研究等業績 - その他 - 羽渕 友則
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褐色細胞腫におけるカテコールアミン合成酵素に関する検討
小林 瑞貴, 沼倉 一幸, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 齋藤 満, 成田 伸太郎, 羽渕 友則
日本内分泌外科学会雑誌 ( (一社)日本内分泌外科学会 ) 38 ( Suppl.1 ) S98 - S98 2021年05月
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Hatakeyama S.
International Journal of Urology ( International Journal of Urology ) 28 ( 4 ) 369 - 375 2021年04月
OBJECTIVES: To compare overall survival between patients with metastatic renal cell carcinoma treated by cytoreductive nephrectomy and those not treated by cytoreductive nephrectomy. METHODS: We retrospectively evaluated 278 patients with metastatic renal cell carcinoma treated with first-line tyrosine kinase inhibitors between January 2008 and November 2019. Patients were divided into two groups: a cytoreductive nephrectomy group (immediate or deferred cytoreductive nephrectomy) and a group who received systemic tyrosine kinase inhibitor therapies alone without cytoreductive nephrectomy (control group). Overall survival comparisons were made in all patients in the control versus the cytoreductive nephrectomy group, the control versus the immediate cytoreductive nephrectomy group, the control versus the deferred cytoreductive nephrectomy group, and the deferred cytoreductive nephrectomy versus the immediate cytoreductive nephrectomy group. Analyses were weighted using the propensity score-based inverse probability of treatment weighting method to adjust for group imbalances. RESULTS: The median (range) age of the patients was 65 (59-73) years. Of the 278 patients, 132 and 146 were in the control group and the cytoreductive nephrectomy (immediate, n = 107 and deferred, n = 39) group, respectively. A significant difference was noted between the control and cytoreductive nephrectomy groups in age, clinical stage, International Metastatic Renal Cell Carcinoma Database Consortium risk factors, and the number of metastatic sites. Inverse probability of treatment weighting-adjusted Cox regression analysis showed a significant difference in overall survival between the control and the cytoreductive nephrectomy groups and between the control and the immediate or deferred cytoreductive nephrectomy groups. However, there was no significant difference in overall survival between the immediate and the deferred cytoreductive nephrectomy groups. CONCLUSIONS: Our findings suggest that metastatic renal cell carcinoma patients undergoing cytoreductive nephrectomy are more likely to have longer overall survival than those who receive tyrosine kinase inhibitor therapy only.
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Muto Y.
Medical Oncology ( Medical Oncology ) 38 ( 4 ) 37 - 37 2021年04月
We conducted a risk-adapted upfront docetaxel (DOC) in patients with metastatic hormone-sensitive prostate cancer (mHSPC). Here, we reported an interim analysis of the study. The study enrolled 68 patients with newly diagnosed mHSPC between 2016 and 2018. According to the presence of visceral metastasis, an EOD score ≥ 3, or prostate-specific antigen (PSA) level at 3 months of ≥ 1 ng/mL, patients were divided into low- and high-risk groups. Patients were treated with androgen deprivation therapy (ADT) with or without bicalutamide; those in the high-risk group received upfront treatment involving six cycles of DOC (70 mg/m2). Short-term treatment effect, adverse events, and quality of life (QOL) were evaluated. Fifty (73.5%) were classified in the high-risk group, and 46 (67%) received upfront ADT + DOC. In the ADT + DOC group, 43.5% (20/46) patients achieved a PSA level ≤ 0.2 ng/mL. PSA nadir and time to PSA nadir were 0.291 ng/mL and 288 days, respectively. In the ADT + DOC group, 76.1% (35/42) patients had adverse events (AEs) of grade ≥ 3. During a median follow-up of 18.5 months, 36.4% (8/22) patients in the ADT group and 43.5% (20/46) in the ADT + DOC group had CRPC. Two QOL scores including the physical status and appetite loss at 6 months significantly worsened in the ADT + DOC group but was resolved by 12 months. Upfront DOC achieved high PSA responses without long-term QOL deterioration. However, the short-term outcomes were limited. Longer follow-up is needed to determine the survival advantage.
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ロボット支援腎部分切除術における腎実質縫合の有無による術後腎実質体積のCT volumetryを用いた比較検討
提箸 隆一郎, 井上 高光, 中島 志織, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 神田 壮平, 沼倉 一幸, 齋藤 満, 成田 伸太郎, 佐藤 滋, 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 ( 1 ) 130 - 135 2021年04月
【目的】ロボット支援腎部分切除術(RAPN)における腎実質縫合の追加が術後の腎実質体積を減少させるかを画像解析ソフトにより検討した.また腎機能,合併症への影響も検討した.【対象と方法】2013年11月から2018年11月までに当科でRAPNを行ったT1a症例69例のうち,腎実質縫合を施行した26例(実質縫合群)と省略した43例(非縫合群)を後方視的に比較した.Synapse Vincent ver. 4を用いて,術前と術後6ヵ月の造影CTから腎実質減少体積を推定した.【結果】2群間の患者背景や手術成績に有意差はなかった.腎実質体積の減少量やeGFRの低下率,合併症の発生率に有意差を認めなかった.【結語】RAPNにおける腎実質縫合の追加は腎実質体積や腎機能,合併症の発生に影響しなかった.(著者抄録)
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高橋 修平, 沼倉 一幸, 小林 瑞貴, 武藤 弓奈, 蘇武 竜太, 小泉 淳, 成田 伸太郎, 熊谷 聡, 橋本 学, 羽渕 友則
日本老年泌尿器科学会誌 ( 日本老年泌尿器科学会 ) 34 ( 1 ) 126 - 126 2021年04月
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超高齢社会におけるロボット支援手術 高齢者のロボット支援膀胱全摘徐術
沼倉 一幸, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 齋藤 満, 成田 伸太郎, 井上 高光, 羽渕 友則
日本老年泌尿器科学会誌 ( 日本老年泌尿器科学会 ) 34 ( 1 ) 36 - 36 2021年04月
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泌尿器科における新規ロボット支援手術の展望 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
日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 ) 25 ( 7 ) SY13 - 2 2021年03月
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泌尿器腹腔鏡技術認定制度の果たした役割とこれから
金山 博臣, 羽渕 友則, 寺地 敏郎, 松田 公志
日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 ) 25 ( 7 ) SP12 - 5 2021年03月
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Narita S.
Sexual Medicine ( Sexual Medicine ) 9 ( 1 ) 100308 - 100308 2021年02月
INTRODUCTION: Neuroprotection and neuroregeneration of cavernous nerve plexus by biological/bioengineering solutions may have the potential to maintain erectile function. AIMS: We evaluated the efficacy of a newly developed artificial nerve sheet using freeze-dried alginate (ALG) with polyglycolic acid (PGA) mesh in a rat model. METHODS: Bilateral cavernous nerves of male rats were excised to make an approximately 2 mm gap. A piece of the sponge-like freeze-dried sheet created by covalent cross-linking of ALG gel combined with PGA mesh was placed over the gap to cover each stump without any neural anastomosis. We compared erectile functions in the ALG groups with those in the sham group and the bilateral nerve excision group (n = 12, each). MAIN OUTCOME MEASURES: Main outcome measure was a rat model with cavernous nerve excision. RESULTS: All rats in the sham group had erection at 63 or 64 days, and mating behavior was confirmed in 10 rats (83.3%) of the sham group at 56 to 62 days. No erection and mating behavior was observed in the excision group. Ten of the 12 (83.3%) rats in the ALG group had a mating behavior and an erection, and the rates of erection and mating behavior were significantly higher in the ALG group than those in the excision group (P < .01, P < .01, respectively). Using a retrograde FluoroGold, the rate of FluoroGold positive pelvic ganglia proximal to the gap at 61 or 62 days was significantly higher in the ALG group than that in the excision group (P = .014). CONCLUSION: The results of our animal study have demonstrated that simply filling the cavernous nerve gap using the non-tubular artificial nerve sheets made of ALG with PGA mesh restored erectile function after cavernous nerve excision. Narita S, Obara T, Ishikawa N, et al. Cavernous Branched Nerve Regeneration Using Non-Tubular Artificial Nerve Sheets Using Freeze-Dried Alginate Gel Combined With Polyglycolic Acid Mesh in a Rat Model. Sex Med 2021;9:100308.
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Inokuchi J.
International Journal of Urology ( International Journal of Urology ) 28 ( 2 ) 208 - 214 2021年02月
OBJECTIVES: To investigate the impact on intravesical recurrence and prognosis according to the ureteral ligation timing during radical nephroureterectomy for upper urinary tract urothelial carcinoma. METHODS: We carried out a retrospective chart review of 664 patients with non-metastatic upper urinary tract urothelial carcinoma who underwent radical nephroureterectomy with ureteral ligation (supplementary analysis of JCOG1110A). We excluded patients with previous and/or synchronous bladder cancer, clinically node-positive disease, no ureteral ligation data, those without ureteral ligation and those with any missing data. We investigated the cumulative incidence of intravesical recurrence and cancer-specific mortality, and overall survival between patients with ureteral ligation before renovascular ligation (early ureteral ligation), or ureteral ligation after renovascular ligation (late ureteral ligation). RESULTS: Early and late ureteral ligation was carried out in 243 patients (36.6%) and 421 patients (63.4%), respectively. Intravesical recurrence occurred in 218 patients (32.8%) during follow up (median 3.9 years). No significant difference in the intravesical recurrence was found between early and late ureteral ligation groups. Meanwhile, survival in the early ureteral ligation group was significantly worse compared with the late ureteral ligation group. Multivariable analysis showed that early ureteral ligation was an independent prognostic factor for overall survival (hazard ratio 1.88, 95% confidence interval 1.24-2.85, P = 0.003) and cancer-specific mortality (hazard ratio 1.93, 95% confidence interval 1.14-3.25, P = 0.014). CONCLUSIONS: Our findings suggest that the incidence of intravesical recurrence is not affected by the timing of ureteral ligation during radical nephroureterectomy. However, early ureteral ligation might have a negative impact on survival outcomes.
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Validated prognostic significance of YB-1 genetic variation in metastatic prostate cancer
Shiota M.
Pharmacogenomics Journal ( Pharmacogenomics Journal ) 21 ( 1 ) 102 - 105 2021年02月
Genetic polymorphism in YB-1 was previously shown to be associated with the prognosis of advanced prostate cancer patients treated with primary androgen-deprivation therapy. However, the significance of this polymorphism remains invalidated. In this study, we aimed to validate the prognostic significance of the YB-1 genetic polymorphism in metastatic prostate cancer. This study included 79 Japanese patients who were diagnosed as metastatic prostate cancer between 2000 and 2016. Genomic DNA was obtained from patient whole blood samples, and genotyping on YB-1 (rs12030724) was performed by PCR-based technique. The association of genotype in YB-1 with clinicopathological parameters and oncological outcome, including progression-free survival and overall survival, was examined. Homozygous wild-type (AA), heterozygous variant (AT), and homozygous variant (TT) were identified in 47 (59.5%), 26 (32.9%) and 6 patients (7.6%), respectively. Heterozygous/homozygous variant (AT/TT) in YB-1 was significantly associated with lower progression risk compared with homozygous wild-type (AA) (hazard ratio = 0.52; 95% confidence interval = 0.30-0.88, P = 0.015). Consistent with this finding, heterozygous/homozygous variant (AT/TT) in YB-1 was significantly associated with lower risk of any-cause mortality compared with homozygous wild-type (AA) (hazard ratio = 0.46; 95% confidence interval = 0.21-0.93, P = 0.031). Gene polymorphism in YB-1 rs12030724 was validated to be a promising predictive biomarker of androgen-deprivation therapy in metastatic prostate cancer to identify patients requiring more intensive therapeutics.
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生体腎移植の手術中にアナフィラキシーを発症した1例
提箸 隆一郎, 齋藤 満, 佐藤 滋, 羽渕 友則
日本臨床腎移植学会プログラム・抄録集 ( (一社)日本臨床腎移植学会 ) 54回 165 - 165 2021年02月
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秋田大学での免疫学的リスク別免疫抑制プロトコールの評価
山本 竜平, 齋藤 満, 藤山 信弘, 提箸 隆一郎, 齋藤 拓郎, 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
日本臨床腎移植学会プログラム・抄録集 ( (一社)日本臨床腎移植学会 ) 54回 201 - 201 2021年02月
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腎移植患者におけるウイルス感染症の注意点 腎移植におけるCMV感染症は未だに要注意 長期生着との関連から
齋藤 満, 佐藤 滋, 藤山 信弘, 提箸 隆一郎, 嘉島 相輝, 山本 竜平, 奈良 健平, 沼倉 一幸, 成田 伸太郎, 羽渕 友則
日本臨床腎移植学会プログラム・抄録集 ( (一社)日本臨床腎移植学会 ) 54回 117 - 117 2021年02月
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Kido K.
International Journal of Clinical Oncology ( International Journal of Clinical Oncology ) 26 ( 1 ) 154 - 162 2021年01月
BACKGROUND: This study compared real-world outcomes of metastatic renal-cell carcinoma (mRCC) patients treated with tyrosine kinase inhibitors or nivolumab plus ipilimumab. METHODS: Using the International mRCC Database Consortium (IMDC), we retrospectively evaluated intermediate- and poor-risk mRCC patients who were treated with nivolumab plus ipilimumab (Nivo-Ipi), tyrosine kinase inhibitors (TKIs) as the first-line therapy between August 2015 and January 2020. We compared oncological outcomes between the Nivo-Ipi group and TKIs group using multivariate logistic regression analysis with the inverse probability of treatment weighting (IPTW) method. RESULTS: In this study 278 patients were included. There were 52 and 226 patients in the Nivo-Ipi and TKIs groups (sunitinib 97, axitinib 118, sorafenib 9, pazopanib 2), respectively. The median age in the Nivo-Ipi and TKIs groups were 69 and 67 years, respectively. There was no significant difference in age, performance status, history of nephrectomy, and the IMDC risk group distribution between the groups. The objective response rate was significantly higher in the Nivo-Ipi group (38%) than in the TKIs group (23%, P = 0.018). The IPTW-adjusted Cox regression analysis showed that a significantly longer progression-free survival (hazard ratio 0.60, P = 0.039) and overall survival (hazard ratio 0.51, P = 0.037) rates in the Nivo-Ipi group than those in the TKIs group. CONCLUSIONS: The oncological outcomes of patients receiving the first-line therapy of nivolumab plus ipilimumab in real-world practice were significantly improved in comparison with first-line TKIs therapy.
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Narita T.
Translational Andrology and Urology ( Translational Andrology and Urology ) 10 ( 1 ) 417 - 425 2021年01月
BACKGROUND: The clinical benefit of the combined androgen blockade (CAB) therapy over luteinizing hormone-releasing hormone analog (LH-RHa) monotherapy for hormone naïve metastatic prostate cancer (mHNPC) is unclear. Therefore, we retrospectively compare the effectiveness of CAB with the LH-RHa monotherapy on the prognosis of Japanese patients with mHNPC. METHODS: We retrospectively evaluated the prognosis of 517 patients diagnosed with mHNPC between August 2001 and May 2017. The patients' data were obtained from the Michinoku Urological Cancer Research Group database and Hirosaki University-related hospitals. Patients were divided into the CAB and LH-RHa monotherapy groups based on primary androgen deprivation therapy (ADT). Overall survival (OS), cancer-specific survival (CSS), and castrate-resistant prostate cancer-free survival (CRPC-FS) were compared between the two groups using the Kaplan-Meier curve analysis. Inverse probability of treatment weighting (IPTW)-adjusted Cox hazard proportional analyses was performed to investigate the effect of primary ADT on oncological outcomes. RESULTS: The median age was 73 years old. The numbers of patients in the CAB and LH-RHa monotherapy groups were 447 and 70, respectively. The Kaplan-Meier curve analysis showed no significant differences in either 5-year OS (56.7% vs. 52.5%, P=0.277), CSS (61.1% vs. 56.4%, P=0.400), and CRPC-FS (33.1% vs. 31.1%, P=0.529) between the groups. IPTW-adjusted multivariate Cox hazard proportional analyses showed no significant differences in OS, CSS, and CRPC-FS between the two groups. CONCLUSIONS: No significant differences in oncological outcomes were observed between the CAB and LH-RHa monotherapy groups in patients with mHNPC.
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Iwamura H.
International Journal of Urology ( International Journal of Urology ) 28 ( 1 ) 125 - 127 2021年01月
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ロボット支援腎部分切除術における腎実質縫合の有無による術後腎実質体積のCT volumetryを用いた比較検討
提箸 隆一郎, 井上 高光, 中島 志織, 嘉島 相輝, 山本 竜平, 小泉 淳, 奈良 健平, 神田 壮平, 沼倉 一幸, 齋藤 満, 成田 伸太郎, 佐藤 滋, 羽渕 友則
Japanese Journal of Endourology ( 日本泌尿器内視鏡学会 ) 34 ( 1 ) 130 - 135 2021年
<p>【目的】ロボット支援腎部分切除術 (RAPN) における腎実質縫合の追加が術後の腎実質体積を減少させるかを画像解析ソフトにより検討した. また腎機能, 合併症への影響も検討した.</p><p>【対象と方法】2013年11月から2018年11月までに当科でRAPNを行ったT1a症例69例のうち, 腎実質縫合を施行した26例 (実質縫合群) と省略した43例 (非縫合群) を後方視的に比較した. Synapse Vincent ver. 4を用いて, 術前と術後6カ月の造影CTから腎実質減少体積を推定した.</p><p>【結果】2群間の患者背景や手術成績に有意差はなかった. 腎実質体積の減少量やeGFRの低下率, 合併症の発生率に有意差を認めなかった.</p><p>【結語】RAPNにおける腎実質縫合の追加は腎実質体積や腎機能, 合併症の発生に影響しなかった.</p>
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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 ( 日本泌尿器内視鏡学会 ) 34 ( 2 ) 318 - 322 2021年
<p> 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.</p><p> 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.</p><p> 手術時間の中央値は308分, 推定出血量の中央値は63 mL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.</p><p> 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.</p>