Tomonori Murayama

Asahi General Hospital, Asahi, Chiba, Japan

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Publications (11)31.96 Total impact

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    ABSTRACT: Background This retrospective study examined gender differences in non-small cell lung cancer (NSCLC) by analyzing surgical cases at a single institution. Patients and Methods In this study, 735 NSCLC patients who underwent surgery from 1995 to 2010 were included. Clinical and pathological characteristics were retrieved by reviewing charts retrospectively, and variables between genders were compared. Results There were 489 males and 246 females in the study. The percentage of screening-detected lung cancers (83.7%), never smokers (82.9%), adenocarcinoma histology (90.7%), and pathological stage IA (42.7%) was higher in females than that in males (71.2, 8.2, 51.3, and 23.1%, respectively). Female patients had fewer cases of coronary artery disease (2.8%) and fewer pneumonectomy cases (2.0%) than the male patients (7.4 and 5.3%, respectively). The median follow-up period after surgery was 5.9 years. The overall survival rates at 5 years were 57.3% for males and 76.2% for females (p < 0.001, log-rank test). Based on univariate analysis, we report that histology, smoking history, and pathological stage were significant prognostic factors in addition to gender. Based on multivariate analysis, pathological stage III/IV (hazard ratio, 3.60; 95% confidence interval [CI], 2.84-4.54) and female gender (hazard ratio, 0.55; 95% CI, 0.37-0.82) were significant prognostic factors. Subgroup analysis demonstrated that female gender and adenocarcinoma histology were significant positive prognostic factors only in pathological stages I and II (n = 557). Conclusion Female gender as well as pathological stage was favorable prognostic factors. The survival advantage observed in female NSCLC patients was limited to those with cancer at stages I and II.
    The Thoracic and Cardiovascular Surgeon 09/2015; DOI:10.1055/s-0035-1558995 · 0.98 Impact Factor

  • Cancer Research 08/2015; 75(15 Supplement):5113-5113. DOI:10.1158/1538-7445.AM2015-5113 · 9.33 Impact Factor
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    ABSTRACT: The Glasgow Prognostic Score (GPS), which is calculated with C-reactive protein (CRP) and albumin (Alb) values, is a prognostic indicator for various types of cancers. However, its role in lung cancer still remains unclear, and its optimal cut-off values are controversial. Here, we evaluated the significance of the GPS and adjusted GPS (a-GPS) using our institution's cut-off values in patients undergoing resection for primary lung cancer. We analysed 1043 lung cancer patients who underwent resection between 1998 and 2012. The overall survival (OS) probabilities of the GPS subgroups were estimated using the Kaplan-Meier method and were compared using the log-rank test. The prognostic significance of the GPS and the a-GPS was assessed by the Cox proportional hazards model with clinicopathological variables and inflammation markers, such as the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR). The GPS was calculated based on cut-off values of 1.0 mg/dl for CRP and 3.5 g/dl for Alb, as previously reported. The a-GPS was calculated based on cut-off values 0.3 mg/dl for CRP and 3.9 g/dl for Alb, which are the standard thresholds used by our institution. The GPS and the a-GPS were correlated with preoperative factors, such as age, sex, smoking status, the NLR and the PLR, and oncological factors, including the pathological stage, histological type and level of lymphovascular invasion. The 5-year OS rates were 82, 55 and 55% with GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.66), respectively, and 88, 67 and 59% with a-GPS 0, 1 and 2 (1 vs 0: P < 0.01; 2 vs 1: P = 0.04), respectively. Multivariable analysis revealed that the GPS [1 vs 0, hazard ratio (HR): 1.63, 2 vs 0, HR: 1.44] and the a-GPS (1 vs 0, HR: 2.00, 2 vs 0, HR: 2.10) were independent prognostic factors. The a-GPS classification showed a clearer prognostic distribution than the GPS classification. The GPS is a useful prognostic indicator of the OS in lung cancer surgery. The optimal cut-off values for GPS estimation may need to be re-evaluated. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
    Interactive Cardiovascular and Thoracic Surgery 08/2015; DOI:10.1093/icvts/ivv204.73 · 1.16 Impact Factor
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    ABSTRACT: We report a case of tracheal resection and reconstruction for a squamous cell carcinoma of the trachea that was found in an 82-year-old male patient who had underwent right lower lobectomy for an adenosquamous cell carcinoma 3.5 years before. He noticed bloody sputum. Chest computed tomography (CT) revealed a 15 mm tumor in the anterior wall of the trachea. A transbronchial biopsy for the tracheal tumor showed a squamous cell carcinoma. Under right thoracotomy, we resected the tumor with 3 tracheal rings. Histologically a squamous cell carcinoma was diagnozed. As there was intraepithelial spread of cancer cells in the oral margin, the tracheal tumor was suspected to be a primary tracheal tumor rather than a metastasis from lung cancer. After the surgery, combination therapies of an external radiation therapy for 50 Gy and brachytherapy 2 times for totally 8 Gy were performed as a postoperative adjuvant therapy. He does not have any signs of recurrence in 1 year and 6 months after the surgery.
    Kyobu geka. The Japanese journal of thoracic surgery 06/2015; 68(6):473-475.

  • The Journal of Heart and Lung Transplantation 04/2015; 34(4):S268-S269. DOI:10.1016/j.healun.2015.01.751 · 6.65 Impact Factor
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    ABSTRACT: Validation of the clinical classification for lung cancer of the 7th edition of the TNM staging system among surgical cases has not been reported previously. Data of 489 males and 246 females, with a mean age of 67.6 years, who underwent surgical resection for non-small-cell lung cancer were analyzed retrospectively. The 5-year survival rate of these patients was 72.2% for clinical stage IA (n = 365), 58.4% for IB (n = 158), 51.2% for IIA (n = 77), 49.1% for IIB (n = 42), 36.8% for IIIA (n = 86), 80% for IIIB (n = 5) and 50% for IV (n = 2). The 5-year survival rate of patients was 100% for pathological stage 0 (n = 2), 86.1% for IA (n = 216), 73.8% for IB (n = 173), 46.1% for IIA (n = 97), 47.2% for IIB (n = 69), 33.3% for IIIA (n = 155), 33.3% for IIIB (n = 3) and 30.9% for IV (n = 20). Prognostic factors included female sex and 70 years of age or younger, as well as adenocarcinoma histology. Deterioration in patient survival was indicated with the exception of stages IIIB and IV, each of which included only a small number of patients. Our study validated the current TNM staging system in surgical cases with regard to both clinical and pathological classifications.
    Asian cardiovascular & thoracic annals 12/2013; 21(6):693-9. DOI:10.1177/0218492312470670
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    ABSTRACT: Purpose: The treatment of primary mediastinal germ cell tumors with cisplatin-based chemotherapy followed by surgery is an established practice; however, the prognosis has remained poor. This study reviews the survival outcomes of patients with primary mediastinal germ cell tumors to evaluate the efficacy of our treatment. Methods: We retrospectively reviewed 11 consecutive patients with primary mediastinal germ cell tumors. Results: We had treated four patients with seminomas and seven patients with non-seminomas. Ten patients had undergone cisplatin-based chemotherapy. All patients underwent complete resection. Two patients showed a failure of first-line chemotherapy and thus received salvage chemotherapies, including paclitaxel plus ifosfamide followed by high-dose carboplatin plus etoposide (TI-CE) with stem cell transplantation. One of them died of relapse 29 months later; while the other patient remained disease-free for 56 months postoperatively. The postoperative overall 3-year survival rates of the patients with non-seminomas and seminomas were 83 and 100%, respectively. Conclusion: Complete resection after establishing normalized or decreased at a low-level serum tumor markers plateau plays a crucial role in the management of patients with primary mediastinal malignant germ cell tumors.
    Surgery Today 04/2013; 44(3). DOI:10.1007/s00595-013-0562-0 · 1.53 Impact Factor
  • Tomohiro Murakawa · Tomonori Murayama · Jun Nakajima · Minoru Ono ·
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    ABSTRACT: Non-cardiac surgical procedures in patients with left ventricular assist devices (LVADs) pose a special challenge given the hemodynamic and hematologic considerations in these patients. During pulmonary procedures in patients with LVADs, special attention should be paid to hemodynamics because lung resection surgery requires a lateral decubitus position, single-lung ventilation and postoperative decrease in the pulmonary vascular bed, all of which may lead to inadequate preload to the LVAD. We present a case of lower lobectomy of the left lung for an adenocarcinoma found in a patient with an implantable continuous-flow LVAD.
    Interactive Cardiovascular and Thoracic Surgery 09/2011; 13(6):676-8. DOI:10.1510/icvts.2011.281493 · 1.16 Impact Factor
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    ABSTRACT: The lung is the most common site for extrahepatic metastasis from hepatocellular carcinoma (HCC). We previously reported in a series of 20 patients that pulmonary metastasectomy for HCC is feasible in selected patients. The objective of this study was to re-evaluate the long-term outcomes and prognostic factors with an additional 25 patients. We retrospectively analyzed the records of 45 consecutive patients who underwent pulmonary metastasectomy due to HCC at our institution between 1990 and 2010. Thirty-nine patients underwent hepatectomy or liver transplantation, whereas six patients underwent locoregional therapy for primary liver lesions. Twenty-seven patients died during a median 17.6-month follow-up period. The 2-year disease-free survival (DFS) was 19.5%. The 5-year overall survival (OS) was 40.9%. History of recurrence and serum des-gamma-carboxy prothrombin (DCP) level >40 mAU ml(-1) at initial pulmonary resection were unfavorably associated with OS in univariate analysis. Pulmonary metastasectomy for HCC in selected patients resulted in relatively good outcomes with regard to OS. History of recurrence and serum DCP levels were shown to be candidates of prognostic factors for OS.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 07/2011; 41(2):376-82. DOI:10.1016/j.ejcts.2011.05.052 · 3.30 Impact Factor
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    ABSTRACT: Human γδ T cells can recognize and kill non-small cell lung cancer (NSCLC) cells using the Vγ9Vδ2 T-cell receptor and/or NKG2D. We have established clinical grade large-scale ex vivo expansion of γδ T cells from peripheral blood mononuclear cells by culturing with zoledronate and interleukin-2 (IL-2). A phase I study was conducted to evaluate safety and potential antitumor effects of re-infusing ex vivo expanded γδ T cells in patients with recurrent or advanced NSCLC. Patient's peripheral blood mononuclear cells were stimulated with zoledronate (5 μM) and IL-2 (1000 IU/mL) for 14 days. Harvested cells, mostly γδ T cells, were given intravenously every 2 weeks without additional IL-2, a total of 6 times. The cumulative number of transferred γδ T cells ranged from 2.6 to 45.1 x 10⁹ (median, 15.7×10⁹). Fifteen patients underwent adoptive immunotherapy with these γδ T cells. There were no severe adverse events related to the therapy. Immunomonitoring data showed that with increasing numbers of infusions, the number of peripheral γδ T cells gradually increased. All patients remained alive during the study period with a median survival of 589 days and median progression-free survival of 126 days. According to the Response Evaluation Criteria In Solid Tumors, there were no objective responses. Six patients had stable disease, whereas the remaining 6 evaluable patients experienced progressive disease 4 weeks after the sixth transfer. We conclude that adoptive transfer of zoledronate-expanded γδ T cells is safe and feasible in patients with NSCLC, refractory to other treatments.
    Journal of immunotherapy (Hagerstown, Md.: 1997) 03/2011; 34(2):202-11. DOI:10.1097/CJI.0b013e318207ecfb · 4.01 Impact Factor
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    ABSTRACT: Solitary pulmonary lesion poses a diagnostic challenge, especially in patients with a history of malignancy. The purpose of this study was to evaluate the characteristics of solitary pulmonary lesions and the outcome of surgical resection. We retrospectively analyzed 243 patients with a history of cancer who underwent surgery for new-found solitary pulmonary lesion between January 1998 and December 2007. The diagnosis was primary lung cancer in 92 patients, metastasis in 133, and benign lesions in 18. The 5-year survival rate was 67.9% in all patients, 74.6% in those with primary lung cancer, 62.8% in those with metastasis, and 79.9% in those with benign lesions (p = 0.56). In metastasis patients, history of extrapulmonary recurrence and larger diameter lesion were risk factors for recurrence by multivariate analysis. History of cancers other than colorectal and bone and soft tissue sarcoma and shorter disease-free interval were indicators of poor prognosis. Pathologic stage was the only indicator of prognosis for primary lung cancer, and none of the factors concerning antecedent cancer influenced prognosis. Surgical resection of solitary pulmonary lesion is essential in patients with a history of cancer because substantial numbers of benign lesions are included. In the case of malignancy, metastasectomy had a life-prolonging effect for selected patients, and prognosis of primary lung cancer was no worse than for the general population if treated appropriately. It is important not to hesitate to take a surgical approach for a diagnosis and to treat with standard therapy for primary lung cancer.
    The Annals of thoracic surgery 12/2010; 90(6):1766-71. DOI:10.1016/j.athoracsur.2010.07.054 · 3.85 Impact Factor