Shin Egawa

The Jikei University School of Medicine, Edo, Tokyo, Japan

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Publications (37)

  • [Show abstract] [Hide abstract] ABSTRACT: Objective: To examine the antitumor activity of zoledronic acid (ZA) combined with androgen deprivation therapy (ADT) for men with treatment-naive prostate cancer and bone metastasis. Methods: We enrolled 227 men with treatment-naive prostate cancer and bone metastasis. Participants were randomly assigned (1:1 ratio) to receive combined androgen blockade alone (CAB group) or ZA with combined androgen blockade (CZ group). Time to treatment failure (TTTF), time to the first skeletal-related event (TTfSRE), and overall survival (OS) rates were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were calculated using the Cox proportional hazards model. Median follow-up duration was 41.5 months. Results: Median TTTFs were 12.4 and 9.7 months for the CZ and CAB groups, respectively (HR 0.75; 95 % CI 0.57-1.00; p = 0.051). For men with baseline prostate-specific antigen levels <200 ng/mL, median TTTFs were 23.7 and 9.8 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.35-0.93; p = 0.023). Median TTfSREs were 64.7 and 45.9 months for the CZ and CAB groups, respectively (HR 0.58; 95 % CI 0.38-0.88; p = 0.009). OS was similar between the groups. Conclusions: This study failed to demonstrate that combined use of ZA and ADT significantly prolonged TTTF in men with treatment-naive prostate cancer and bone metastasis. However, it generates a new hypothesis that the combined therapy could delay the development of castration resistance in a subgroup of patients with low baseline prostate-specific antigen values <200 ng/mL. The treatment also significantly prolonged TTfSRE but did not affect OS.
    Article · Sep 2016 · International Journal of Clinical Oncology
  • Takahiro Kimura · Shin Egawa
    Article · Sep 2016 · European Urology
  • Kenichi Hata · Takahiro Kimura · Shunsuke Tsuzuki · [...] · Shin Egawa
    [Show abstract] [Hide abstract] ABSTRACT: Objectives: To prospectively evaluate the safety of postoperative fondaparinux in comparison with low molecular weight heparin in patients undergoing uro-oncological surgery. Methods: The present study was a prospective, single-blind, non-inferiority randomized trial. A total of 359 patients undergoing surgery for urological malignancy were enrolled from January 2011 to December 2012. A total of 298 of these patients (fondaparinux group, 152; low molecular weight heparin group, 146) were evaluable for the intention-to-treat-analysis. Patients were randomly assigned to low-dose unfractionated heparin, 5000 units twice daily until postoperative day 1 plus either fondaparinux 2.5 mg once daily or low molecular weight heparin 2000 units twice daily until postoperative day 5. The primary end-point was postoperative bleeding as by independent review, and the study was powered to show the non-inferiority of fondaparinux versus low molecular weight heparin. The other adverse events were evaluated. D-dimer and soluble fibrin monomer complex levels were measured perioperatively. Results: Bleeding occurred in 21 patients (12 in the fondaparinux group and 9 in low molecular weight heparin group, respectively). No significant differences were detected in the incidence of postoperative bleeding and the other adverse events between the two groups. The D-dimer was elevated on postoperative day 1 in one patient (16.6 μg/mL). In another patient, the soluble fibrin monomer complex was elevated (109 μg/mL). Conclusions: Fondaparinux is non-inferior to low molecular weight heparin with respect to risk of bleeding. The favorable safety profile of fondparinux supports its prophylactic use as an alternative to low molecular weight heparin after surgery for urological malignancy.
    Article · Aug 2016 · International Journal of Urology
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    Kenichi Hata · Takahiro Kimura · Gen Ishii · [...] · Shin Egawa
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Heparin-induced thrombocytopenia (HIT) is a rare but serious condition due to heparin use for treating thromboprophylaxis, regardless of the dosage. Here, we present a case of non-immune thrombocytopenia caused by thromboprophylaxis for urological surgery, which is sometimes difficult to discriminate from immune-mediated thrombocytopenia. Presentation of case: A 55-year-old man with renal cancer underwent portless endoscopic radical nephrectomy through a single small incision and was subsequently administered unfractionated heparin as well as mechanical devices to prevent venous thromboembolism. On postoperative day 2, a subcutaneous hemorrhage developed around the surgical site and the lower abdomen, and the platelet count simultaneously decreased to 50% of the baseline value. We suspected HIT and immediately conducted the 4Ts score examination. The 4Ts score was 3 points (low probability), and the result of the platelet factor 4-heparin complex antibody assay was negative. The patient was diagnosed with non-immune mediated thrombocytopenia. We took precaution by discontinuing heparin, which fortunately did not result in any adverse effects, and this led to platelet count normalization. Discussion: Due to the rarity of HIT, it is difficult to distinguish HIT from non-immune mediated thrombocytopenia. Conclusion: This article emphasizes that early and accurate diagnosis of postoperative thrombocytopenia is important for accurate therapy. Hence, all surgeons should know that the HIT diagnosis is based on clinical and serologic findings.
    Full-text Article · Jul 2016 · International Journal of Surgery Case Reports
  • Yusuke Koike · Shin Egawa · Yasuyuki Suzuki · [...] · Akira Furuta
    Article · Jul 2016 · International Journal of Urology
  • [Show abstract] [Hide abstract] ABSTRACT: Objective High-risk clinically localized prostate cancer is seen in a highly heterogeneous population with a wide variation of clinical aggressiveness and a novel subclassification for the better prediction of clinical outcomes is needed. The aim of this study is to validate a modified D’Amico risk criteria for substratification of high-risk prostate cancer with regard to the prediction of biochemical recurrence, clinical progression-free survival or prostate cancer–specific mortality after radical prostatectomy.
    Article · May 2016 · Japanese Journal of Clinical Oncology
  • Takahiro Kimura · Mariko Honda · Kojiro Tashiro · [...] · Shin Egawa
    Article · Apr 2016
  • Article · Apr 2016
  • JUN MIKI · Takafumi Yanagisawa · Fumihiko Urabe · [...] · Shin Egawa
    Article · Apr 2016
  • Takahiro Kimura · Hiroyuki Takahashi · Mioko Okayasu · [...] · Shin Egawa
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: Incidence of prostate cancer (PCa) is reported to be increasing in Asia including Japan. Although this trend has been attributed partly to a more westernized diet, this assumption may involve variable confounders. To have more insight, we examined histological features of contemporary versus historical latent PCa. Methods: Prostatic specimens from a consecutive autopsy series (n=127, Present study, 2008 to 2013) were examined. Each prostatic gland was fixed and sliced in step-sections. The findings were compared to those from another autopsy series (n=501, Wada study, 1983 to 1987) at our institution. Results: The mean age of subjects in the Present study was 68.9 years, while the mean age was not available from the original paper of Wada study. However, the mean age of the 566 entrants in the expanded database (1983-1989) was 63.5 years (P=0.0001). Prostatic weights were significantly higher in the Present study (P<0.0001). Latent PCa was found more frequently in the Present study than Wada study (43.3% and 20.8%, respectively, P<0.0001). No distinct difference was seen in the proportion of tumor grade between groups. Increasing trend of moderately to poorly-differentiated tumors with advancing age was more evident in the Present study. Index cancer volume was greater in the Present study; with 25.5% measuring ≥500mm3, compared to only 9.6% of cancers in Wada study (P=0.008). Conclusions: Chronological changes in histological characteristics of Japanese latent PCa were noted; it is more frequent and larger in the contemporary series. Our data may reflect a worldwide trend in the increasingly aging societies.
    Article · Dec 2015 · The Journal of urology
  • F. Urabe · K. Tashiro · S. Kimura · [...] · S. Egawa
    [Show abstract] [Hide abstract] ABSTRACT: A 30-year-old man who had a painless mass in the right scrotum since 5 years ago underwent biopsy followed by right high orchiectomy. The tumor originating from the epididymis was histologically diagnosed as a malignant lymphoma (a diffuse large B-cell lymphoma). The tumor grew very slowly even though the MIB-1 index was more than 90%. The patient underwent six courses of R-CHOP chemotherapy, intrathecal administration of methotrexate, and radiation therapy to the contralateral testis. Currently, 10 months after surgery, the patient has shown no clinical evidence of recurrence.
    Article · Dec 2015
  • Conference Paper · Aug 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Degarelix is a gonadotropin-releasing hormone (GnRH) antagonist that is approved for the treatment of prostate cancer. GnRH antagonists bind directly to and block GnRH receptors, without causing the initial testosterone surge associated with GnRH agonists. A pivotal phase III study indicated that degarelix induced significantly faster reduction of testosterone and prostate-specific antigen level than GnRH agonist does. In addition, its 5-year extension trial suggested that patients could be safely switched from GnRH agonist to degarelix treatment with sustained efficacy, as measured by biochemical markers. Possible benefits of GnRH antagonists over agonists were suggested especially in patients with advanced prostate cancer with metastatic and symptomatic disease. Moreover, the recent reports including pooled data analyses on degarelix suggest improved disease control, quality of life, and lower urinary tract symptoms and decreased risk of cardiovascular diseases when compared with GnRH agonists. However, interpretation of these reports should be conducted cautiously because of the potential biases involved. This article critically reviews the results of the clinical trials and subsequent analyses and evaluates the points and counterpoints of the conclusions. Copyright © 2015 Elsevier Inc. All rights reserved.
    Article · Jul 2015 · Urologic Oncology
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    [Show abstract] [Hide abstract] ABSTRACT: To investigate antimicrobial susceptibility patterns of various bacterial pathogens isolated from complicated urinary tract infection (UTI) cases, the Japanese Society of Chemotherapy, the Japanese Association of Infectious Disease, and the Japanese Society of Clinical Microbiology conducted the second nationwide surveillance from January to September 2011. With the cooperation of 42 medical institutions throughout Japan, 1036 strains belonging to 8 clinically relevant bacterial species were collected. Among methicillin-resistant Staphylococcus aureus (MRSA) strain, the vancomycin (VCM) MIC for 5.5% (3/55) of the strains was 2 μg/mL. Ampicillin, VCM, and linezolid were relatively active against 209 Enterococcus faecalis strains. The proportion of fluoroquinolone (FQ)-resistant strains was >20%. The MIC90 of FQs against the 382 Escherichia coli strains was 2-64 mg/L and the proportion resistant to FQs was approximately 30%. However, susceptibility of E. coli to sitafloxacin was still high (MIC90 = 2 mg/L). Fifty-eight (15.2%) of 382 E. coli, 6 (4.5%) of 132 Klebsiella pneumoniae, 1 (2.4%) of 41 Klebsiella oxytoca and 4 (6.8%) of 59 Proteus mirabilis strains were suspected of producing extended-spectrum beta-lactamase. Of 93 Pseudomonas aeruginosa strains, the proportions resistant to imipenem, amikacin, and ciprofloxacin were 21.5%, 4.3%, and 20.4%, respectively. Four strains (4.3%) were found to be multidrug-resistant. In complicated UTI cases, all of MRSA and E. faecalis were susceptible to all anti-MRSA agents. Sitafloxacin was active against other FQ-resistant E. coli strains. The isolation of extended-spectrum beta-lactamase-producing and multidrug-resistant strains increased. Copyright © 2015. Published by Elsevier Ltd.
    Full-text Article · Jun 2015 · Journal of Infection and Chemotherapy
  • [Show abstract] [Hide abstract] ABSTRACT: Well-trained clinicians may be able to provide diagnosis and prognosis from very short biomarker series using information and experience gained from previous patients. Although mathematical methods can potentially help clinicians to predict the progression of diseases, there is no method so far that estimates the patient state from very short time-series of a biomarker for making diagnosis and/or prognosis by employing the information of previous patients. Here, we propose a mathematical framework for integrating other patients' datasets to infer and predict the state of the disease in the current patient based on their short history. We extend a machine-learning framework of "prediction with expert advice" to deal with unstable dynamics. We construct this mathematical framework by combining expert advice with a mathematical model of prostate cancer. Our model predicted well the individual biomarker series of patients with prostate cancer that are used as clinical samples.
    Article · May 2015 · Scientific Reports
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    [Show abstract] [Hide abstract] ABSTRACT: The Gleason grading system represents the cornerstone of the management of prostate cancer. Gleason grade 4 (G4) is a heterogeneous set of architectural patterns, each of which may reflect a distinct prognostic value. We determined the prevalence of the various G4 architectural patterns and intraductal carcinoma (IDC) in latent prostate cancer in contemporary Russian (n = 220) and Japanese (n = 100) autopsy prostates and in cystoprostatectomy (CP) specimens (n = 248) collected in Italy. We studied the association of each G4 pattern with extraprostatic extension (EPE) and tumor volume to gain insight into their natural history. Presence of IDC and nine architectural features of Gleason grade 4 and 5 cancer were recorded. The prevalence of Gleason score ≥7 PC was higher in the autopsy series (11%) compared to the CP series (6.5%, P = 0.04). The prevalence of IDC and carcinoma with a cribriform architecture was 2.2% and 3.4% in the autopsy series and 0.8% and 3.6% in the cystoprostatectomy series, respectively. In multivariable analysis, cribriform architecture was significantly associated with increased tumor volume (P < 0.001) and EPE (OR:11.48, 95%CI:2.30-57.16, P = 0.003). IDC was also significantly associated with EPE (OR:10.08, 95%CI:1.58-64.28, P = 0.014). Small fused glands had a strong negative association with EPE in the autopsy series (OR:0.06, 95%CI:0.01-0.58, P = 0.015). Our study revealed that in latent prostate cancer both cribriform architecture and IDC are uniquely associated with poor pathological outcome features. In contrast, Gleason score 7 (3 + 4) cancers with small-fused gland pattern might possibly include some prostate cancers with a more indolent biology. Prostate © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    Full-text Article · May 2015 · The Prostate
  • Nozomu Furuta · Takehito Naruoka · Taro Igarashi · [...] · Shin Egawa
    [Show abstract] [Hide abstract] ABSTRACT: Primary aldosteronism characterized by the overproduction of aldosterone by the adrenal glands, is sometimes accompanied by autonomous cortisol secretion. In this study, we retrospectively analyzed 8 cases of primary aldosteronism (PA) with subclinical Cushing's syndrome (SCS). A total of 71 patients with PA underwent surgery at Jikei University Hospital from 2004 to 2013, and 8 of them were diagnosed with coexistent SCS. Four patients were male and four were female. The mean patient age was 56.9 years. One of the patients also had pheochromocytoma in the adrenal gland on the ipsilateral side. All patients had hypertension, 6 had hypokalemia, 5 had diabetes mellitus, and 3 had hyperlipidemia. All patients had autonomous cortisol secretion as shown in 1mg- or 8mg-dexamethasone suppression tests even though baseline cortisol levels were normal. Adrenal venous blood sampling with adrenocorticotropic hormone (ACTH) stimulation was performed on 5 patients, but the localization of PA could not be detected in 1 patient. Adrenocortical scintigraphy revealed suppression of the contra-lateral adrenal uptake in all 7 patients. Six patients including one patient who showed complete suppression of the contra-lateral adrenal uptake in adrenocortical scintigraphy, and 2 patients, whose ACTH levels were less than the detection limit, received postoperative steroid hormone replacement. In the literature, SCS co-existed in approximately 8. 6% of the patients with PA. In our study, SCS co-existed in approximately 11.3%. The degree of the autonomous secretion of cortisol varied with the patient, and some cases are accompanied by Cushing's syndrome. Therefore, it is important to analyze the autonomous cortisol secretion even in patients with PA.
    Article · May 2015 · Hinyokika kiyo. Acta urologica Japonica
  • Shunsuke Tsuzuki · Jun Miki · Jun Moritake · [...] · Shin Egawa
    [Show abstract] [Hide abstract] ABSTRACT: (Objectives): We retrospectively evaluated characteristics of Tl high-grade bladder cancer in patients in our hospitals. (Patients and methods): Data was reviewed from 134 patients who were diagnosed with Tl high-grade bladder cancer and who underwent transurethral resection (TUR) in our hospitals between January 2006 and December 2012. The clinical course for each patient, the recurrence and progression rates, and the risk factors for recurrence and progression were evaluated. (Results): The median follow-up was 31.5months. A second TUR was performed in 55 patients (41.0%), and showed 32 cases of residual tumor (58.2%) and 4 cases of upstaging (7.3%). The recurrence rate was 41.5%. The risk factors for recurrence were (1) no muscle obtained in initial TUR, (2) no BCG, and (3) no second TUR. The progression rate was 10.5%; no significant risk factors were identified for progression. Within the Tl high-grade bladder cancer cohort, a total of 31 patients underwent radical cystectomy (RC). When we graphed cancer-specific survival (CSS) curves stratified by pathological T stage at the time of RC, and then compared findings from the upstage group (greater than pT2) and the non-upstage group (less than pT2), the CSS rate was significantly higher in the non-upstage group (p = 0.0027). (Conclusion): No muscle in initial TUR, no BCG, and no second TUR are factors associated with recurrence of Tl high-grade bladder cancer. Further investigation is needed for preventing recurrence and progression and for improving survival following radical cystectomy in Tl high-grade bladder cancer.
    Article · Apr 2015 · Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology
  • [Show abstract] [Hide abstract] ABSTRACT: A case of vesico-appendiceal fistula caused by appendiceal cancer is reported. A 37-year-old male was admitted with the chief complaint of suspended dust in the urine. Under cystoscopy, a tumor (1 cmdiameter) was found in the right posterior wall of the bladder. Transurethral resection of the bladder tumor was performed. The pathological outcome was intestinal metaplasia without malignancy. Preoperative abdominal computed tomography suggested vesico-appendiceal fistula, retrospectively. Therefore, appendectomy with partial cystectomy was attempted. However, the appendix was adhered to the sigmoid mesocolon, therefore, appendectomy, partial cystectomy, and sigmoid colectomy were performed. We diagnosed the tumor as mucinous adenocarcinoma. The patient has been receiving adjuvant chemotherapy with tegafur-gimeracil-oteracil potassium for 17 months, because he refused right hemicolectomy. Therewas no evidence of recurrence after 58 months of follow-up. Vesico-appendiceal fistula caused by appendiceal cancer is very rare. Our case is the 21st case reported in Japan.
    Article · Mar 2015 · Hinyokika kiyo. Acta urologica Japonica
  • Conference Paper · Mar 2015