Takeshi Ishii

Chiba Cancer Center, Tiba, Chiba, Japan

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Publications (58)218.5 Total impact

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    ABSTRACT: We investigated whether surgical rib fixation improved outcomes in patients with traumatic rib fractures. This was a retrospective study using a Japanese administrative claim and discharge database. We included patients with traumatic rib fractures admitted to hospitals where surgical rib fixation was available from July 1 2010, to March 31, 2013. We detected patients who underwent surgical rib fixation within 10 days of hospital admission (surgical group) and those who did not (control group). The main outcome was prolonged mechanical ventilation, defined as that performed for 5 or more days, or death within 28 days. One-to-four propensity score matching was performed between the 2 groups with adjustment for possible confounders. Among 4577 eligible patients, 90 (2.0%) underwent the surgical rib fixation. After the matching, we obtained 84 and 336 patients in the surgical and control groups, respectively. Logistic regression analyses showed that the surgical group was significantly less likely to receive prolonged mechanical ventilation or die within 28 days than the control group (22.6% vs 33.3%; odds ratio, 0.59; 95% confidence interval, 0.36-0.96; P = .034). Surgical rib fixation within 10 days of hospital admission may improve outcomes in patients with traumatic rib fractures. Copyright © 2015. Published by Elsevier Inc.
    Journal of critical care 08/2015; DOI:10.1016/j.jcrc.2015.07.027 · 2.00 Impact Factor
  • Cancer Research 08/2015; 75(15 Supplement):78-78. DOI:10.1158/1538-7445.AM2015-78 · 9.33 Impact Factor
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    ABSTRACT: In this era of individualized cancer treatment, data that could be applied to predicting the survival of patients with osteosarcoma are still limited because of the rarity of the disease and the difficulty in accumulating a sufficient number of patients. Therefore, a multi-institutional collaboration was implemented to develop and externally validate nomograms that would predict metastasis-free survival (MFS) and overall survival (OAS) for patients with nonmetastatic osteosarcoma. This study retrospectively examined 1070 patients treated with neoadjuvant chemotherapy and surgery for nonmetastatic osteosarcoma. Data from Japanese patients (n = 557) were used to develop multivariate nomograms based on Cox regression. Six clinical and pathologic variables were built into nomograms estimating the probability of MFS and OAS 3 and 5 years after diagnosis. The model was internally validated for discrimination and calibration with bootstrap resampling and was externally validated with an independent patient cohort from Korea (n = 513). A patient's age, tumor site, and histologic response were found to have a stronger influence on MFS and OAS in the model than sex, tumor size, or pathologic fracture. The nomograms and calibration plots based on these results well predicted the probability of MFS (concordance index, 0.631) and OAS (concordance index, 0.679). The concordance indices for external validation were 0.682 for MFS and 0.665 for OAS. The nomograms were externally validated and verified to be useful for the prediction of MFS and OAS and for the assessment of the postoperative prognosis. They can be used for counseling patients and for establishing appropriate surveillance strategies after surgery. Cancer 2015. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. © 2015 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
    Cancer 07/2015; DOI:10.1002/cncr.29575 · 4.89 Impact Factor
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    ABSTRACT: Distant metastases from osteosarcoma most commonly occur in the lungs. Osteosarcoma can be cured by complete surgical resection of all metastatic lesions if the number is limited (oligo-recurrence: ≤5 metastatic or recurrent lesions with controlled primary lesions). This study aimed to clarify the prognostic factors for osteosarcoma patients with pulmonary metastasis and determine their oligo-recurrence status. Patients with conventional osteosarcoma who underwent definitive surgery for the primary lesion and at least one thoracotomy for pulmonary metastases were recruited to this retrospective study. Clinicopathological information was collected on each thoracotomy from 1976 to 2011, and was then analyzed statistically. We counted the number of resected nodules that were pathologically confirmed as metastatic lesions from osteosarcoma. In total, 151 thoracotomies in 71 patients were analyzed. Forty-seven patients (66 %) underwent up to two thoracotomies, and the maximum number of thoracotomies was six. The median number of resected nodules on each thoracotomy was two, and the median total size of metastatic lesions was 20 mm. Incomplete surgical remission [relative risk (RR) 3.42], a less than 1-year interval from a previous thoracotomy (RR 1.97), more than three resected nodules (RR 2.42); and total size of more than 30 mm for pulmonary metastases (RR 2.19) were independent predictors of increased risk of tumor death by multivariate analysis. We propose that factors contributing to oligo-recurrence of patients with pulmonary metastatic osteosarcoma include complete surgical remission, an interval from a previous thoracotomy, number of resected nodules, and total size of pulmonary metastases.
    Annals of Surgical Oncology 06/2015; DOI:10.1245/s10434-015-4682-1 · 3.93 Impact Factor
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    ABSTRACT: Epithelioid sarcoma (ES) is an extremely rare soft tissue sarcoma. Recently, the proximal variant has been reported to be a more aggressive subtype; however, as most reports of ES have involved small case series, the actual prognostic implications remain unclear. We investigated the clinicopathological features of patients with ES to identify the prognostic factors that influence survival. We retrospectively analyzed the clinicopathological features of 44 patients with ES who had been treated at our institutions between 1991 and 2011. Among these patients, 26 were diagnosed histologically as having classic-type ES, whereas the remaining 18 had proximal-type ES. Thirty-three of the patients, all without distant metastases, underwent curative surgery, and the remaining 11 with distant metastases (M1) received palliative treatment. The proximal subtype was significantly correlated with a proximal tumor location, distant metastases at presentation, presence of rhabdoid cells, a higher tumor grade, and vascular invasion. The overall survival (OS) rate at 5 years for the 44 patients was 45 %. A superficial tumor location and lymph node metastases (N1) at presentation were independently predictive of local recurrence-free survival (LRFS), and N1 and M1 tumors were independently predictive of distant metastasis-free survival and OS, respectively. The proximal subtype was associated with unfavorable LRFS and OS, although not to a statistically significant degree. Proximal-type ES has significantly more aggressive clinicopathological features than classic-type ES, and lymph node or distant metastasis has the most critical impact on prognosis.
    Annals of Surgical Oncology 02/2015; 22(8). DOI:10.1245/s10434-014-4294-1 · 3.93 Impact Factor
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    ABSTRACT: IntroductionTissue inhibitor of metalloproteinase-2 (TIMP-2) is an emerging acute kidney injury (AKI) biomarker. We evaluated the performance of urinary TIMP-2 in an adult mixed ICU by comparison with other biomarkers that reflect several different pathways of AKI.Methods This study prospectively enrolled 98 adult critically ill patients who had been admitted to the adult mixed ICU. Urinary TIMP-2 and N-acetyl-ß-D-glucosaminidase (NAG), and plasma neutrophil gelatinase-associated lipocalin (NGAL), interleukin-6 (IL-6), and erythropoietin (EPO) were measured on ICU admission. We evaluated these biomarkers¿ capability of detecting AKI and its severity as determined by the Kidney Disease Improving Global Outcomes (KDIGO) serum creatinine criteria and of predicting in-hospital mortality. The impact of sepsis, the leading cause of AKI in ICUs, was also evaluated.ResultsWe found AKI in 42 (42.9%) patients. All biomarkers were significantly higher in AKI than in non-AKI. In total, 27 (27.6%) patients developed severe AKI. Urinary TIMP-2 was able to distinguish severe AKI from non-severe AKI with the area under the receiver operating characteristic curve (AUC-ROC) of 0.80 (95% confidence interval 0.66 to 0.90). A total of 41 one (41.8%) cases were complicated with sepsis. Although plasma NGAL and IL-6 were increased by sepsis, urinary TIMP-2 and NAG were increased not by sepsis but by the presence of severe AKI. Plasma EPO was increased only by septic AKI. In-hospital mortality was 15.3% in this cohort. Urinary TIMP-2 and NAG, and plasma NGAL were significantly higher in non-survivors than in survivors, although plasma IL-6 and EPO were not. Among the biomarkers, only urinary TIMP-2 was able to predict in-hospital mortality significantly better than serum creatinine.Conclusion Urinary TIMP-2 can detect severe AKI with performance equivalent to those of plasma NGAL and urinary NAG with an AUC-ROC value higher than 0.80. Furthermore, urinary TIMP-2 was associated with mortality. Sepsis appeared to have only a limited impact on urinary TIMP-2, in contrast to plasma NGAL.
    Critical care (London, England) 12/2014; 18(6):716. DOI:10.1186/s13054-014-0716-5 · 4.48 Impact Factor
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    ABSTRACT: Background and Objectives Infiltrative growth, frequently observed in undifferentiated pleomorphic sarcoma (UPS) and myxofibrosarcoma (MFS), is often associated with a positive surgical margin as well as a local failure. The purpose of our study was to determine whether the radiographic growth patterns were associated with the outcomes of patients with UPS and MFS.Methods We reviewed 89 patients diagnosed with UPS or MFS and underwent initial surgery at our institute between 1994 and 2011. Growth patterns were assessed radiographically on preoperative MRI. Clinicopathological factors were collected and uni- and multivariate analyses were performed for survival.ResultsInfiltrative growth was observed in 21 patients (24%), which correlated with superficial tumors and positive surgical margin. Infiltrative growth correlated with poor disease-specific and distant failure-free survivals relative to non-infiltrative growth. Multivariate analysis confirmed that these factors remained as significant factors. Patients with non-infiltrative tumors resected inadequately exhibited slightly more favorable local control with postoperative radiotherapy, although no clinical benefit was seen for those with infiltrative tumors.Conclusions Infiltrative growth was an adverse prognostic factor for not only local control, but also disease-specific and metastasis-free survival in patients with UPS and MFS. Radiotherapy could not salvage inadequately resected infiltrative tumors. J. Surg. Oncol. © 2014 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 11/2014; 110(6). DOI:10.1002/jso.23708 · 3.24 Impact Factor
  • Cancer Research 10/2014; 74(20 Supplement):A49-A49. DOI:10.1158/1538-7445.PEDCAN-A49 · 9.33 Impact Factor
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    ABSTRACT: Objectives: To investigate the performance of acute kidney injury (AKI) biomarkers for mortality prediction. Materials and methods: Cutoff values of urinary L-type fatty acid-binding protein (L-FABP) and N-acetyl-β-d-glucosaminidase (NAG) for AKI diagnosis in ICU were determined in the derivation cohort. The performance of these AKI biomarkers for mortality prediction was evaluated in the validation cohort with stratification of serum-creatinine based AKI diagnosis. Results: Mortality in the AKI patients diagnosed by serum creatinine was increased remarkably when urinary L-FABP and NAG were positive. Conclusions: These AKI biomarkers can specifically detect high-risk patients among creatinine-base diagnosed AKI.
    Biomarkers 10/2014; 19(8):1-6. DOI:10.3109/1354750X.2014.968209 · 2.26 Impact Factor
  • Cancer Research 10/2014; 74(19 Supplement):3102-3102. DOI:10.1158/1538-7445.AM2014-3102 · 9.33 Impact Factor
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    ABSTRACT: Background: Osteosarcoma as second malignancy of childhood cancers rarely occurs, and its clinical characteristics are unclear. Methods: Patients with osteosarcoma occurring as second malignancy of childhood cancers were retrospectively surveyed. Results: Of 323 patients with osteosarcoma registered in the database, 10 (3.1%) had a past history of childhood cancers. The mean age at the onset of the first childhood cancer was 2.7 years, and the diagnosis of the first childhood cancer was adrenocortical carcinoma, malignant teratoma, ovarian carcinoma, Ewing's sarcoma, and rhabdomyosarcoma in 1 patient each, and retinoblastoma in 5 patients. Osteosarcoma as second malignancy occurred 14.6 years after the first childhood cancer on average. Seven patients were alive and 3 died. In 1 patient, the cause of death was related to a complication of treatment for the first childhood cancer. Except for this patient, 7 (77.8%) of 9 patients survived with no disease (mean follow-up period: 10.9 years). Conclusions: Attention should be paid to complications of treatment for the first childhood cancer in the treatment for osteosarcoma occurring as second malignancy. The prognosis of osteosarcoma as second malignancy of childhood cancers may be more favorable than that of conventional osteosarcoma.
    International Journal of Clinical Oncology 07/2014; 20(3). DOI:10.1007/s10147-014-0729-8 · 2.13 Impact Factor
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    ABSTRACT: Background: Perioperative complication of end-organ injury including acute kidney injury (AKI) is a frequent and severe problem for patients undergoing left ventricular assist device (LVAD) implantation. This study evaluated an emerging AKI biomarker, plasma neutrophil gelatinase-associated lipocalin (NGAL), in a LVAD implantation cohort. Methods and results: Of 31 LVAD implantation patients enrolled to this study, 17 (55%) patients were diagnosed as having AKI. Six AKI patients showed severe AKI requiring renal replacement therapy (RRT). Plasma NGAL values in the AKI-with-RRT group (n=6) were significantly higher than that in other patients, although the AKI-without-RRT (n=11) group showed a similar level of plasma NGAL to that of the non-AKI group (n=14). Multiple logistic regression analysis revealed that plasma NGAL measured at pre-operation and central venous pressure at pre-operation and 12 h after surgery independently discriminated against postoperative RRT requirement. In the AKI-with-RRT group, plasma NGAL decreased before termination of RRT in 4 patients who eventually showed renal recovery, although no decline of plasma NGAL was observed in 2 patients who showed no recovery of renal function. Removal of blood NGAL by continuous hemodiafiltration was shown to be 70-75% lower than that of creatinine. Conclusions: Measurement of perioperative plasma NGAL is useful for predicting severe AKI requiring RRT and renal recovery in patients who have had LVAD implantation surgery. Further investigation is necessary to confirm these findings because this study examined a low number of patients.
    Circulation Journal 06/2014; 78(8). DOI:10.1253/circj.CJ-14-0008 · 3.94 Impact Factor
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    ABSTRACT: Plasma neutrophil gelatinase-associated lipocalin (NGAL) is reportedly useful for post-cardiac surgery acute kidney injury (AKI). Although chronic kidney disease (CKD) is a strong risk factor for AKI development, no clinical evaluation of plasma NGAL has specifically examined AKI occurring in patients with CKD. This study evaluated plasma NGAL in AKI superimposed on CKD after cardiac surgery. This study prospectively evaluated 146 adult patients with scheduled cardiac surgery at 2 general hospitals. Plasma NGAL was measured before surgery, at ICU arrival after surgery (0 hours), and 2, 4, 12, 24, 36, and 60 hours after ICU arrival. Based on the Kidney Disease Improving Global Outcomes (KDIGO) CKD guideline, 72 (49.3%) were diagnosed as having CKD. Of 146 patients, 53 (36.3%) developed AKI after surgery. Multiple logistic regression analysis revealed that preoperative plasma NGAL, estimated glomerular filtration rate (eGFR), and operation time are significantly associated with AKI occurrence after surgery. Plasma NGAL in AKI measured after surgery was significantly higher than in non-AKI irrespective of CKD complication. However, transient decrease of plasma NGAL at 0 to 4 hours was observed especially in AKI superimposed on CKD. Plasma NGAL peaked earlier than serum creatinine and at the same time in mild AKI and AKI superimposed on CKD with increased preoperative plasma NGAL (>300 ng/ml). Although AKI superimposed on CKD showed the highest plasma NGAL levels after surgery, plasma NGAL alone was insufficient to discriminate de novo AKI from CKD without AKI after surgery. Receiver operating characteristics analysis revealed different cutoff values of AKI for CKD and non-CKD patients. Results show the distinct features of plasma NGAL in AKI superimposed on CKD after cardiac surgery: 1) increased preoperative plasma NGAL is an independent risk factor for post-cardiac surgery AKI; 2) plasma NGAL showed an earlier peak than serum creatinine did, indicating that plasma NGAL can predict the recovery of AKI earlier; 3) different cutoff values of post-operative plasma NGAL are necessary to detect AKI superimposed on CKD distinctly from de novo AKI. Further investigation is necessary to confirm these findings because this study examined a small number of patients.
    Critical care (London, England) 11/2013; 17(6):R270. DOI:10.1186/cc13104 · 4.48 Impact Factor
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    ABSTRACT: It is unclear whether the prehospital termination of resuscitation (TOR) rule is applicable in specific situations such as in areas extremely dense with hospitals. The objective of the study is to assess whether the prehospital TOR rule is applicable in the emergency medical services system in Japan, specifically, in an area dense with hospitals in Tokyo. This study was a retrospective, observational analysis of a cohort of adult out-of-hospital cardiopulmonary arrest (OHCA) patients who were transported to the University of Tokyo Hospital from April 1, 2009, to March 31, 2011. During the study period, 189 adult OHCA patients were enrolled. Of the 189 patients, 108 patients met the prehospital TOR rule. The outcomes were significantly worse in the prehospital TOR rule-positive group than in the prehospital TOR-negative group, with 0.9% vs 11.1% of patients, respectively, surviving until discharge (relative risk [RR], 1.11; 95% confidence interval [CI], 1.03-1.21; P = .0020) and 0.0% vs 7.4% of patients, respectively, discharged with a favorable neurologic outcome (RR, 1.08; 95% CI, 1.02-1.15; P = .0040). The prehospital TOR rule had a positive predictive value (PPV) of 99.1% (95% CI, 96.3-99.8) and a specificity of 90.0% (95% CI, 60.5-98.2) for death and a PPV of 100.0% (95% CI, 97.9-100.0) and a specificity of 100.0% (95% CI, 61.7-100.0) for an unfavorable neurologic outcome. This study suggested that the prehospital TOR rule predicted unfavorable outcomes even in an area dense with hospitals in Tokyo and might be helpful for identifying the OHCA patients for whom resuscitation efforts would be fruitless.
    The American journal of emergency medicine 10/2013; 32(2). DOI:10.1016/j.ajem.2013.10.032 · 1.27 Impact Factor
  • Resuscitation 10/2013; 84:S88. DOI:10.1016/j.resuscitation.2013.08.224 · 4.17 Impact Factor
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    ABSTRACT: Objective: The prevalence of epilepsy in patients with Down syndrome (DS) is 5-13%, which is higher than the prevalence in the general population. Transient hyperammonemia is often observed following seizure, but it typically resolves within a day. Here, we describe the case a 37-year-old woman who had DS and a history of adult-onset epilepsy and was admitted to our hospital with recurrent seizures. After admission, her ammonia levels fluctuated without any apparent cause, and dynamic computed tomography revealed a portosystemic shunt. The findings suggest that her seizures possibly precipitated from hyperammonemia secondary to a portosystemic shunt, and we reviewed the relevant literature. Methods: We conducted PubMed, Web of Science, and EMBASE searches without language restrictions for articles published between 1970 and February 2013. Results: In addition to the present case, 7 cases were ultimately included in this review. Four patients were newborns, 2 patients were 1month old, and 1 patient was 3years old. No adult cases were described until now. Conclusion: Adult patients with DS diagnosed with epilepsy are not routinely assessed for portosystemic venous shunts. Measuring ammonia levels in patients with DS the day after admission would help detect portosystemic shunts, even if the patients have been previously diagnosed with epilepsy. Practice Implications: If ammonia levels fluctuate without any apparent cause after seizure, dynamic computed tomography should be performed, especially for patients with DS, whether or not they have been previously diagnosed with epilepsy.
    Brain & development 09/2013; 36(7). DOI:10.1016/j.braindev.2013.08.007 · 1.88 Impact Factor
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    ABSTRACT: IntroductionFibrous dysplasia (FD) is a benign medullary fibro-osseous lesion that may present as monostotic or polyostotic. Bone deformities often manifest in polyostotic FD, especially in the femoral neck region, due to repeated microfractures. The deformity observed in the proximal femur has been referred to as shepherd’s crook deformity and is characterized by coxa vara. This deformity causes shortening of the affected limb, limited range of motion (ROM) of the hip joint, and a reduction in the gluteus medius muscle, resulting in the marked aggravation of function in the affected limb [1, 2]. Surgical treatment for FD should be performed when a pathological fracture occurs or serious symptoms develop due to the deformity; however, correcting shepherd’s crook deformity to obtain a desirable mechanical axis and lengthening the lower limb is challenging [2-6]. Furthermore, weight bearing is restricted for a long period until both treated femora obtain sufficient bony union. We report ...
    Journal of Orthopaedic Science 09/2013; 20(2). DOI:10.1007/s00776-013-0463-5 · 0.94 Impact Factor
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    ABSTRACT: To determine (1) the proportion and number of clinically relevant alarms based on the type of monitoring device; (2) whether patient clinical severity, based on the sequential organ failure assessment (SOFA) score, affects the proportion of clinically relevant alarms and to suggest; (3) methods for reducing clinically irrelevant alarms in an intensive care unit (ICU). A prospective, observational clinical study. A medical ICU at the University of Tokyo Hospital in Tokyo, Japan. All patients who were admitted directly to the ICU, aged ≥18 years, and not refused active treatment were registered between January and February 2012. The alarms, alarm settings, alarm messages, waveforms and video recordings were acquired in real time and saved continuously. All alarms were annotated with respect to technical and clinical validity. 18 ICU patients were monitored. During 2697 patient-monitored hours, 11 591 alarms were annotated. Only 740 (6.4%) alarms were considered to be clinically relevant. The monitoring devices that triggered alarms the most often were the direct measurement of arterial pressure (33.5%), oxygen saturation (24.2%), and electrocardiogram (22.9%). The numbers of relevant alarms were 12.4% (direct measurement of arterial pressure), 2.4% (oxygen saturation) and 5.3% (electrocardiogram). Positive correlations were established between patient clinical severities and the proportion of relevant alarms. The total number of irrelevant alarms could be reduced by 21.4% by evaluating their technical relevance. We demonstrated that (1) the types of devices that alarm the most frequently were direct measurements of arterial pressure, oxygen saturation and ECG, and most of those alarms were not clinically relevant; (2) the proportion of clinically relevant alarms decreased as the patients' status improved and (3) the irrelevance alarms can be considerably reduced by evaluating their technical relevance.
    BMJ Open 09/2013; 3(9):e003354. DOI:10.1136/bmjopen-2013-003354 · 2.27 Impact Factor
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    ABSTRACT: The occurrence of osteosarcoma in elderly patients has recently been increasing, and the outcome is poor. This multi-institutional retrospective study was conducted to investigate clinical features and prognostic factors in patients older than 40 years with osteosarcoma. Patients with conventional high-grade osteosarcoma older than 40 years were recruited to this study. Secondary osteosarcoma arising from Paget's disease or irradiated bones was excluded. Information on tumor- and treatment-related factors was collected and statistically analyzed. The median follow-up was 57 months (range 8-244 months) for all surviving patients. A total of 86 patients were enrolled in this study. The median age at diagnosis was 61 years. Surgery and chemotherapy were conducted in 73 and 63 % of all patients, respectively. The 5-year overall and event-free survival rates were 38.8 and 34.0 %, respectively. Tumor site (extremity 57.9 %; axial 19.0 %; p < 0.0001), metastasis at diagnosis (yes 12.2 %; no 48.3 %; p < 0.0091), and definitive surgery (yes 56.2 %; no 10.6 %; p < 0.0001) were associated with overall survival. Although patients without metastasis who received definitive surgery were regarded as good candidates for chemotherapy, the addition of chemotherapy did not have any impact on the outcome (yes 63.4 %; no 65.2 %; p = 0.511). The present study revealed the distinct clinical features, such as the high incidence of truncal tumors or metastasis at diagnosis, in patients older than 40 years with osteosarcoma. Additionally, prognostic factor analyses revealed that tumor site, metastasis at diagnosis, definitive surgery, and surgical margins were significant prognostic factors, whereas chemotherapy did not influence survival.
    Annals of Surgical Oncology 08/2013; 21(1). DOI:10.1245/s10434-013-3210-4 · 3.93 Impact Factor
  • Cancer Research 08/2013; 73(8 Supplement):3815-3815. DOI:10.1158/1538-7445.AM2013-3815 · 9.33 Impact Factor

Publication Stats

503 Citations
218.50 Total Impact Points


  • 1999–2015
    • Chiba Cancer Center
      Tiba, Chiba, Japan
  • 2007–2014
    • The University of Tokyo
      • Department of Nephrology and Endocrinology
      Tōkyō, Japan
  • 2013
    • Tokyo Women's Medical University
      Edo, Tōkyō, Japan
    • Tokyo Medical University
      • Department of Emergency and Critical Care Medicine
      Edo, Tōkyō, Japan
  • 2002
    • Sapporo Medical University
      • Division of Orthopaedic Surgery
      Sapporo, Hokkaidō, Japan