記述言語：日本語   出版者・発行元：泌尿器科紀要刊行会  

症例1(17歳男性)。肉眼的血尿を主訴に、前医のCT検査にて右腎腫瘤が指摘され、精査加療目的で当科へ紹介となった。症例2(61歳女性)。当院でHBVフォロー中に撮影したCTで偶発的に右腎下極の腫瘤が認められ、当科へ紹介となった。両症例とも、画像所見から乳頭状腎細胞癌が疑われ、Robot-assisted partial nephrectomyが施行された。病理組織学的に後腎性腺腫と確定診断され、いずれも経過良好で術後8日目に退院となった。

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J01269&link_issn=&doc_id=20240903440004&doc_link_id=1390865409046350976&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390865409046350976&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Small cell carcinoma of the bladder (SCCB) is a rare cancer that accounts for approximately 1% of primary malignant bladder tumors. It is highly malignant and has a poor prognosis. Similar to small cell lung cancer, platinum-based chemotherapy is recommended as the first-line therapy, and amrubicin (AMR) is recommended as the second-line therapy, but there is no established therapy after the second line. We report a case of SCCB that was refractory to multiple chemotherapies but responded to pembrolizumab. A 77-year-old male, diagnosed with clinical stage T3N0M0 small cell carcinoma and invasive urothelial carcinoma by transurethral resection of bladder tumor (TURBT), underwent robot-assisted radical cystectomy after three cycles of neoadjuvant cisplatin-irinotecan chemotherapy, and pathological examination revealed only small cell carcinoma in his cystectomy specimen. After three courses of adjuvant carboplatin-etoposide chemotherapy, the patient developed liver and bone metastases. Furthermore, after two courses of amrubicin, we started pembrolizumab due to the progression of metastases. Metastases decreased after starting pembrolizumab and continued to decrease after discontinuation because of immunerelated adverse events (irAEs). Therefore, pembrolizumab may be an option for the treatment of refractory SCCB.

DOI： 10.14989/ActaUrolJap_70_4_93

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Objective: Complete endophytic renal tumors (CERTs) are the most challenging for robot-assisted partial nephrectomy (RAPN). This study aimed to determine the impact of CERT on outcomes of RAPN. Methods: All RAPN cases for localized renal tumor undertaken at Yokohama City University Hospital between 2016 and 2023 were enrolled. Tumor characteristics and surgical, functional, and oncologic outcomes of RAPN were compared between CERT and non-CERT groups. Results: Consecutive 666 patients were enrolled, and 76 (11.4%) were identified as CERT (3 points of "E" score). CERT showed smaller tumor diameters (p < 0.001), more predominant hilar tumor (p = 0.029), higher "N" scores (p < 0.001) and "L" scores (p = 0.006) than non-CERT. The CERT group showed longer warm ischemia times (p < 0.001), more frequent positive surgical margins (p = 0.028), and relatively lower trifecta achievement rates (p = 0.101) than the non-CERT group. In multivariable analysis, the CERT was an independent predictor for trifecta achievement but not for pentafecta achievement. Conclusions: CERT was associated with longer warm ischemia time, positive surgical margin, and lower trifecta achievement, but not with surgical complication and pentafecta achievement in RAPN. This study suggested that CERT had limited influence on long-term renal functional preservation; however, it had strong impacts on short-term surgical outcome.

DOI： 10.1089/end.2023.0608

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: There are no definitive prognostic factors for patients with pathological Grade Group 5 (pGG 5) prostate cancer (PCa) undergoing robot-associated radical prostatectomy (RARP). This study aimed to explore the prognostic factors among patients with pGG 5 PCa in a large Japanese cohort (MSUG94). METHODS: This retrospective, multi-institutional cohort study was conducted between 2012 and 2021 at ten centers in Japan and included 3195 patients. Patients with clinically metastatic PCa (cN1 or cM1) and those receiving neoadjuvant and/or adjuvant therapy were excluded. Finally, 217 patients with pGG5 PCa were analyzed. RESULTS: The median follow-up period was 28.0 months. The 3- and 5-year biochemical recurrence-free survival (BCRFS) rates of the overall population were 66.1% and 57.7%, respectively. The optimal threshold value (47.2%) for the percentage of positive cancer cores (PPCC) with any GG by systematic biopsy was chosen based on receiver operating characteristic curve analysis. Univariate analysis revealed that the prostate-specific antigen level at diagnosis, pT, pN, positive surgical margins (PSMs), lymphovascular invasion, and PPCC were independent prognostic factors for BCRFS. A multivariate analysis revealed that PSMs and PPCC were independent prognostic factors for BCRFS. Using these two predictors, we stratified BCRFS, metastasis-free survival (MFS), and castration-resistant PCa-free survival (CRPC-FS) among patients with pGG 5 PCa. CONCLUSION: The combination of PSMs and PPCC may be an important predictor of BCRFS, MFS, and CRPC-FS in patients with pGG 5 PCa undergoing RARP.

DOI： 10.1007/s00345-024-04864-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The influence of chronic kidney disease stage on robot-assisted partial nephrectomy outcomes remains underexplored. This study aimed to assess the impact of chronic kidney disease stage on functional and surgical outcomes of robot-assisted partial nephrectomy and identify preoperative predictors of significant postoperative 1-year renal-function loss (RFL). Clinical data of 408 patients who underwent robot-assisted partial nephrectomy at Yokohama City University Hospital between 2016 and 2023 were retrospectively reviewed. The da Vinci Surgical System was applied in all patients, and outcomes assessed included surgical parameters, postoperative estimated glomerular filtration rate, trifecta and pentafecta achievements, and complications. Significant RFL was defined as estimated glomerular filtration rate reduction ≥ 25% from baseline. Higher chronic kidney disease stages correlated with older age, hypertension, diabetes, and solitary kidneys. Postoperative estimated glomerular filtration rate decline was most pronounced in patients with chronic kidney disease stages 4-5. Although the chronic kidney disease stage did not significantly affect most surgical parameters, pentafecta achievement was higher in patients with chronic kidney disease stage 3 than in those with stages 4-5. Two patients required hemodialysis after robot-assisted partial nephrectomy. Multivariable logistic regression analysis showed that preoperative hemoglobin level and maximum tumor diameter were significant predictive factors for significant RFL. In conclusion, preoperative CKD stage did not influence on surgical outcome except for pentafecta achievement. RAPN may be feasible for patients with CKD stages 4-5 because of no rapid progression to hemodialysis induction and no procedure-related mortality. Preoperative hemoglobin levels and tumor diameter emerged as predictors of significant RFL.

DOI： 10.1007/s11701-024-01873-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: In December 2021, enfortumab vedotin (EV), an antibody-drug conjugate directed against nectin-4, was approved in Japan as a new treatment after platinum-containing chemotherapy and PD-1/PD-L1 inhibitors. This study evaluated, using real-world data, the efficacy and safety of EV therapy in patients with metastatic urothelial carcinoma (mUC). MATERIALS AND METHODS: Fifty-five patients with mUC who discontinued pembrolizumab therapy due to disease progression between June 2018 and April 2023 at Yokohama City University Hospital were evaluated retrospectively. Of the 55 patients, 25 received EV therapy (EV group) and 30 did not (non-EV group). All patients who underwent EV therapy were diagnosed with disease progression after the approval of EV in Japan. RESULTS: The median (range) follow-up period after pembrolizumab discontinuation was 6.3 (0.7-31.1) months. There were eight (32.0%) deaths due to cancer in the EV group and 27 (90.0%) in the non-EV group. The overall survival (OS) after pembrolizumab discontinuation was not reached in the EV group versus 2.6 months in the non-EV group (p < 0.001). A multivariate analysis revealed that EV therapy (EV vs. non-EV group; hazard ratio 0.26; 95% confidence interval 0.16-0.41; p < 0.001) was an independent prognostic factor for OS. CONCLUSION: EV prolonged OS in mUC following pembrolizumab therapy in real-world data.

DOI： 10.1111/iju.15437

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

To investigate the incidence and risk factors of inguinal hernia (IH) after robot-assisted radical prostatectomy (RARP) using a multicentric database. The present study used a multicentric database (the MSUG94) containing data on 3,195 Japanese patients undergoing RARP between 2012 and 2021. Surgical procedures utilized for IH prevention were as follows: isolation of the vas deferens, transection of the vas deferens, isolation of the spermatic vessels, and separation of the peritoneum from the internal inguinal ring. The primary and secondary endpoints were IH-free survival and any association between post-RARP IH and clinical covariates. The prophylactic effect of the above procedures were also assessed. IH prevention was attempted in 1,465 (46.4%) patients at five of the nine hospitals. During follow-up (median 24 months), post-RARP IH developed in 243 patients. The post-RARP IH-free survival rates at years 1, 2, and 3 were 94.3%, 91.7%, and 90.5%, respectively. Old age (hazard ratio [HR] 1.037; 95% confidence interval [CI] 1.014-1.061; p = 0.001), low BMI (HR 0.904; 95% CI 0.863-0.946: p < 0.001), and low hospital volume (HR 1.385; 95% CI 1.003-1.902; p = 0.048) were independently associated with IH development. None of the procedures for IH prevention were associated with IH development. Our findings may represent the current, real-world status of post-RARP IH in Japan. The prophylactic effects of the surgical procedures for IH prevention should be further investigated in well-designed, prospective studies to optimize the surgical technique.

DOI： 10.1007/s11701-023-01761-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: This study aimed to investigate whether lymphovascular invasion (LVI) was associated with oncological outcomes in patients with prostate cancer (PCa) undergoing robotic-assisted radical prostatectomy (RARP). METHODS: This retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP in nine institutions in Japan. The primary endpoints were the associations between biochemical recurrence (BCR) and LVI and between BCR and clinicopathological covariates, while the secondary endpoints were the association between LVI and the site of clinical recurrence and metastasis-free survival (MFS). RESULTS: In total, 2608 patients met the inclusion criteria. At the end of the follow-up period, 311 patients (11.9%) were diagnosed with BCR and none died of PCa. In patients with pathological stage T2 (pT2) + negative resection margins (RM-), and pT3+ positive RM (RM+), LVI significantly worsened BCR-free survival (BRFS). For patients with PCa who had pT3 and RM+, the 2-year BRFS rate in those with LVI was significantly worse than in those without LVI. Patients with LVI had significantly worse MFS than those without LVI with respect to pT3, RM+, and pathological Gleason grade (pGG). In multivariate analysis, LVI was significantly associated with BRFS in patients with pT3 PCa, and with worse MFS in PCa patients with pT3, RM+, and pGG ≥ 4. CONCLUSIONS: LVI was an independent prognostic factor for recurrence and metastasis after RARP, particularly in patients with pT3 and RM+ PCa. Locally advanced PCa with positive LVI and RM+ requires careful follow-up because of the high likelihood of recurrence.

DOI： 10.1245/s10434-023-14691-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Objectives: We aimed to examine the relationship between the inflammation-related parameters, such as the neutrophil-to-lymphocyte ratio (NLR), and the pathological findings and biochemical recurrence (BCR) in patients with prostate cancer (PCa) undergoing robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective multicenter cohort study of patients with PCa who underwent RARP at 10 institutes in Japan was conducted. This study enrolled 3195 patients. We focused on patients undergoing RARP who underwent the preoperative measurement of their inflammation-related parameters and who did not receive any neo- or adjuvant therapy. Data on the pre- and postoperative variables for the enrolled patients were obtained. The primary endpoint of this study was the association between BCR and the inflammation-related parameters after RARP. The secondary endpoint was the association between the inflammation-related parameters and the pathological diagnosis of PCa. Results: Data from 2429 patients with PCa who met the study's eligibility criteria were analyzed. The median follow-up period was 25.1 months. The inflammation-related parameters were divided into two groups, and cutoff values were determined based on the receiver operating characteristics. There were no statistically significant differences in biochemical recurrence-free survival for any of the parameters. In the univariate analysis, the NLR was predictive of pathological T3 and lymphovascular invasion; however, there were no significant differences in the multivariate analysis. Conclusions: The inflammation-related parameters did not significantly affect the incidence of BCR, at least among patients with PCa who underwent RARP.

DOI： 10.3390/jcm12247732

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To investigate the predictive factors for pentafecta achievement of robot-assisted partial nephrectomy (RAPN) for intermediate highly complex renal tumors (RENAL score ≥ 7). METHODS: We retrospectively analyzed the data of 247 patients with renal tumors with a RENAL score ≥ 7 who underwent RAPN. Baseline characteristics and perioperative outcomes were compared between the pentafecta achieved group and the unachieved group. A multivariable logistic regression model was used to identify the predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. RESULTS: Of the 247 patients, 75 (30.3%) patients were in the achieved group and 172 (69.7%) patients were in the unachieved group. The median warm ischemia time and total operation time were 18 min versus 23 min (p < 0.001) and 179 min versus 201 min (p < 0.001) in the achieved and unachieved groups, respectively. In the unachieved group, six patients (3.4%) had major perioperative complications (Clavien-Dindo classification system ≥3). The median preservation rates of estimated GFR at the 1-year postoperative period were 96.5% versus 83.0% (p < 0.001) in the achieved and unachieved groups. Multivariable logistic regression models revealed that age and tumor size were independent predictive factors for pentafecta achievement for cT1 renal tumors with a RENAL score ≥ 7. There were no significant differences in cancer-free survival between the two groups (p = 0.456). CONCLUSION: Age and tumor size were independent predictive factors for pentafecta achievement, although there was no difference in oncological outcomes between the pentafecta achieved group and the unachieved group in RAPN for cT1 renal tumors with a RENAL score ≥ 7.

DOI： 10.1111/iju.15274

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Partial nephrectomy (PN) is the standard treatment for T1 renal cell carcinoma. PN is affected more by surgical variations and requires greater surgical experience than radical nephrectomy. Patient-specific simulations and navigation systems may help to reduce the surgical experience required for PN. Recent advances in three-dimensional (3D) virtual reality (VR) imaging and 3D printing technology have allowed accurate patient-specific simulations and navigation systems. We reviewed previous studies about patient-specific simulations and navigation systems for PN. Recently, image reconstruction technology has developed, and commercial software that converts two-dimensional images into 3D images has become available. Many urologists are now able to view 3DVR images when preparing for PN. Surgical simulations based on 3DVR images can change surgical plans and improve surgical outcomes, and are useful during patient consultations. Patient-specific simulators that are capable of simulating surgical procedures, the gold-standard form of patient-specific simulations, have also been reported. Besides VR, 3D printing is also useful for understanding patient-specific information. Some studies have reported simulation and navigation systems for PN based on solid 3D models. Patient-specific simulations are a form of preoperative preparation, whereas patient-specific navigation is used intraoperatively. Navigation-assisted PN procedures using 3DVR images have become increasingly common, especially in robotic surgery. Some studies found that these systems produced improvements in surgical outcomes. Once its accuracy has been confirmed, it is hoped that this technology will spread further and become more generalized.

DOI： 10.1111/iju.15287

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The impact of unilateral and bilateral nerve-sparing robot-assisted laparoscopic radical prostatectomy (NS-RARP) procedures on continence and the time to continence recovery have not been established. MATERIAL AND METHODS: We retrospectively reviewed a total of 2801 patients who underwent RARP in 9 institutions. Procedures were classified as NS or non-NS; NS procedures were further classified as unilateral or bilateral. The recovery of continence was analysed using propensity score matching method. RESULTS: The pad-free rates at 12 months after surgery were higher in the NS group (95% confidence interval of odds ratio, 1.06-1.51). Pad-free rates at all time points within 12 months of surgery did not significantly differ between the unilateral and bilateral NS groups. CONCLUSIONS: NS-RARP resulted in better urinary continence outcomes than non-NS-RARP in the first 12 months after surgery. Urinary recovery rates did not significantly differ between unilateral and bilateral NS-RARP.

DOI： 10.1002/rcs.2593

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Locally advanced prostate cancer (PCa) with pathological seminal vesicle invasion (pT3b) is a very-high-risk disease associated with biochemical recurrence (BCR), local recurrence, distant metastases, or mortality following definitive therapies. This study aimed to evaluate the risk factors associated with BCR following robot-assisted radical prostatectomy (RARP) in PCa patients with pT3b. A retrospective multicenter cohort study was conducted on 3,195 patients with PCa who underwent RARP at nine domestic centers between September 2011 and August 2021. Biochemical recurrence-free survival (BRFS) after RARP in PCa patients with pT3b was the primary end-point of the study. The secondary end-point was to determine the association between BCR and covariates. We enrolled 188 PCa patients with pT3b. The median follow-up period was 32.8 months. At the end of the follow-up period, 76 patients (40.4%) developed BCR, of whom 15 (8.0%) were BCR at the date of surgery. The 1-, 2-, and 3-year BRFS rates were 76.4, 65.9, and 50.8%, respectively. Multivariate analysis identified initial prostate-specific antigen level and positive surgical margins (PSM) as significant predictors of BCR in PCa patients with pT3b undergoing RARP. In this study, we investigated the BRFS in PCa patients with pT3b. As PSM was an independent predictor of BCR in PCa patients with pT3b, these patients may require a combination of therapies to improve the BCR.

DOI： 10.1007/s11701-023-01567-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-023-13856-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Radical prostatectomy can be performed more safely and with fewer com- plications since the advent of robot-assisted surgery. However, increased bleeding is a concern when robot-assisted radical prostatectomy includes lymph node dissection and nerve sparing. In real-world clinical practice, inexperienced surgeons sometimes perform robot-assisted radical prostatectomy. In this study, we investigated the effec- tiveness of microporous polysaccharide hemospheres as a local hemostatic agent in robot-assisted radical prostatectomy. METHODS: We retrospectively evaluated 301 patients who underwent robot-assisted radical prostatectomy at our institution between December 2017 and November 2020. The patients were divided into 2 groups according to whether their surgery was per- formed after the introduction of microporous polysaccharide hemospheres as a local hemostatic agent (group A, n = 140) or before it (group B, n = 161: historical control). RESULTS: Preoperative androgen deprivation therapy was significantly more common in group A than in group B (23 vs. 11, P = .009). Furthermore, surgeons were significantly less experienced (P < .001) and the operation time was significantly longer (260 min- utes vs. 229 minutes; P < .001) in group A than in group B. There was no significant difference in any other patient background characteristics or in the surgical outcomes between the groups. CONCLUSION: The use of microporous polysaccharide hemospheres allowed even inex- perienced surgeons to perform robot-assisted radical prostatectomy without compro- mising surgical outcomes.

DOI： 10.5152/tud.2023.22242

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: We created a clinically applicable nomogram to predict locally advanced prostate cancer using preoperative parameters and performed external validation using an external independent validation cohort. PATIENTS AND METHODS: From a retrospective multicenter cohort study of 3622 Japanese patients with prostate cancer who underwent robot-assisted radical prostatectomy at ten institutions, the patients were divided into two groups (MSUG cohort and validation cohort). Locally advanced prostate cancer was defined as pathological T stage ≥ 3a. A multivariable logistic regression model was used to identify factors strongly associated with locally advanced prostate cancer. Bootstrap area under the curve was calculated to assess the internal validity of the prediction model. A nomogram was created as a practical application of the prediction model, and a web application was released to predict the probability of locally advanced prostate cancer. RESULTS: A total of 2530 and 427 patients in the MSUG and validation cohorts, respectively, met the criteria for this study. On multivariable analysis, initial prostate-specific antigen, prostate volume, number of cancer-positive and cancer-negative biopsy cores, biopsy grade group, and clinical T stage were independent predictors of locally advanced prostate cancer. The nomogram predicting locally advanced prostate cancer was demonstrated (area under the curve 0.72). Using a nomogram cutoff of 0.26, 464 of 1162 patients (39.9%) could be correctly diagnosed with pT3, and 2311 of 2524 patients (91.6%) could avoid underdiagnosis. CONCLUSIONS: We developed a clinically applicable nomogram with external validation to predict the probability of locally advanced prostate cancer in patients undergoing robot-assisted radical prostatectomy.

DOI： 10.1245/s10434-023-13747-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Birt-Hogg-Dubé (BHD) syndrome, caused by germline alteration of folliculin (FLCN) gene, develops hybrid oncocytic/chromophobe tumour (HOCT) and chromophobe renal cell carcinoma (ChRCC), whereas sporadic ChRCC does not harbor FLCN alteration. To date, molecular characteristics of these similar histological types of tumours have been incompletely elucidated. METHODS: To elucidate renal tumourigenesis of BHD-associated renal tumours and sporadic renal tumours, we conducted whole genome sequencing (WGS) and RNA-sequencing (RNA-seq) of sixteen BHD-associated renal tumours from nine unrelated BHD patients, twenty-one sporadic ChRCCs and seven sporadic oncocytomas. We then compared somatic mutation profiles with FLCN variants and RNA expression profiles between BHD-associated renal tumours and sporadic renal tumours. FINDINGS: RNA-seq analysis revealed that BHD-associated renal tumours and sporadic renal tumours have totally different expression profiles. Sporadic ChRCCs were clustered into two distinct clusters characterized by L1CAM and FOXI1 expressions, molecular markers for renal tubule subclasses. Increased mitochondrial DNA (mtDNA) copy number with fewer variants was observed in BHD-associated renal tumours compared to sporadic ChRCCs. Cell-of-origin analysis using WGS data demonstrated that BHD-associated renal tumours and sporadic ChRCCs may arise from different cells of origin and second hit FLCN alterations may occur in early third decade of life in BHD patients. INTERPRETATION: These data further our understanding of renal tumourigenesis of these two different types of renal tumours with similar histology. FUNDING: This study was supported by JSPS KAKENHI Grants, RIKEN internal grant, and the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute (NCI), Center for Cancer Research.

DOI： 10.1016/j.ebiom.2023.104596

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To investigate whether subgroups of prostate cancer patients, stratified by positive surgical margin locations, have different oncological outcomes following robot-assisted radical prostatectomy. METHODS: A retrospective multicenter cohort study in prostate cancer patients undergoing robot-assisted radical prostatectomy was conducted at 10 institutions in Japan. Pre- and post-operative outcomes were collected from enrolled patients. Biochemical recurrence and clinical and pathological variables were evaluated among subgroups with different positive surgical margin locations. RESULTS: A total of 3195 patients enrolled in this study. Data from 2667 patients (70.1% [N = 1869] with negative surgical margins and 29.9% [N = 798] with positive surgical margins based on robot-assisted radical prostatectomy specimens) were analyzed. The median follow-up period was 25.0 months. The numbers of patients with apex-only, middle-only, bladder-neck-only, seminal-vesicle-only and multifocal positive surgical margins were 401, 175, 159, 31 and 32, respectively. In the multivariate analysis, PSA level at surgery, pathological Gleason score based on robot-assisted radical prostatectomy specimens, pathological T stage, pathological N stage and surgical margin status were independent risk factors significantly associated with biochemical recurrence-free survival. Patients undergoing robot-assisted radical prostatectomy with multifocal positive surgical margins and seminal-vesicle-only positive surgical margins were associated with worse biochemical recurrence-free survival than those with apex-only, middle-only and bladder-neck-only positive surgical margins. Patients undergoing robot-assisted radical prostatectomy with apex-only positive surgical margins, the most frequent positive surgical margin location, were associated with more favorable biochemical recurrence-free survival that those with middle-only and bladder-neck-only positive surgical margins. The study limitations included the lack of central pathological specimen evaluation. CONCLUSIONS: Although positive surgical margin at any locations is a biochemical recurrence risk factor after robot-assisted radical prostatectomy, positive surgical margin location status should be considered to accurately stratify the biochemical recurrence risk after robot-assisted radical prostatectomy.

DOI： 10.1093/jjco/hyad004

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: This retrospective multicenter cohort study investigated the association of hospital volume with perioperative and oncological outcomes in patients treated with robot-assisted radical prostatectomy (RARP). METHODS: We collected the clinical data of patients who underwent RARP at eight institutions in Japan between September 2012 and August 2021. The patients were divided into two groups based on the treatment site-high- and non-high-volume hospitals. We defined a high-volume hospital as one where RARP was performed for more than 100 cases per year. RESULTS: After excluding patients who received neoadjuvant therapy, a total of 2753 patients were included in this study. In the high-volume hospital group, console time and estimated blood loss were significantly (p < 0.001) lower than that of the non-high-volume hospital group. However, the continence rate at 3 months after RARP, positive surgical margins, and prostate-specific antigen (PSA)-relapse-free survival showed no significant differences between the two groups. Furthermore, the console time was significantly shorter after 100 cases in the non-high-volume hospital group but not in the high-volume hospital group. CONCLUSIONS: A higher hospital volume was significantly associated with shorter console time and less estimated blood loss. However, oncological outcomes and early continence recovery appear to be comparable regardless of the hospital volume in Japan.

DOI： 10.1186/s12894-023-01178-w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Androgen deprivation therapy, primarily via a gonadotropin-releasing hormone receptor agonist or antagonist together with or without an androgen receptor antagonist, remains the mainstay of medical treatment for advanced prostate cancer. Meanwhile, relugolix has been developed as the first orally active, non-peptide, selective antagonist for the gonadotropin-releasing hormone receptor. Previous randomized studies involving patients with prostate cancer have demonstrated comparable efficacy in androgen suppression between relugolix vs other gonadotropin-releasing hormone antagonists or agonists. This review summarizes available data on the design and development of relugolix and its therapeutic application, and discusses if relugolix represents a promising oral alternative to injectable androgen deprivation therapy. Based on current published evidence, further investigation is likely required to determine the actual clinical benefits of relugolix therapy against prostate cancer.

DOI： 10.2147/DDDT.S373546

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

(Objective) To compare the initial results of robot-assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP) for uretero-pelvic junction obstruction (UPJO). (Methods) Between April 2008 to October 2021, we identified 104 cases of UPJO where LP was performed and 18 cases where RALP was performed at our hospital. We retrospectively analyzed their perioperative outcomes. Furthermore, we recorded the operative times for each cases of LP and RALP. (Results) The median operative time for RALP was 141 minutes, which was significantly shorter than that for LP (204 minutes). No patient in the RALP group demonstrated any Clavien-Dindo complications (≥grade 3). During the observation period, improvement of symptoms was observed in all cases. The median suturing time in RALP was 38 minutes. Compared with the last 20 cases of LP, the time to expose the uretero-pelvic junction, the time of renal pelvis incision, and suturing time were significantly shorter in RALP. In addition, the console and suturing times were stable since the initial stage. In cases with a high grade of hydronephrosis, there was a large variation in the time to expose the uretero-pelvic junction and suture the renal pelvis and ureter in LP; however, this variation was smaller in RALP. (Conclusion) At our hospital, RALP for UPJO is considered to be a safe procedure. In the future, it is necessary to consider the long-term results and effectiveness of RALP.

DOI： 10.5980/jpnjurol.114.1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We aimed to examine the relationship between D'Amico intermediate-risk and pathological grade group 1 (pGG1) after robot-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: In this retrospective multicenter cohort study, D'Amico intermediate-risk prostate cancer patients who did not receive neoadjuvant therapy, and underwent RARP at 10 institutions in Japan were examined for preoperative factors associated with pGG1. RESULTS: In total, we enrolled 1161 D'Amico intermediate-risk prostate cancer patients. The pGG1 and pGG ≥2 groups comprised 73 (6.3%), and 1088 (93.7%) cases, respectively. Biochemical recurrence-free survival (BCRFS) of the pGG1 group was equivalent to that of the D'Amico low-risk patients. Among the 3 D'Amico intermediate-risk factors (IRF), the pGG1-rate was 24% with prostate-specific antigen (PSA) of 10 to 20 ng/mL alone, and 30% with cT2b alone. Both groups had significantly higher pGG1-rates than other groups. Down-grading from biopsy GG ≥2 to pGG1 was relatively rare (3.9%). Patients with pGG1 were further stratified by prostate volume (PV) (cutoff, 40 cc) among patients with one IRF and PSA of 10 to 20 ng/mL. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV >40 cc had a relatively good BCRFS similar to that of the D'Amico low-risk group. CONCLUSION: Among intermediate-risk prostate cancer patients, those with pGG1 have a good prognosis. Downgrading from biopsy GG ≥2 is rare, and definitive treatment may be recommended for patients with biopsy GG ≥2. Patients with one IRF, PSA of 10 to 20 ng/mL, and PV >40 cc who are eligible for RARP may be candidates for active surveillance.

DOI： 10.1016/j.clgc.2022.06.005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

In this multicenter retrospective cohort study, we aimed to evaluate whether pelvic lymph node dissection (PLND) improved biochemical recurrence (BCR) in patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy (RARP) in Japan. A multicenter retrospective cohort study of 3195 PCa patients undergoing RARP at nine institutions in Japan was conducted. Enrolled patients were divided into two groups: those who underwent RARP without PLND (non-PLND group) and those who underwent PLND (PLND group). The primary endpoint was biochemical recurrence-free survival (BRFS) in PCa patients who underwent PLND. We developed a propensity score analysis to reduce the effects of selection bias and potential confounding factors. Propensity score matching resulted in 1210 patients being enrolled in the study. The 2-year BRFS rate was 95.0% for all patients, 95.8% for the non-PLND group, and 94.3% for the PLND group (p = 0.855). For the all-risk group according to the National Comprehensive Cancer Network risk stratification, there were no significant differences between patients who did and did not undergo PLND. Based on the results of the log-rank study, PLND may be unnecessary for patients with PCa undergoing RARP.

DOI： 10.3390/cancers14235803

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: To create a nomogram for predicting prostate cancer (PCa) with lymph node involvement (LNI) in the robot-assisted radical prostatectomy (RARP) era. METHODS: A retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP at nine institutions in Japan between September 2012 and August 2021. A multivariable logistic regression model was used to identify factors strongly associated with LNI. The Bootstrap-area under the curve (AUC) was calculated to assess the internal validity of the prediction model. RESULTS: A total of 1855 patients were enrolled in this study. Overall, 93 patients (5.0%) had LNI. On multivariable analyses, initial prostate-specific antigen, number of cancer-positive and-negative biopsy cores, biopsy Gleason grade, and clinical T stage were independent predictors of PCa with LNI. The nomogram predicting PCa with LNI has been demonstrated (AUC 84%). Using a nomogram cut-off of 6%, 492 of 1855 patients (26.5%) would avoid unnecessary pelvic lymph node dissection, and PCa with LNI would be missed in two patients (0.1%). The sensitivity, specificity, and negative predictive values associated with a cutoff of 6% were 74%, 80%, and 99.6%, respectively. CONCLUSIONS: We developed a clinically applicable nomogram for predicting the probability of patients with PCa with LNI.

DOI： 10.3390/diagnostics12102545

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: We evaluated oncological outcomes of patients undergoing robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) and their perioperative complications in Japan. We investigated clinical and pathological covariates to predict biochemical recurrence (BCR) after RARP. METHODS: A retrospective multicenter cohort study was conducted in RARP patients with PCa at 10 institutions in Japan. Pre- and postoperative covariates were collected from enrolled patients. The primary endpoint was defined as biochemical recurrence-free survival (BRFS). Additionally, the association between BCR and clinicopathological covariates was determined. RESULTS: We enrolled 2670 patients in this study. The median follow-up period was 26.0 months. RARP-related perioperative complications were identified in 198 patients (7.4%), including 69 patients (2.6%) with grade 3/4 complications according to the Clavien-Dindo classification. The 2-year BRFS was 88.0%. Using the Kaplan-Meier method, initial prostate-specific antigen (PSA) level of ≤7.6 ng/mL, biopsy and pathological Gleason score (GS) of ≤7, clinical and pathological T1/2, and low/intermediate risks according to the National Comprehensive Cancer Network risk classification, and negative surgical margin status had significant BRFS than their counterparts. In multivariate analysis, initial PSA, biopsy and pathological GS, clinical and pathological T stage, and surgical margin status significantly correlated with BCR after RARP. CONCLUSION: In this study, RARP achieved a lower incidence of perioperative complications than other studies.

DOI： 10.1111/ases.13074

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To investigate whether the International Society of Urological Pathology Grade Group 4 (GG 4) subgroups have different oncological outcomes in Japanese prostate cancer (PCa) patients undergoing robotic-assisted radical prostatectomy (RARP). PATIENTS AND METHODS: We conducted a retrospective multicentre cohort study in PCa patients undergoing RARP at 10 institutions in Japan. Pre- and post-operative variables were collected from enrolled patients. We evaluated biochemical recurrence and clinical and pathological variables in the different GG 4 subgroups. RESULTS: A total of 3195 patients were enrolled in the study. Among them, 298 patients with GG 4 tumours (pathological Gleason scores [GSs] of 3 + 5 [N = 37], 4 + 4 [N = 257] and 5 + 3 [N = 4]) based on RARP specimens were analysed. The median follow-up period was 25.2 months. The 3-year biochemical recurrence (BCR)-free survival (BCRFS) rate in the overall population was 74.5%. The 3-year BCRFS rates in the pathological GS 3 + 5, GS 4 + 4 and GS 5 + 3 subgroups were 93.8%, 71.9% and 50.0%, respectively (P = 0.01). In multivariate analysis, pathological GS based on RARP specimens, PSA levels at surgery, pathological T stage, pathological N stage and surgical margins were independent risk factors significantly associated with BCRFS. In particular, patients with pathological GSs 4 + 4 and 5 + 3 were at higher risk of BCR than patients with pathological GS 3 + 5 (hazard ratio 4.54, P = 0.03 and hazard ratio 11.2, P = 0.01, respectively). The study limitations include the lack of central pathological specimen evaluation. CONCLUSIONS: For patients with localized PCa undergoing RARP, pathological GS 4 + 4 and GS 5 + 3 were significantly associated with worse BCRFS than pathological GS 3 + 5. Pathological GS 3 + 5 may be overrated in GG 4. This observation emphasizes that primary and secondary GS should be considered to accurately stratify the risk of BCR after RARP.

DOI： 10.1002/bco2.160

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background and Objectives: This study's objective was to examine patients treated with robot-assisted radical prostatectomy (RARP) for intermediate-risk prostate cancer (IR-PCa), and to identify preoperative risk factors for biochemical recurrence (BCR) in these patients in Japan. Materials and Methods: We conducted a retrospective multicenter cohort study of patients with PCa who underwent RARP at 10 institutions in Japan. A total of 3195 patients were enrolled in this study. We focused on patients with IR-PCa who underwent RARP. We obtained data on pre- and postoperative covariates from the enrolled patients. Biochemical recurrence-free survival was the primary endpoint of this study. We also identified useful preoperative predictive factors for BCR in patients with IR-PCa after RARP. Results: A total of 1144 patients with IR-PCa were enrolled in this study. The median follow-up period was 23.7 months. At the end of the follow-up period, 94 (8.2%) patients developed BCR. The 2 and 3 year biochemical recurrence-free survival (BRFS) rates were 92.2% and 90.2%, respectively. Using the Kaplan-Meier method, Gleason grade (GG) 3 was significantly associated with poor BRFS compared with ≤GG 2. In multivariate analysis, GG 3 was a significant predictive factor for BCR in patients with IR-PCa. Conclusions: The results of the study indicated a significant relationship between GG 3 and post-RARP BCR in patients with IR-PCa.

DOI： 10.3390/medicina58080990

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Preoperative prediction of surgical difficulty of partial nephrectomy (PN) is essential to minimize the perioperative complications and to achieve a good surgical outcome. Recently, various scoring systems have been used to evaluate the difficulty of PN including R.E.N.A.L (Radius, Exophytic/Endophytic, Nearness, Anterior/Posterior, Location) nephrometry score. There were no scoring systems evaluating the roughness of the renal tumor surface and we hypothesized that the roughness of the renal tumor surface might affect the surgical difficulty of robot-assisted partial nephrectomy (RAPN). This study aimed to evaluate the impact of roughness of the renal tumor surface on the surgical outcome of RAPN. METHODS: Overall, 161 patients underwent RAPN performed by the same surgeon between May 2016 and April 2019. We divided those tumors into two groups, like "roughness positive (tumor with roughness of tumor surface)" and "roughness negative (tumor without roughness of tumor surface)" according to the roughness of the endophytic region on preoperative computed tomography images. Clinical and pathological outcomes were compared between the two groups. RESULTS: Eighty-five and 78 tumors were identified roughness negative and positive, respectively. Cases with roughness positive showed a significantly longer operative time, console time, and ischemia time and had greater blood loss than those with roughness negative. Significant and independent predictors of ischemia time and estimated glomerular filtration rate (eGFR) decrease were roughness of tumor surface, tumor size (not for eGFR decrease), and N score of the R.E.N.A.L nephrometry score. CONCLUSION: Roughness of renal tumor surface was significantly and positively associated with ischemia time and the eGFR decrease rate.

DOI： 10.1111/ases.13058

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To ensure that the use of surgical training tools results in improvement of surgical skills, it is necessary to be able to measure and assess surgeons' skills. We established the Short-Time Power of Difference (STPOD) method as an evaluation tool for evaluating targeting technique. The STPOD method evaluates the distance from the actual movement of the forceps to the shortest linear path between two points in a short time period. We examined the effectiveness of the STPOD method as a new forceps kinematic analysis. METHODS: Six residents were categorized as novices and six urologists as experts. All participants performed box trainer training and LapPASS® Simulator training. During the procedure, objective scores (time, distance, and STPOD) were recorded. STPOD (Power) evaluated motion smoothness and STPOD (Stop) evaluated the stop time of the forceps. RESULTS: STPOD (Stop) on the right side of the experts was significantly lower than that of the novices in the box trainer. Furthermore, there were significant differences in the distances of left side and STPOD (Power) between the experts and the novices in the simulator. In the correlation of parameters between the box trainer and the simulator, time showed the strongest correlation, STPOD (Power) and distance showed a mild correlation. CONCLUSION: We showed the construct validity of STPOD (Power) and STPOD (Stop) using both the box trainer and the simulator. This method is a good evaluation tool for assessing a physician's skill; however, there are much more complex motions that are performed in actual surgery. Future studies are needed to focus on evaluation in an environment closer to actual surgery and comparing with other existing methods.

DOI： 10.1007/s11548-022-02622-2

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: To determine whether training laparoscopic nephrectomy (LN) with a virtual reality (VR) simulator improves the performance of porcine LN. METHODS: Twelve urological residents were assigned to two groups: a training and a non-training group. All participants performed baseline assessments of LN skills and time on the LapPASS® simulator. The training group received preoperative LapPASS® training. Both groups then performed LN using a porcine model. The operations were videotaped and evaluated using the Global Operative Assessment of Laparoscopic Skills (GOALS) system. After porcine LN, the training group performed a final LN with the LapPASS® simulator. RESULTS: There was no significant difference in the operation time required for porcine LN. There were no significant differences in the total A (autonomy), B (bimanual dexterity), D (depth perception), or T (tissue handling) GOALS scores. However, the total E (efficiency) score in the training group was higher than that in the non-training group (P = .030). The final LN score with LapPASS® was significantly higher than the baseline (P = .004). CONCLUSIONS: The results of this study demonstrated that VR LN training improved performance in an actual operation. VR-based procedural simulation could become a vital part of the laparoscopic training program for residents.

DOI： 10.1111/ases.13005

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: In laparoscopic surgery, surgical instruments are inserted from a trocar to the target organ in a blind fashion, which carries a risk of organ injury. To clarify the risks associated with surgical instrument insertion, we measured grip strength and pushing/pressing force during surgical instrument insertion in laparoscopic surgery. METHODS: Using forceps with sensors inside a trocar, 10 urologists performed a laparoscopic procedure in pigs, in which they were asked to touch the abdominal wall. The surgeons closed their eyes during the procedure and stopped moving the forceps when they felt them come into contact with the abdominal wall. They were ordered to grip the forceps strongly or softly and to move them rapidly or slowly during the procedure. Grip strength and the pushing/pressing force when the forceps hit the abdominal wall were measured and analyzed. RESULTS: The mean pushing/pressing force when the surgeons gripped the forceps strongly and moved them rapidly (strong/rapid), strongly/slowly, softly/rapidly, and softly/slowly were 2.8, 2.0, 1.7, and 1.1 N, respectively. The pushing/pressing force was significantly greater when the surgeons gripped the forceps strongly, regardless of the forceps speed (P < .001). The pushing/pressing force was significantly greater when the surgeons moved the forceps rapidly, regardless of grip strength (P < .001). CONCLUSIONS: When surgeons insert laparoscopic instruments through trocars, the instruments should be gripped softly and moved slowly to avoid organ injuries.

DOI： 10.1111/ases.12904

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Lymphoepithelioma-like carcinoma (LELC) of the ureter is very rare and only 14 previous cases have been reported. Here, we report a case of LELC of the ureter. A 76-year-old woman was admitted to our hospital complaining of gross hematuria. Left ureteral cancer was suspected by the imaging examination, and laparoscopic left total nephroureterectomy was performed. Histopathological examination showed pure type of LELC in the ureter. She is alive without disease recurrence at fifteen months after surgery.

DOI： 10.14989/ActaUrolJap_67_5_205

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: To assess the correlation of urine loss rate after catheter removal with long-term continence after robot-assisted radical prostatectomy. METHODS: We enrolled 163 patients on whom robot-assisted radical prostatectomy was carried out and whose urine loss rate we were able to evaluate after catheter removal. Urinary incontinence was evaluated from immediately after removal of the catheter to the date of discharge, and at 1, 3, 6 and 12 months after surgery. Urine loss rate was defined as the urine loss volume divided by the total urine volume. RESULTS: The continence rates of patients with ≤1% urine loss rate on the day of catheter removal were 100% at 6 and 12 months after surgery. A multivariate analysis proved that ≤10% urine loss rate on the day of catheter removal was a significant predictor of continence at 3 months after surgery. Furthermore, the continence rate at 12 months of patients who did not achieve ≤10% urine loss rate on the day of catheter removal was 79.5%. Among them, the continence rate at 12 months of patients who achieved ≥15% urine loss rate improvement from the day of catheter removal to the next day was 95.2%; the factor differed significantly between the continence and incontinence groups at 12 months after surgery. CONCLUSIONS: The urine loss rate on the day of catheter removal is significantly related to the acquisition of urinary continence. Furthermore, our findings suggest that long-term urinary continence can be expected, even in the event of poor urine loss rate on the day of catheter removal, if it improves on the next day.

DOI： 10.1111/iju.14488

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/iju.14413

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Radical prostatectomy and radiotherapy are currently the main treatment options for localized prostate cancer. However, no large cohort study comparing surgery and radiation has been performed in Japan or Asia. The objective of the current study was to compare the survival outcomes of patients with clinically localized prostate cancer and in elderly and young patients receiving surgery and radiotherapy. The survival outcomes of patients with localized prostate cancer (age at diagnosis ≤79 years, clinical T1-3) initially treated with surgery or radiotherapy were retrospectively analyzed. Data were collected from the population-based cancer registry of the Kanagawa Prefecture, Japan. A 1:1 coarsened exact matching of age at diagnosis, clinical T stage and cancer differentiation was performed between the two treatment groups. Patients were also categorized into two subgroups by age using a cutoff of 70 years for analysis. The cohort comprised 4,810 patients aged 50-79 years. No significant difference in cancer-specific survival (CSS) was observed between the two groups (P=0.612). However, the surgery group had significantly better overall survival (OS; P=0.004). When stratified for age, similar tendencies were observed in the elderly group (aged 70-79 years; CSS, P=0.961 and OS, P=0.007). No significant difference in either CSS or OS was identified in the younger group (P=0.550 and P=0.408, respectively). Intrinsic deaths were more likely to occur in elderly patients treated with radiotherapy than those undergoing surgery (69.3 vs. 78.2%; P=0.128). The results indicated that surgery provided significantly better OS than radiotherapy, particularly among the elderly. However, no significant difference was observed in CSS. These results should be interpreted with caution, given that some important factors were unavailable in the present study, such as prostate-specific antigen values and Gleason scores. Prospective trials evaluating these therapies are warranted.

DOI： 10.3892/ol.2020.12013

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Recently, the effectiveness of anti-programmed death 1 (PD-1) antibody therapy in the treatment of renal cell carcinoma (RCC) has been established. Nevertheless, efficacy has been reported to be limited to only 10-30% of patients. To develop more effective immunotherapy for RCC, we analyzed the immunological characteristics in RCC tissues by immunohistochemistry (IHC). We prepared a tissue microarray that consisted of tumor tissue sections (1 mm in diameter) from 83 RCC patients in Kanagawa Cancer Center between 2006 and 2015. IHC analysis was performed with antibodies specific to immune-related (CD8 and Foxp3) and immune checkpoint (programmed death ligand 1 (PD-L1) and 2 (PD-L2), B7-H4 and galectin-9) molecules. The numbers and proportions of positively stained tumor cells or immune cells were determined in each section. From multivariate analysis of all 83 patients, higher galectin-9 expression was detected as a factor associated with worse overall survival (OS) (P = 0.029) and that higher stage and higher B7-H4 expression were associated with worse progression-free survival (PFS) (P < 0.001 and P = 0.021, respectively). Similarly, in multivariate analysis of 69 patients with clear cell RCC, though not statistically significant, there was a trend for association between higher galectin-9 expression and worse OS (P = 0.067), while higher stage was associated with worse PFS (P < 0.001). This study suggests that higher galectin-9 expression is an independent adverse prognostic factor of OS in RCC patients. Therefore, to develop more effective personalized immunotherapy to treat RCC, it may be important to target not only PD-1/PD-L1, but also other immune checkpoint molecules such as galectin-9.

DOI： 10.1007/s00262-020-02608-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/iju.14240

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Urologists are often referred to manage the extrinsic malignant ureteral obstruction (MUO) caused by nonurological malignancies. Usually palliative urinary diversion (ureteral stent or nephrostomy) will be performed; however, in the cases of no symptom or poor prognosis, observation (OBS) without any intervention will be selected. There are few reports about outcome of the OBS policy for MUO. Objective: To evaluate the outcome of palliative urinary diversion or OBS for MUO. Design: We retrospectively reviewed the selection of treatment and the prognosis. Setting/Subjects: A total of 151 cases were introduced to our department as MUO between April 2011 and December 2016. Measurements: The patients were divided to immediate palliative urinary diversion (immediate-DIV) or OBS. The latter patients were subdivided to OBS followed by deferred palliative urinary diversion (deferred-DIV), and observation only (OBS-only). Results: There was no significant difference between immediate-DIV and OBS about overall survival (OS) from the consultation. In OBS group, deferred-DIV did not prolong prognosis from the consultation more than OBS-only. In the same way, there was no significant difference between immediate-DIV and deferred-DIV in OS from the intervention. Unfavorable prognostic factors for OS were lack of anticancer treatment after consultation, symptoms of MUO, and gastrointestinal cancer. When we classified the patients by these factors, the group with three factors showed significantly poorer prognosis than the others. Conclusion: Immediate-DIV or OBS did not influence the prognosis in the whole patients. Three prognostic factors that will be judged by urologists easily might be useful for the indication and timing of palliative urinary diversion.

DOI： 10.1089/jpm.2019.0038

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1111/iju.14101

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION AND OBJECTIVES: The neutrophil-to-lymphocyte ratio (NLR) has been suggested as a simple marker of the systemic inflammatory response in critical care patients. The NLR can be easily calculated from routine complete blood counts in the peripheral blood. This parameter has been reported to be an independent prognosticator for some solid malignancies. In the present study, we examined the importance of the NLR as a prognostic marker for castration-resistant prostate cancer (CRPC) patients who received docetaxel- (DOC-) based chemotherapy. METHODS: We analyzed a total of 73 patients who received DOC chemotherapy for CRPC in Yokohama City University Medical Center and affiliated hospitals. Complete blood cell counts were performed, and the NLR was calculated using the neutrophil and lymphocyte counts obtained on the same day or a few days before the initiation of DOC chemotherapy. We determined the NLR cutoff value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. RESULTS: The median overall survival (OS) after DOC was 21.0 months (range: 2.0-51.0). The median OS was shorter in patients with a high NLR (≥2.59) than in those with a low NLR (<2.59) (12.0 versus 31.6 months, p=0.001). In the multivariate analysis, the NLR and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.643, p=0.001; hazard ratio 2.184, p=0.038, respectively). CONCLUSIONS: The higher NLR group showed a significantly poorer OS than the lower NLR group. Pre-DOC NLR might be a new marker for predicting the prognosis of patients who receive DOC chemotherapy.

DOI： 10.1155/2019/2535270

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We investigated time-dependent changes in the relapse features of renal cell carcinoma (RCC) after curative surgery. Between 1985 and 2015, 1398 patients with RCC (1226 clear cell RCC, 89 papillary RCC, and 53 chromophobe RCC) underwent curative surgery at Yokohama City University Hospital and its affiliated hospitals. We retrospectively reviewed the clinicopathologic factors of patients with relapse after surgery. Median follow-up was 56.3 months. Recurrence occurred in 245 patients (217 clear cell RCC, 12 papillary RCC, and 3 chromophobe RCC). Papillary RCC and chromophobe RCC had no recurrence beyond 5 years after surgery, but 20 cases of clear cell carcinoma had recurrence beyond 10 years after surgery. The typical recurrence sites of clear cell RCC were lung (46.6%), bone (17.9%), liver (7.6%), and lymph nodes (6.5%). The proportion of recurrences at these typical sites was 83.9% for recurrences within 5 years, 76.3% between 5 and 10 years, and 40.0% beyond 10 years. In contrast, the proportion of retroperitoneal organ recurrence, including contralateral kidney, pancreas, and adrenal glands, increased with increasing time after surgery. Interestingly, the hazard ratio of typical site relapse decreased whereas that of retroperitoneal organ relapse increased in a time-dependent manner. In summary, clear cell RCC showed potential to relapse beyond 10 years after surgery. Recurrence at typical sites decreased whereas retroperitoneal organ recurrence increased in a time-dependent manner. Clinicians should check for recurrence at various sites beyond 10 years, especially in clear cell RCC.

DOI： 10.1007/s10585-018-9883-0

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 34-year-old man presented with scrotal pain and slight fever. The scrotal pain was improved by the treatment of antibiotics, but the slight fever remained and an abdominal protuberance appeared. Computed tomography showed a 22 cm abdominal tumor with lipid density. He was then referred to our hospital. He was diagnosed as retroperitoneal liposarcoma and a surgical resection was performed for retroperitoneal tumor and surrounding organs. Histopathological diagnosis was dedifferentiated liposarcoma. 3 months after surgery, a PET/CT scan showed multiple lung metastases. We treated the patient with AI therapy by doxorubicin and ifosfamide. After 6 courses were performed, a complete response was achieved. 30months after the initial surgery, a PET/CT scan showed there was just one metastasis which was in the left lung. Thoracoscopic lung tumor resection was performed. Histopathological diagnosis was metastatic dedifferentiated liposarcoma. As adjuvant therapy, we treated with IE therapy by ifosfamide and VP-16. 3 courses were performed. 3 years and 6 months after the first surgery, he has had no recurrence up to the present day.

DOI： 10.5980/jpnjurol.109.25

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記述言語：英語  

A 56-year-old man was admitted to our hospital for urachal carcinoma with peritoneal dissemination. He received first-line chemotherapy with gemcitabine and cisplatin. After the fifth cycle, a computed tomography (CT) scan revealed abdominal fluid, and his serum tumor marker levels were increased. The patient was started on second-line therapy with FOLFIRI. After 11 cycles, his tumor decreased in size and no new metastatic lesions were detected. The patient underwent complete tumor resection with partial cystectomy and pelvic lymph node dissection. The tumor was removed, along with adhering surrounding organs, including the omentum, peritoneum, abdominal rectus muscle, and vermiform appendix. Although pathological examination confirmed peritoneal dissemination, his tumor markers normalized soon after surgery. The patient has survived 62 months after surgery without any adjuvant therapy and with no evidence of recurrence. To our knowledge, this is the longest duration of survival without recurrence of a patient with urachal carcinoma with peritoneal dissemination who received multimodal therapy.

DOI： 10.1155/2018/9836154

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記述言語：英語  

DOI： 10.1159/000447175

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 74-year-old man underwent transurethral resection for a bladder tumor (TURBT). The pathological diagnosis was urothelial carcinoma, grade 3 pT2 at least. He desired preservation of the bladder. Thus, MEC (methotrexate 100-150 mg/body (day 1), etoposide 100 mg/m2 (day 2-4), cisplatin 20 mg/m2 (day 2-6)) chemotherapy was administered for 2 courses. The next year, he had a relapse in the bladder, and the pathological diagnosiswasurothelial carcinoma, grade 2 pTa and pTis. He underwent Calmette-Guerin Bacillus (BCG) immunotherapy for 6 courses that resulted in a complete response without recurrence for 6 years. Six months after the latest examination, he complained of difficulty in voiding. An 8 cm tumor in the bladder and enlargement of obturator lymph node were detected. The pathological diagnosis by TURBT was small cell carcinoma. He rejected cystectomy, so we applied MEC therapy again. After 2 courses of MEC therapy, the bladder tumor and lymphadenopathy markedly shrunk in image and almost disappeared subsequently. The patient refused further therapy, but he had been followed without recurrence for 48 monthsafter the chemotherapy.

DOI： 10.14989/ActaUrolJap_63_6_245

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We describe a case of testicular tumor with multiple metastasis to the lung,retoroperitoneal lymph node, and brain. After chemotherapy the retroperitoneal lymph node and brain metastasis disappeared,but the multiple pulmonary metastases but not disappear,although they were reduced in size. Since the human chorionic gonadotoropin (HCG) was persistently dected at a low level,we performed a testosterone tolerance test. The HCG level became undetectable for a while,but was detected at a low level again. Then the patient underwent residual tumor removal of some of the residual pulmonary disease,which was diagnosed as tumor necrosis. The patient has been followed on an ambulatory basis after surgery for 12 months without recurrence. In this case a definitive diagnosis was difficult,because of the low positive level of HCG.

DOI： 10.14989/ActaUrolJap_63_3_119

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION AND OBJECTIVES: An elevated neutrophil-to-lymphocyte ratio (NLR) has been suggested to be associated with a poor prognosis in several cancers. We evaluated the utility of an elevated NLR as a biomarker to predict the prognosis of metastatic castration-resistant prostate cancer (mCRPC) patients treated with cabazitaxel (CBZ). METHODS: We analyzed 47 patients who received CBZ chemotherapy for mCRPC in our institutions. The NLR was calculated using the neutrophil and lymphocyte counts before CBZ chemotherapy. We determined the NLR cut-off value based on the sensitivity and specificity levels derived from area under the receiver operator characteristic curves for death. A multivariate analysis was performed to investigate the association between the NLR and the prognosis. RESULTS: The median overall survival (OS) after CBZ was 10.0 months (range: 6.3-13.2). The median OS was shorter in patients with a high NLR (≥3.83) than in those with a low NLR (<3.83) (5.8 versus 13.2 months, p = 0.018). In the multivariate analysis, the NLR, patient age, and lymph node (LN) metastasis were independent predictors of the OS (hazard ratio 3.01, p = 0.030; hazard ratio 3.10, p = 0.029; hazard ratio 12.38, p = 0.001, resp.). CONCLUSIONS: NLR might be a useful prognostic biomarker in mCRPC patients treated with CBZ.

DOI： 10.1155/2017/7538647

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 70-year-old man underwent left partial nephrectomy for renal cell carcinoma (pT1aN0M0). One year after the surgery, he presented with hematuria and fatigue. Computed tomography showed a left 8 cm renal tumor and multiple liver and lung metastases. We performed percutaneous renal and liver biopsy with echo guidance. The diagnosis of both kidney and liver was urothelial carcinoma. He died 3 weeks after the diagnosis. Ipsilateral occurrence of the pelvic renal carcinoma after partial nephrectomy for renal cell carcinoma is extremely rare. To our knowledge, this case is the first to be reported in Japan and elsewhere.

DOI： 10.14989/ActaUrolJap_62_10_535

PubMed

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本泌尿器科学会総会事務局  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 72-year-old man presenting with a 14-cm left renal mass, an inferior vena cava (IVC) tumor thrombus, and pulmonary metastases underwent renal mass biopsy that revealed clear cell renal cell carcinoma. Because of metastases and the extent of the tumor thrombus, sunitinib was administered, which resulted in a marked reduction in the tumor thrombus (from level III to level II after 11 weeks of treatment). Ultrasonography, preceding computed tomography, showed a slight shrinkage of the tumor thrombus level in the first 2 weeks. Therefore, ultrasound may be advantageous to monitor the IVC tumor thrombus level during the early phase of targeted therapy.

DOI： 10.1007/s10396-013-0448-1

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Malignant peripheral nerve sheath tumors (MPNST) are highly malignant soft tissue sarcomas. It is very rare for MPNST to arise in the abdominal wall. We report a case of abdominal wall MPNST that was difficult to distinguish from a urachal disease. A 72-year-old woman found a mass of the umbilicus in October 2011. She visited a digestive surgery department in November because it gradually enlarged. Diagnostic imaging suggested a urachal tumor. She was then referred to our clinic. Contrast enhanced CT showed that the 5-cm cystic tumor extended from the umbilicus to abdominal wall. The tumor showed low uptake value in PET-CT. We diagnosed her with a urachal cyst, but could not deny urachal carcinoma. Therefore, we performed surgical resection in January 2012. The pathological diagnosis was MPNST. She has not experienced recurrence for 9 months. MPNST mostly occur in the retroperitoneum close to the spine, extremities, head, and neck. It is very rare for them to occur in the abdominal wall. This is the sixth case including overseas reports. In addition, this is the first case in which it was difficult to distinguish from a urachal disease.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 56-year-old man was referred to our clinic because of left lumbar pain and a left solitary renal tumor (9. 8 cm in diameter) and bilateral pulmonary metastases detected by computed tomographic scan. Pathologic diagnosis following open radical nephrectomy was papillary renal cell carcinoma, G2, pT2aN0M1. Subsequently, the patient was sequentially treated with interleukin-2 (3 months (mo), progressive disease (PD)), interferon-alpha (3 mo, PD), and oral S-1 as a clinical trial (28 mo, PD). Because of skin fibrofolliculomas, pulmonary cysts, and spontaneous pneumothorax history, Birt-Hogg-Dubé (BHD) syndrome was suspected during the treatment course, despite his having no family history of the disease. Subsequent genetic testing revealed a FLCN germline mutation (c. 1285dupC). He was started on molecular-targeting therapies sequentially, i.e., sorafenib (1 mo, PD), sunitinib (4 mo, PD), and everolimus (7 mo, PD). The patient died of progressive disease at 78 mo from the initial nephrectomy and 30 mo from the start of targeted agents. Loss of FLCN function has been shown to result in the upregulation of the PI3K/mTORC1 pathway in both in vitro experiments and in vivo FLCN knockout mice models. Despite its use as the sixth-line systematic treatment, the mTOR inhibitor everolimus exhibited a relatively long-term effect as compared with the previously used tyrosine kinase inhibitors and in contrast to the results in the RECORD-1 clinical trial. This finding may provide insight into the molecular mechanism of BHDassociated renal tumors.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 63-year-old man presenting with a 7.2-cm right renal mass, an inferior vena cava tumor thrombus, and pulmonary metastases underwent renal mass biopsy that revealed clear cell renal cell carcinoma. Temsirolimus (25 mg weekly) was given because of the extent of the disease and poor performance status, which resulted in a marked reduction in the tumor thrombus (from level III to level I) after 20 weeks of treatment. Subsequently, radical nephrectomy and tumor thrombectomy were carried out. Final pathological analysis confirmed the diagnosis of high-grade clear cell carcinoma (pT4N0M1). One year after initiation of temsirolimus therapy, the patient remained alive despite the presence of disease.

DOI： 10.1111/iju.12012

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We treated 27 patients of castration resistant prostate cancer (CRPC) with low-dose docetaxel (DCT) in our hospital. The efficacy and safety were evaluated. DCT was given at a dose of 25 mg/m2 on days 1 and 8 every 3 weeks. The patients were from 54 to 84 years old (median 69). PSA value before DCT treatment was from 1.005 to 1,710 ng/ml (median 28.1). Patients received a median of ten cycles (range: 0-49). PSA decreased in 21 patients (84%). PSA decrement greater than 50% was seen in 13 (52%). Median time to progression and overall survival was 8.7 and 27.6 months, respectively. Grade 3-4 myelosuppression was observed in only one patient (4%). Low-dose DCT therapy is an effective and well tolerated treatment for CRPC patients.

Scopus

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 65-year-old male was referred to our clinic from orthopedics because his right gastrocnemius muscle tumor was diagnosed as a metastatic renal cell carcinoma (RCC) with clear cell/spindle cell morphology. He had right nephrectomy for RCC 18 years previously. At 17 months following the first visit to our clinic, brain, lung and right gluteus medius muscle metastases were identified on positron emission tomography computed tomography (PET-CT). The echocardiogram for the evaluation of his heart function incidentally revealed a 3 cm nodular lesion in the right ventricular wall suggesting myocardiac metastasis. He started to take sunitinib at a standard dose of 50 mg/day. A subsequent echocardiogram during the 2nd cycle of sunitinib showed complete disappearance of the myocardiac metastasis. After the 2nd cycle, PET-CT revealed a partial response (PR) for the other metastases. He received 8 cycles of sunitinib. The best response was PR, and progression-free survival was 6 months. After that, he took everolimus for 7 months. Although the myocardiac metastasis continued to show a complete response during the treatment course, he died of progressive lung metastases at 21 months following the administration of sunitinib. Diagnosis of myocardiac metastasis of RCC during the treatment course as well as its successful treatment with molecular targeting agents has rarely been reported.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: To report the first case of preoperative training using a patient-specific laparoscopic simulator for a patient with situs inversus totalis (SIT). MATERIALS AND METHODS: A 61-year-old man presented with gross hematuria and was diagnosed with right renal pelvic cancer T1N0M0. A whole-body computed tomography (CT) scan also revealed his organs showed a mirror image, with left-to-right reversal, and SIT was diagnosed. A laparoscopic right nephroureterectomy through a retroperitoneal approach was scheduled. Before the operation, we practiced the operation using a patient-specific laparoscopic surgical simulator that we have developed. The patient's CT data were used to reproduce the retroperitoneal space in the simulator, and the surgeon trained and became familiar with his SIT anatomy. RESULTS: The insufflation time was 182 minutes, and the estimated blood loss was 50 mL. The surgeon was able to complete the right retroperitoneoscopic nephroureterectomy safely, without any problems. CONCLUSION: To our knowledge, we report the first case of preoperative training using a patient-specific simulator for a patient with SIT. Preoperative training was useful, and retroperitoneoscopic nephroureterectomy was successfully performed in a patient with renal pelvic urothelial carcinoma and SIT.

DOI： 10.1016/j.urology.2012.08.054

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Training systems for laparoscopic surgery are useful for basic training but are not suitable for specific training corresponding to the condition of a given patient. We, therefore, have developed an unusual training system: a patient-specific simulator for laparoscopic surgery. When specific data of each individual patient are entered, this system helps surgeons perform a "rehearsal" operation. We applied this technique in laparoscopic surgery by using volume data obtained by multislice computed tomography imaging. CASE PRESENTATION: A 39-year-old Japanese woman consulted a doctor because of back pain and underwent pyeloplasty after an examination revealed a ureteropelvic junction obstruction. Computed tomography data showed that the network of arteries and veins was very complicated. Therefore, we decided to use our simulator before performing surgery. Simulation was helpful because we could obtain information about the complicated vessel network and "rehearse" the procedure. CONCLUSIONS: Our simulator allows surgeons to perform a sham operation with different perspectives and tactile sensations and has received favorable reviews from users.

DOI： 10.1186/1752-1947-6-338

PubMed

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記述言語：日本語   出版者・発行元：Japanese Society of Endourology  

【目的】当院で腹腔鏡下腎盂形成術と腎盂切石術を同時に施行した6例の手術成績を評価した．<br> 【対象と方法】2005年1月から2011年7月までに，当院で腹腔鏡下腎盂形成術を施行した38症例のうち，腎結石を合併していた6症例を対象とし，各々の患者背景，術式，治療成績について評価検討した．すべて経腹膜アプローチで，腎盂形成はdismembered法を施行した．<br> 【結果】手術時間は中央値260分（208-284分），結石摘出時間の中央値は52分（4-63分），すべての症例で出血量は少量であった．術中合併症，術後合併症は認めていない．17個中13個の結石を摘除できた．<br> 【結論】腎結石を伴った腎盂尿管移行部狭窄症に対する腹腔鏡下腎盂形成術と同時に施行する腎盂切石術は合理的で施行可能な治療法といえる．

DOI： 10.11302/jsejje.25.149

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JALC/10028431458?from=CiNii

記述言語：日本語   出版者・発行元：Japanese Society of Endourology  

【目的】腹腔鏡下腎部分切除術の手術成績と術後成績について検討を行った．<br> 【対象と方法】2007年1月から2011年10月までに横浜市立大学附属病院で腹腔鏡下腎部分切除術を施行した67症例を対象とし，後腹膜アプローチ群43例と経腹膜アプローチ群24例の2群に分けて後方視的に解析し検討を行った．<br> 【結果】平均手術時間，平均阻血時間，平均術中出血量は後腹膜アプローチ群で171.7分，25.6分，78.3ml，経腹膜アプローチ群で182.3分，26.3分，102.9mlであった．術中，術後合併症は3例に認めた．術後再発をきたした症例は1例もなかった．<br> 【結論】当院での腹腔鏡下腎部分切除術の初期成績は制癌性の面においても阻血時間の面においても満足できるものであった．

DOI： 10.11302/jsejje.25.305

CiNii Books

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その他リンク： https://jlc.jst.go.jp/DN/JALC/10028431878?from=CiNii

会議種別：ポスター発表  

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会議種別：ポスター発表  

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会議種別：口頭発表（一般）  

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会議種別：口頭発表（一般）  

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会議種別：口頭発表（一般）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：シンポジウム・ワークショップ パネル（公募）  

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会議種別：ポスター発表  

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会議種別：口頭発表（一般）  

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会議種別：ポスター発表  

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会議種別：ポスター発表  

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会議種別：ポスター発表  

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会議種別：ポスター発表  

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会議種別：ポスター発表  

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会議種別：ポスター発表  

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