. TFE3 immunohistochemistry identified 3 positive cases (1.5%) among the remaining 199 cases. The median age of the 7 patients was 41 years (range, 15-59 years), and 15% of RCC patients (4 of 26) who were younger than ages 45 years had this type of RCC. Of the four Xp11 translocation RCC patients whose karyotypes were determined, two had an ASPL-TFE3 gene fusion. Of these 2, 1 had pulmonary metastasis at presentation, and the other developed liver metastasis 12 months after nephrectomy and died of the disease. The remaining two patients had PRCC-TFE3 and PSF-TFE3 gene fusions, respectively. Both had nodal involvement but remained disease free for 3 and 5 years, respectively, after surgical resection of lymph node metastases. Of the 3 immunohistochemically diagnosed patients, 1 had nodal metastases at presentation and died 9 months after surgery.
This is the first report to determine the incidence of Xp11 translocation RCC in adult patients. We found that this disease is relatively common in young adults.
Clinical Cancer Research 03/2009; 15(4):1170-6. · 7.74 Impact Factor
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Hajime Tanaka,
Hitoshi Masuda, Yoshinobu Komai,
Minato Yokoyama,
Aki Iwai,
Noboru Numao,
Yasuyuki Sakai,
Kazutaka Saito,
Yasuhisa Fujii,
Tsuyoshi Kobayashi,
Satoru Kawakami,
Kazunori Kihara
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ABSTRACT: A 64-year old female presented with urinary retention. Physical examination revealed a firm mass on the anterior vaginal wall. Magnetic resonance imaging showed a tumor surrounding the urethra, which invaded to the vesical triangle and the anterior vaginal wall. Serum levels of carcinoembryonic antigen and carbohydrate antigen 19-9 were elevated, but squamous cell carcinoma antigen and prostate specific antigen were within normal limits. Pathological examinations of the transurethral and transvaginal needle biopsy specimen suggested mucinous adenocarcinoma. First, the patient received local chemoradiotherapy and systemic chemotherapy using a fluoropyrimidine drug TS-1 and cisplatin. The tumor markers declined to within normal limits after this preoperative therapy. Then she underwent total cysto-urethrectomy with anterior vaginal wall resection, pelvic lymphadenectomy, and urinary diversion with ureterocutaneous fistula. Histopathological examination of the surgical specimen showed mutinous adenocarcinoma invading to the vesical triangle and the anterior vaginal wall. No metastasis was found in the lymph nodes. The final diagnosis was urethral adenocarcinoma, pT4N0, Stage IV. Five months after surgery, local recurrence and distant metastases appeared, and she died 14 months after surgery.
Hinyokika kiyo. Acta urologica Japonica 02/2009; 55(1):43-6.
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ABSTRACT: C-reactive protein has been shown to be a prognostic factor for renal cell carcinoma. We developed a new prediction model including C-reactive protein in patients with clear cell renal cell carcinoma.
This study is based on 2 cohorts of Japanese patients with clear cell renal cell carcinoma, including 249 for evaluating prognostic factors and developing the prediction model, and 290 for external validation. Analyzed factors included TNM classification, tumor size, Fuhrman nuclear grade, tumor necrosis and preoperative serum C-reactive protein (cutoff 0.5 mg/dl). We developed a scoring model based on multivariate analysis to predict cancer specific survival. Predictive ability of the model was evaluated using the concordance index.
Multivariate analysis showed that pT stage, lymph node involvement, distant metastasis, tumor necrosis and C-reactive protein were independent predictors of cancer specific survival. A new scoring model was developed, consisting of C-reactive protein and the TNM classification. The 5-year cancer specific survival rate in patients with a score of 0, 1 and 2, 3 and 4, and 5 or more was 99%, 89%, 69% and 18%, respectively. Cancer specific survival rates were clearly discriminated by the stratification according to the scoring model (p <0.001). The concordance index of the new model was 0.820, which was externally validated as a concordance index of 0.865.
In patients with clear cell renal cell carcinoma a new simple scoring model based on serum C-reactive protein and the TNM classification is a useful and easy to use tool for predicting outcome.
The Journal of urology 01/2009; 181(3):1004-12; discussion 1012. · 4.02 Impact Factor
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ABSTRACT: To evaluate the efficacy and toxicity of perioperative combination chemotherapy with ifosfamide, 5-fluorouracil, etoposide and cisplatin (IFEP) in bladder cancer patients with regional lymph node metastases treated by radical cystectomy.
We reviewed the medical records of 183 consecutive patients who underwent radical cystectomy for invasive urothelial carcinoma of the bladder. Of those, 26 patients with regional lymph node metastasis who were regarded as being rendered surgically disease-free (pT1-4, N1-2, cM0) and treated with perioperative IFEP chemotherapy were the subjects of the present study.
Median follow-up of 26 patients was 49 months (range 4-150). Grade 3 and 4 bone marrow toxicities were seen in 15 and four patients, respectively. Neither chemotherapy-related death nor febrile neutropenia occurred. The 5-year overall and cancer-specific survival rate was 60% and 68%, respectively. The overall survival rate of the patients with pT4 disease was significantly worse than that of patients with pT1-3. There were four N2 patients who survived for over 5 years free of disease.
Perioperative IFEP therapy appeared to be effective in the treatment of lymph node positive bladder cancer patients who underwent radical cystectomy. Further study may be warranted.
International Journal of Urology 10/2008; 15(11):971-5. · 1.75 Impact Factor
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ABSTRACT: We report three cases of metastatic renal cell carcinoma (RCC) in which combination treatment of cimetidine, cyclooxygenase-2 inhibitor and renin-angiotensin system inhibitor (angiotensin converting enzyme inhibitor or angiotensin II type 1 receptor antagonist) (CCA therapy) was effective. Case 1: A 47-year-old man who had a 12-cm right renal tumor with multiple pulmonary and hepatic metastases refused cytokine therapy for economic reasons and received CCA therapy. All of the metastases showed partial remission, which continued for 12 months. Case 2: A 62-year-old man with multiple pulmonary and mediastinal lymph node metastases from clear cell RCC refractory to interferon-alpha and interleukin-2 started CCA therapy. Partial remission has been maintained for 16 months. Case 3: A 64-year-old man with pulmonary metastases from clear cell RCC discontinued interferon-alpha treatment due to its side effects after six months and received CCA therapy. Pulmonary metastases showed partial remission for 31 months. The CCA therapy could be an alternative treatment for metastatic RCC patients unfit for cytokine therapy.
International Journal of Urology 10/2008; 15(9):848-50. · 1.75 Impact Factor
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ABSTRACT: We report the effectiveness of a combination chemotherapy consisting of ifosfamide, 5-fluorouracil, etoposide and cisplatin (IFEP chemotherapy) against metastatic adenocarcinoma of the urachus. From April 1995 to November 2004, four patients with adenocarcinoma of the urachus who developed metastases after definitive surgery were treated with the IFEP chemotherapy followed by consolidative radiotherapy or salvage surgery in good responders. During the median follow-up period of 26 months, three of the four patients responded to the regimen (75%). In one patient with pulmonary metastases, four cycles of the IFEP chemotherapy, followed by stereotactic consolidative radiotherapy resulted in a complete remission for more than 8 years. Two patients achieved partial remission after the IFEP chemotherapy. We have demonstrated the IFEP chemotherapy is one of the most effective chemotherapy regimens against metastatic adenocarcinoma of the urachus. A multimodal treatment strategy, even with curative intent, can be considered when a sufficient effect was obtained by the IFEP chemotherapy.
International Journal of Urology 10/2008; 15(9):851-3. · 1.75 Impact Factor
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ABSTRACT: We report the effectiveness of a combination chemotherapy consisting of ifosfamide, 5-fluorouracil, etoposide and cisplatin (IFEP chemotherapy) against metastatic adenocarcinoma of the urachus. From April 1995 to November 2004, four patients with adenocarcinoma of the urachus who developed metastases after definitive surgery were treated with the IFEP chemotherapy followed by consolidative radiotherapy or salvage surgery in good responders. During the median follow-up period of 26 months, three of the four patients responded to the regimen (75%). In one patient with pulmonary metastases, four cycles of the IFEP chemotherapy, followed by stereotactic consolidative radiotherapy resulted in a complete remission for more than 8 years. Two patients achieved partial remission after the IFEP chemotherapy. We have demonstrated the IFEP chemotherapy is one of the most effective chemotherapy regimens against metastatic adenocarcinoma of the urachus. A multimodal treatment strategy, even with curative intent, can be considered when a sufficient effect was obtained by the IFEP chemotherapy.
International Journal of Urology 09/2008; 15(9):851 - 853. · 1.75 Impact Factor
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ABSTRACT: To investigate the association of lymphovascular invasion (LVI) in radical prostatectomy (RP) specimens with prostate-specific antigen (PSA) failure in patients with pT3aN0 prostate cancer (PCA).
We retrospectively reviewed the clinical records of 94 patients with pT3aN0 PCA treated with RP alone. All of the 94 patients were prospectively observed without any treatment until PSA failure was confirmed. We investigated the association of LVI with the adverse pathological findings in RP specimens and the PSA failure-free survival rate. The Cox proportional hazard model was used to elucidate predictors of PSA failure.
Median follow up was 47.4 months (quartile range 9.1 to 146.8). LVI was found in 26 (27.7%) of the 94 patients. In a multivariate analysis, PSA (P = 0.0054) and LVI (P = 0.015) were significant and independent predictors of PSA failure. Stratifying patients into four risk groups by LVI status and PSA level, the PSA failure-free survival rate in patients with negative LVI and PSA < or =10 ng/mL was significantly better than any other groups (positive LVI and/or PSA >10 ng/mL).
Adjuvant therapy would not be indicated to patients with pT3aN0 PCA with negative LVI and PSA < or =10 ng/mL.
International Journal of Urology 09/2008; 15(10):895-9. · 1.75 Impact Factor
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ABSTRACT: To investigate the prognostic effect of the prostate cancer (PCa) volume involving the seminal vesicles (CVSVs) in the radical prostatectomy specimen from patients with Stage pT3bpN0 PCa.
We retrospectively reviewed the clinical records of 27 patients with Stage pT3bpN0 PCa who had undergone radical prostatectomy alone. We measured the CVSVs using a grid method on the glass slide under microscopic inspection and investigated the association of the CVSVs with clinicopathologic variables.
Prostate-specific antigen (PSA) failure was confirmed in 11 of the 27 patients (41%) during a median follow-up of 34 months. The 3-year PSA failure-free survival rate was 48%. The median CVSVs was 1.14 cm(3). On univariate analysis, a CVSVs of >1.63 cm(3) was associated with positive surgical margins (P = .018), bilateral seminal vesicle involvement (P = .03), a long maximal tumor dimension (P = .031), and a greater preoperative PSA level (P = .0007). The 3-year PSA failure-free survival rate for those with a CVSVs of <or=1.63 cm(3) vs >1.63 cm(3) was 80% and 0%, respectively (P = .0009). On multivariate analysis, only the PSA level and CVSVs were identified as significant and independent predictors of PSA failure. Stratifying patients into 3 risk groups by these predictors, the PSA failure-free survival rate for patients with a PSA level >or=10 ng/mL and a CVSVs of >1.63 cm(3) was significantly worse than for any other group.
The CVSVs is useful and invaluable as an independent predictor of PSA failure in patients with Stage pT3bpN0 PCa. The measurement of the CVSVs is simple and helped to determine the indication for adjuvant treatment after radical prostatectomy.
Urology 09/2008; 72(6):1224-8. · 2.43 Impact Factor
