研究等業績 - その他 - 成田 伸太郎
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腎移植前の貧血管理の意義
齋藤 満, 藤山 信弘, 提箸 隆一郎, 齋藤 拓郎, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 沼倉 一幸, 成田 伸太郎, 佐藤 滋, 羽渕 友則
秋田腎不全研究会誌 ( 秋田腎不全研究会 ) 24 71 - 77 2021年11月
2004年7月〜2016年12月に生体腎移植を受けた症例を、移植後1ヵ月以内に濃厚赤血球輸血を受けた輸血有り群148例(61.4%)と輸血なし群93例(38.6%)に分け、輸血療法の危険因子、それに伴うドナー特異的新規抗体産生リスクや移植腎予後について検討した。輸血あり群は男性81例、女性67例、平均年齢49.3歳、輸血なし群は男性72例、女性21例、平均年齢48.5歳であり、多変量解析では女性、先行的腎移植症例、移植前日Hb 11g/dL未満、移植時出血300mL以上が独立した危険因子であった。腎移植前日Hb値と輸血療法施行とのROC曲線での評価では感度74.2%、特異度67.6%、カットオフ値10.4g/dLでAUC 0.747であった。輸血療法を回避するためには、腎移植術前Hb値を11g/dL程度まで上昇させておくべきである。
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岡田 脩平, 神田 壮平, 中島 志織, 佐藤 博美, 山本 竜平, 本間 直子, 奈良 健平, 千葉 修治, 沼倉 一幸, 齋藤 満, 成田 伸太郎, 井上 高光, 佐藤 滋, 羽渕 友則
泌尿器外科 ( 医学図書出版(株) ) 34 ( 11 ) 1289 - 1289 2021年11月
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鏡視下膀胱全摘除術の術後再発を如何に防ぐか 当院におけるRARCの拡大リンパ節郭清
成田 伸太郎, 沼倉 一幸, 齋藤 満, 羽渕 友則
日本泌尿器内視鏡学会総会 ( (一社)日本泌尿器内視鏡・ロボティクス学会 ) 35回 SY - 4 2021年11月
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高難度症例に対するロボット支援腎部分切除術:症例から学ぶ 高難度症例に対するロボット支援腎部分切除術
沼倉 一幸, 齋藤 満, 成田 伸太郎, 羽渕 友則
日本泌尿器内視鏡学会総会 ( (一社)日本泌尿器内視鏡・ロボティクス学会 ) 35回 WS - 3 2021年11月
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Narita S.
Current Oncology ( Current Oncology ) 28 ( 5 ) 4109 - 4117 2021年10月
Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.
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Prognosis of Japanese metastatic renal cell carcinoma patients in the targeted therapy era
Naito S.
International Journal of Clinical Oncology ( International Journal of Clinical Oncology ) 26 ( 10 ) 1947 - 1954 2021年10月
BACKGROUND: The aims of this study were to investigate prognosis and validate prognostic models [Memorial Sloan-Kettering Cancer Center (MSKCC), International Metastatic Renal Cell Carcinoma Data Consortium (IMDC), and Japanese metastatic renal cancer (JMRC) models] in the targeted therapy era in Japanese patients with metastatic renal cell carcinoma. METHODS: We retrospectively analyzed 692 patients who were diagnosed with mRCC from January 2008 to August 2018 in the Michinoku Japan Urological Cancer Study Group database. Nivolumab as sequential therapy was widely used. Other immune checkpoint inhibitors were excluded from this study. RESULTS: The median overall survival (95% confident interval) in all, MSKCC favorable, intermediate, and poor risk patients was 41.0 months (33.9-46.8), not reached (63.5 to not estimable), 46.8 months (37.1-52.9), and 10.4 months (8.9-14.4), respectively. The median overall survival (95% confident interval) in IMDC favorable, intermediate, and poor risk patients was not reached (61.6 to not estimable), 47.4 months (41.4-56.5), and 11.5 (9.9-16.3), respectively. The c-index of the MSKCC, IMDC, and JMRC models calculated at mRCC diagnosis was 0.680, 0.689, and 0.700, respectively. No statistical differences were found in the c-index among the models. CONCLUSION: While the real-world overall survival in Japanese patients with mRCC in the targeted therapy era improved compared to that previously reported in the cytokine era, there was no clear difference in the survival of poor risk patients between these eras. There were no differences in the superiority among the models.
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当院泌尿器科でのFoundationOne CDxがんゲノムプロファイル施行症例の検討
石田 雅宣, 成田 伸太郎, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 沼倉 一幸, 齋藤 満, 羽渕 友則
日本癌治療学会学術集会抄録集 ( (一社)日本癌治療学会 ) 59回 P28 - 5 2021年10月
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Narita T.
International Journal of Urology ( International Journal of Urology ) 28 ( 9 ) 899 - 905 2021年09月
OBJECTIVES: To assess the clinical benefit of pembrolizumab as second-line therapy for advanced urothelial carcinoma. METHODS: We retrospectively compared the effects of pembrolizumab with those of conventional chemotherapy on the prognosis of patients with advanced urothelial carcinoma at six hospitals between January 2004 and August 2020. We compared the oncological outcomes between the patients treated with pembrolizumab and those treated with conventional chemotherapy using Kaplan-Meier curve analysis and multivariate Cox regression analysis with the inverse probability of treatment weighting method. RESULTS: The numbers of patients in the pembrolizumab and chemotherapy groups were 121 and 67, respectively. Patients in the pembrolizumab group were significantly older (median 72 vs 66 years, P = 0.001), and had poor Eastern Cooperative Oncology Group performance status (median 1 vs 0, P = 0.001). The unadjusted Kaplan-Meier curve analysis showed no significant differences in the median overall survival from the first-line chemotherapy (24.7 months vs 16.3 months, P = 0.159). Inverse probability of treatment weighting-adjusted multivariate Cox proportional hazards analyses showed a significant difference between the pembrolizumab and chemotherapy groups in overall survival (P = 0.003, hazard ratio 0.63). CONCLUSIONS: Despite the non-negligible age difference between the trial and our clinical practice, our study supports the benefit of second-line pembrolizumab over chemotherapy in real-world practice.
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Matsuda Y.
Annals of Surgical Oncology ( Annals of Surgical Oncology ) 28 ( 9 ) 5341 - 5348 2021年09月
PURPOSE: This study was designed to assess the relationship between nerve-sparing (NS) status, positive surgical margin (PSM) location, and biochemical recurrence (BCR) based on a multicenter, radical prostatectomy (RP) database. METHODS: We retrospectively reviewed data from 726 patients who underwent RP without any neoadjuvant or adjuvant treatment between 2010 and 2014. We statistically assessed the impact of NS sides on PSM location and BCR. RESULTS: PSM rates were 21.9% in the 726 patients studied, 13.2% in patients with ≤pT2, and 46.8% in patients with ≥pT3. Regarding PSM locations, the anterior-apex (AA) was the most common site for PSM (43.3%). After adjusting for confounding factors, bilateral nerve sparing (BNS) had a significantly higher odds ratio of PSM than the absence of NS did (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.85-4.99). In the UNS RP in patients with ≤pT2, non-AA PSM on the non-NS side was significantly higher than that on the NS side (92.9% vs. 45.5%, p = 0.009). In all patients, 5.8% experienced BCR during a median follow-up of 43.5 months. PSM was significantly associated with BCR-free survival in patients with ≤pT2 (p = 0.013), but not in patients with ≥pT3 (p = 0.185). Non-AA PSM at the non-NS side was an independent risk factor for BCR (hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.12-5.85), whereas AA PSMs, including NS/non-NS sides and non-AA PSM at the NS side, were not associated with BCR-free survival. CONCLUSIONS: Avoidance of non-AA PSM on the non-NS side may be rather important for maintaining BCR-free survival after RP.
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Shiota M.
Cancer Science ( Cancer Science ) 112 ( 9 ) 3616 - 3626 2021年09月
The metastatic burden is a critical factor for decision-making in the treatment of metastatic hormone-sensitive prostate cancer (HSPC). This study aimed to develop and validate a novel risk model for survival in patients with de novo low- and high-burden metastatic HSPC. The retrospective observational study included men with de novo metastatic prostate cancer who were treated with primary androgen-deprivation therapy at 30 institutions across Japan between 2008 and 2017. We created a risk model for overall survival (OS) in the discovery cohort (n = 1449) stratified by the metastatic burden (low vs high) and validated its predictive ability in a separate cohort (n = 951). Based on multivariate analyses, lower hemoglobin levels, higher Gleason grades, and higher clinical T-stage were associated with poor OS in low-burden disease. Meanwhile, lower hemoglobin levels, higher Gleason grade group, liver metastasis, and higher extent of disease scores in bone were associated with poor OS in patients with high-burden disease. In the discovery and validation cohorts, the risk model using the aforementioned parameters exhibited excellent discriminatory ability for progression-free survival and OS. The predictive ability of this risk model was superior to that of previous risk models. Our novel metastatic burden-stratified risk model exhibited excellent predictive ability for OS, and it is expected to have several clinical uses, such as precise prognostic estimation.
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特集 今こそ知りたい! ロボット時代の腹腔鏡手術トレーニング-腹腔鏡技術認定を目指す泌尿器科医のために〈特別付録Web動画〉 〈腹腔鏡技術認定を目指した取り組み〉 腎移植を積極的に行う施設でのトレーニング法
齋藤 満, 成田 伸太郎, 羽渕 友則
臨床泌尿器科 ( 株式会社医学書院 ) 75 ( 10 ) 730 - 735 2021年09月
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上部尿路上皮癌に対するロボット支援腹腔鏡下腎尿管全摘除術の経験
齋藤 満, 成田 伸太郎, 沼倉 一幸, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 羽渕 友則
Japanese Journal of Endourology ( (一社)日本泌尿器内視鏡・ロボティクス学会 ) 34 ( 2 ) 318 - 322 2021年09月
今回我々はロボット支援腹腔鏡下腎尿管全摘除術(RNU)の初期経験を得た.対象は2019年7月から2020年7月にda Vinci Si(4例)またはXi(2例)サージカルシステムでRNUを受けた6症例.全例男性で患側は左4例,右2例,cT3の3例を含む4例で術前化学療法を施行した.完全側臥位,軽度ジャックナイフ体位,6または7ポート,経腹膜アプローチで手術を施行した.術中,体位変換やペイシェントカートの移動は行わなかった.手術時間の中央値は308分,推定出血量の中央値は63mLで輸血や開腹手術移行は無かった.pT3の左尿管癌症例1例で摘出標本断端が陽性であった.周術期合併症はClavien-dindo分類でGrade IIの乳糜腹水,下痢を1例ずつ認めた.RNUは手術手技の標準化とより多くの症例を対象とした長期追跡調査が必要であるが,UTUC症例に対する新たな治療選択肢となり得る.(著者抄録)
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細胞内レチノイン酸結合蛋白2は飽和脂肪酸誘導性の前立腺癌進展を促進する
佐藤 博美, 成田 伸太郎, 石田 雅宣, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 黄 明国, 沼倉 一幸, 齋藤 満, 堂前 直, 羽渕 友則
日本癌学会総会記事 ( (一社)日本癌学会 ) 80回 [P14 - 4] 2021年09月
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術前肥満が腎移植後のアウトカムに与える影響についての検討
山本 竜平, 齋藤 満, 提箸 隆一郎, 青山 有, 嘉島 相輝, 小泉 淳, 奈良 健平, 沼倉 一幸, 成田 伸太郎, 佐藤 滋, 羽渕 友則
移植 ( (一社)日本移植学会 ) 56 ( 総会臨時 ) P1 - 47 2021年09月
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高脂肪食摂取による前立腺癌増殖とホスファチジルイノシトールの関連
黄 明国, 佐々木 雄彦, 沼倉 一幸, 齋藤 満, 成田 伸太郎, 羽渕 友則
日本癌学会総会記事 ( (一社)日本癌学会 ) 80回 [P23/24/26 - 2] 2021年09月
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【今こそ知りたい! ロボット時代の腹腔鏡手術トレーニング-腹腔鏡技術認定を目指す泌尿器科医のために】腹腔鏡技術認定を目指した取り組み 腎移植を積極的に行う施設でのトレーニング法
齋藤 満, 成田 伸太郎, 羽渕 友則
臨床泌尿器科 ( (株)医学書院 ) 75 ( 10 ) 730 - 735 2021年09月
＜文献概要＞ポイント ・生体腎移植ドナーは疾患や肥満などの影響が少ないことから,鏡視下ドナー腎採取術は腹腔鏡手術のトレーニングに適している.・鏡視下ドナー腎採取術には,通常の鏡視下腎摘除術とは異なる注意点があり,あらかじめ手術手順を決めておく.・鏡視下ドナー腎採取術が安全かつ適切にできる知識・技術を習得できれば,標準的な腹腔鏡下腎摘除術の指導は十分可能である.
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新鮮凍結血漿の血液型は血漿交換の有害事象の発生に影響するか?
提箸 隆一郎, 齋藤 満, 齋藤 拓郎, 山本 竜平, 藤山 信弘, 嘉島 相輝, 小泉 淳, 奈良 健平, 沼倉 一幸, 成田 伸太郎, 佐藤 滋, 羽渕 友則
移植 ( (一社)日本移植学会 ) 56 ( 総会臨時 ) P1 - 39 2021年09月
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脂肪由来間葉系幹細胞によるPI3/AKT経路を介した腎癌の浸潤能の亢進
武藤 弓奈, 沼倉 一幸, 成田 伸太郎, 羽渕 友則
日本癌学会総会記事 ( (一社)日本癌学会 ) 80回 [P14 - 1] 2021年09月
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腎細胞がんの組織型によって寄与する遺伝子が異なることを示した大規模ゲノム解析
関根 悠哉, 平田 真, 松田 浩一, 菅野 康吉, 吉田 輝彦, 村上 善則, 福井 智洋, 赤松 秀輔, 小川 修, 中川 英刀, 沼倉 一幸, 成田 伸太郎, 羽渕 友則, 桃沢 幸秀
日本癌学会総会記事 ( (一社)日本癌学会 ) 80回 [J7 - 1] 2021年09月
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高脂肪食摂取による前立腺癌増殖とホスファチジルイノシトールの関連
黄 明国, 佐々木 雄彦, 沼倉 一幸, 齋藤 満, 成田 伸太郎, 羽渕 友則
日本癌学会総会記事 ( (一社)日本癌学会 ) 80回 [P23/24/26 - 2] 2021年09月