研究等業績 - その他 - 羽渕 友則
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Inoue T.
Urology ( Urology ) 167 158 - 164 2022年
OBJECTIVE: To compare the therapeutic effect of Bacille Calmette-Guérin (BCG) intravesical instillation in older and younger patients with high-risk non-muscle-invasive bladder cancer. The comparison was performed with propensity score matching (PSM) without terminating the death of the older patients using relatively large-scale retrospective data from multiple institutes in Japan. MATERIALS AND METHODS: Overall, 3283 patients diagnosed with non-muscle-invasive bladder cancer treated with intravesical BCG instillation during 2000-2018 in 31 institutes were examined; 1437 and 602 patients with high-grade T1 and Tis tumors were divided into those aged ≥75 and <75 years. Multivariate analysis using the Fine-Gray competing risks regression model before PSM and survival analysis using the cumulative incidence method after PSM were performed. RESULTS: In the pre-PSM series of high-grade T1 tumors, age ≥75 years was an independent prognostic factor for both recurrence and progression in multivariate analysis (P = .015 and P = .013). In the pre-PSM series with Tis tumor, no variables to predict recurrence and progression was found. In the post-PSM series of 870 high-grade T1 tumors, cumulative probability of recurrence after BCG intravesical instillation were significantly higher in patients aged ≥75 years than in those aged <75 years (P = .008). The frequency of discontinuation of BCG instillation in patients aged ≥75 years with high-grade T1 and Tis was not significantly different from those in patients aged <75 years (P = .564 and P = .869). CONCLUSION: The cumulative probability of recurrence after intravesical BCG instillation was significantly higher in older than in younger patients with high-grade T1 bladder cancer.
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Sobu R.
Cancer Medicine ( Cancer Medicine ) 12 ( 4 ) 4100 - 4109 2022年
It remains unknown whether the early response to vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR-TKI) management in malignancies links to long-term survival. The objective of this study was to investigate the survival rates and predictive factors of early response in patients with metastatic renal cell carcinoma (mRCC) managed by VEGFR-TKIs. From Jan. 2008 to Oct. 2018, 496 patients were treated with VEGFR-TKIs as first-line treatment at the eight Japanese hospitals (Michinoku RCC). Early cessation was defined as VEGFR-TKIs being given up within 3 months after their initiation. The number of patients in early cessation VEGFR-TKIs (Cohort I) was 173 (34.9%), and in long-term use (Cohort II) was 323 (65.1%). The cancer-specific survival (CSS) and overall survival (OS) were better in Cohort II. IMDC Poor-risk was at risk of early cessation of a first-line VEGFR-TKI. Axitinib was the most preferred drug for long-term treatment. On closer examination, both Cohort I and II were divided into two groups, the patients ceased VEGFR-TKI due to adverse events (Group A [67 from Cohort I] and Group C [51 from Cohort II]) and disease progression (Group B [106 from Cohort I] and Group D [272 from Cohort II]). Despite that the cessation was adverse events, CSS and OS in Group A were worse than both Group C and D. Axitinib was administered with the safer profile. IMDC Poor risk was the risk factor for the early disease progression. Managing early adverse events may contribute to a better prognosis in mRCC patients treated VEGFR-TKIs.
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Yanagisawa T.
World Journal of Urology ( World Journal of Urology ) 41 ( 8 ) 2051 - 2062 2022年
PURPOSE: The aim of this study was to investigate the oncologic efficacy of combining docetaxel with androgen deprivation therapy (ADT) versus nonsteroidal antiandrogen (NSAA) with ADT in patients with high-volume metastatic hormone-sensitive prostate cancer (mHSPC) with focus on the effect of sequential therapy in a real-world clinical practice setting. METHODS: The records of 382 patients who harbored high-volume mHSPC, based on the CHAARTED criteria, and had received ADT with either docetaxel (n = 92) or NSAA (bicalutamide) (n = 290) were retrospectively analyzed. The cohorts were matched by one-to-one propensity scores based on patient demographics. Overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), including time to castration-resistant prostate cancer (CRPC), and time to second-line progression (PFS2) were compared. 2nd-line PFS defined as the time from CRPC diagnosis to progression after second-line therapy was also compared. RESULTS: After matching, a total of 170 patients were retained: 85 patients treated with docetaxel + ADT and 85 patients treated with NSAA + ADT. The median OS and CSS for docetaxel + ADT versus NSAA + ADT were not reached (NR) vs. 49 months (p = 0.02) and NR vs. 55 months (p = 0.02), respectively. Median time to CRPC and PFS2 in patients treated with docetaxel + ADT was significantly longer compared to those treated with NSAA (22 vs. 12 months; p = 0.003 and, NR vs. 28 months; p < 0.001, respectively). There was no significant difference in 2nd-line PFS between the two groups. CONCLUSIONS: Our analysis suggested that ADT with docetaxel significantly prolonged OS and CSS owing to a better time to CRPC and PFS2 in comparison to NSAA + ADT in high-volume mHSPC.
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Numakura K.
European Urology Focus ( European Urology Focus ) 8 ( 6 ) 1666 - 1672 2022年
BACKGROUND: Although bacillus Calmette-Guerin (BCG) is a standard treatment for high-risk non-muscle-invasive bladder cancer (NMIBC), a high rate of adverse events with a variety of grades remains a difficulty. OBJECTIVE: In this randomized, prospective, multicenter study, we examined whether levofloxacin, given after each intravesical instillation of BCG, could improve its tolerance in patients with intermediate- to high-risk urothelial carcinoma of the bladder without compromising its efficacy. DESIGN, SETTING, AND PARTICIPANTS: Overall, 106 Japanese patients (85 men and 21 women; age: median, 69.5 yr) with primary or recurrent NMIBC were randomized after transurethral resection to induce treatment with intravesical BCG plus levofloxacin (group 1) or BCG alone (group 2). INTERVENTION: Patients who underwent intravesical instillation of BCG were randomized with or without levofloxacin administration. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Adverse events were assessed using the National Cancer Institute-Common Toxicity Criteria version 3.0. Cumulative incidence functions and Kaplan-Meier methods were applied to estimate survival outcomes. RESULTS AND LIMITATIONS: There was no significant difference in baseline characteristics between the groups. The completion rate of group 1 (85.5%) was not significantly lower than that of group 2 (76.5%; p = 0.321). There was no significant difference in the completion rate of patients with pollakisuria, painful micturition, gross hematuria, fever elevation, and others between the groups. The incidence of adverse events in patients with high-grade pollakisuria (7.3% vs 25.4%, p = 0.041) and fever (0% vs 9.1%, p = 0.034) was significantly lower in group 1. The 5-yr progression-free and cancer-specific survival rates were significantly better in group 1. CONCLUSIONS: Prophylactic levofloxacin administration may reduce the severity of adverse events and contribute to better outcomes from BCG intravesical therapy in patients with NMIBC. PATIENT SUMMARY: Levofloxacin administration seems to be a safe and effective therapy for non-muscle-invasive bladder cancer patients treated with bacillus Calmette-Guerin intravesical therapy.
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Takahashi S.
Cancer Science ( Cancer Science ) 113 ( 12 ) 4059 - 4069 2022年
Human leukocyte antigen class I (HLA-I) genotypes are suggested to influence the cancer response to checkpoint blockade immunotherapy. This study assessed the impact of germline HLA genotypes on clinical outcomes in patients with chemoresistant advanced urothelial cancer (UC) treated with pembrolizumab. Zygosity, supertypes, evolutionary divergency, and specific alleles of germline HLA-I and -II were evaluated using the Luminex technique in 108 patients with chemoresistant metastatic or locally advanced UC treated with pembrolizumab. Among the 108 patients, 69 died and 83 showed radiographic progression during follow-up. Homozygous for at least one HLA-I locus, absence of the HLA-A03 supertype, and high HLA-I evolutionary divergence were associated with a radiographic response, but were not associated with survival outcomes. Patients with the HLA-DQB1*03:01 allele had significantly lower disease control rates than patients without the allele (17.4% vs. 53.8%, p = 0.002); its presence was also an independent risk factor for progressive disease (hazard ratio 4.35, 95% confidence interval 1.03-18.46). Furthermore, patients with the HLA-DQB1*03:01 allele had significantly worse progression-free survival than patients without the allele (median progression-free survival 3.1 vs. 4.8 months, p = 0.035). There was no significant relationship between any HLA status and the incidence of severe adverse events. Several germline HLA genotypes, especially HLA-DQB1*03:01, may be associated with radiographic progression. However, their impact on treatment response is limited, and germline HLA genotypes was not independently associated with survival outcomes. Further prospective studies are needed to confirm the relationship between germline HLA genotypes and clinical outcomes in patients with chemoresistant advanced UC treated with pembrolizumab.
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Takahashi Y.
European Journal of Clinical Pharmacology ( European Journal of Clinical Pharmacology ) 79 ( 1 ) 89 - 98 2022年
PURPOSE: We assessed the impact of plasma trough concentrations of abiraterone (ABI) and its metabolite Δ4-abiraterone (D4A) and related polymorphisms on adverse events (AEs) in patients with metastatic prostate cancer who received abiraterone acetate (AA). METHODS: This prospective study enrolled patients with advanced prostate cancer treated with AA between 2016 and 2021. Plasma trough concentrations of ABI and D4A were measured using high-performance liquid chromatography. The impact of HSD3B1 rs1047303, SRD5A2 rs523349, and cytochrome P450 family 3A member 4 rs2242480 polymorphisms on plasma concentrations of ABI and D4A and the incidence of AEs were also assessed. RESULTS: In 68 patients treated with AA, the median ABI and D4A concentrations were 18.1 and 0.94 ng/mL, respectively. The high plasma trough concentration of ABI (≥ 20.6 ng/mL) was significantly associated with the presence of any AE and its independent risk factor based on multivariable analysis (odds ratio, 7.20; 95% confidence interval (CI): 2.20-23.49). Additionally, a high plasma trough concentration of ABI was an independent risk factor of time to withdraw AA (hazard ratio, 4.89; 95% CI: 1.66-14.38). The risk alleles of three polymorphisms were not statistically associated with the ABI and D4A concentrations and the incidence of AEs. CONCLUSIONS: The plasma trough concentration of ABI is associated with the presence of AEs and treatment failure after AA administration. ABI concentration monitoring may be useful in patients with prostate cancer who received AA.
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「特集２．内分泌臓器・腫瘍に対するロボット支援手術の国内外の現況と展望」によせて
羽渕 友則
日本内分泌・甲状腺外科学会雑誌 ( 日本内分泌外科学会・日本甲状腺外科学会 ) 39 ( 1 ) 28 - 28 2022年
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後腹膜・骨盤腔内の内分泌腫瘍に対するロボット支援手術
奈良 健平, 沼倉 一幸, 羽渕 友則
日本内分泌・甲状腺外科学会雑誌 ( 日本内分泌外科学会・日本甲状腺外科学会 ) 39 ( 1 ) 44 - 48 2022年
<p>後腹膜腫瘍・骨盤腔内の内分泌腫瘍に対するロボット支援手術は，従来の開放手術と比較しても，術後の早期回復が期待でき，より低侵襲な治療となる可能性がある。しかし，現時点では症例報告がほとんどでエビデンスに乏しい。腫瘍の生物学的な特質や解剖学的な位置関係などから，開放手術を選択するなどケースバイケースの対応が求められるが，今後の症例の蓄積によって，後腹膜腫瘍・骨盤腔内の内分泌腫瘍に対するロボット支援手術の適応の拡大と術中や術後短期・長期の成績向上が期待される。</p>
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秋田大学医学部附属病院における生体腎移植希望者が腎移植に至らなかった理由の検討
瀬田川 美香, 齋藤 満, 藤山 信弘, 山本 竜平, 羽渕 友則, 伊藤 歩, 相庭 結花, 桂田 歩, 夏井 遼
移植 ( 一般社団法人 日本移植学会 ) 57 ( Supplement ) s277_1 - s277_1 2022年
<p>【はじめに】秋田大学医学部附属病院泌尿器科で、1998年～2021年10月までで生体腎移植を希望して術前検査を開始したドナー・レシピエントのペアは計555組であった。今回、当院での生体腎移植希望者が腎移植に至らなかった理由および詳細を明らかにすることを目的に本調査を行った。</p><p>【方法】当院での生体腎移植希望者の中で、移植に至らなかった腎移植ドナー・レシピエント148組の外来カルテから腎移植に至らなかった理由を抽出し、それぞれカテゴリ化して分析した。</p><p>【結果】腎移植に至らなかった理由としてドナー要因が82件（55.8％）、レシピエント要因が53件（36.1％）とドナー要因の方が多かった。ドナー要因としては「採血・採尿検査結果」、レシピエント要因としては「全身状態不良」「抗体陽性で拒絶リスクが高い」が最多であった。腎移植に至らなかったペアにおけるドナー候補とレシピエント候補との関係性によって腎移植不施行の理由は異なっていた。【考察】腎移植に至らなかった理由はペアの属性により腎移植不施行の理由により異なるため、対象に合わせた検査の順番が必要になる可能性がある。また、腎提供の意思がないドナー候補がいた場合に外来で対応できる体制構築が必要と考える。</p><p>【結論】当院での生体腎移植希望者のうち腎移植に至らなかった理由として、ドナー要因の方がレシピエント要因よりも多かった。各ペアの特徴にあわせた検査順序の検討が必要かもしれない。</p>
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秋田大学における腎移植後貧血に対するHIF-PH阻害薬の初期使用経験
山本 竜平, 齋藤 満, 青山 有, 藤山 信弘, 提箸 隆一郎, 小林 瑞貴, 嘉島 相輝, 奈良 健平, 沼倉 一幸, 成田 伸太郎, 羽渕 友則
移植 ( 一般社団法人 日本移植学会 ) 57 ( Supplement ) s233_2 - s233_2 2022年
<p>【目的】腎移植後貧血(PTA)に対する治療は長年エリスロポエチン製剤 (ESA)が主体であったが、ESA抵抗性貧血を呈する症例も存在する。近年、ESA抵抗性PTAに対するHypoxia Inducible Factor-Prolyl Hydroxylase (HIF-PH)阻害薬の有効性が報告されている。当院ではHIF-PH阻害薬の適応をESA高用量でも貧血が改善しない症例、および受診間隔延長によりESAの効果が乏しい症例としている。今回、当院でHIF-PH阻害薬を使用した20例について検討をおこなった。</p><p>【対象と方法】腎移植後に当院でHIF-PH阻害薬投与歴のある20例を対象とし、HIF-PH阻害薬投与投与開始後前の背景や投与開始後の臨床因子を後方視的に検討した。</p><p>【結果】年齢平均値50歳、男性８例、女性12例、移植後平均年数は6.9年、19例がESAからの切り替えであった。開始後1、3、6ヶ月時点で投与継続中の症例はそれぞれ18、10、6例であり、有害事象で投与中止となった症例は２例でいずれも消化器症状であった。また１例は悪性腫瘍の発症により中止となった。HIF-PH阻害薬開始前の平均ヘモグロビン(Hb)値9.4 g/dL、平均血清Fe値96μg/dL、平均TSAT38.6％、平均フェリチン値203ng/ml であった。1、3、6ヶ月継続症例の平均Hbはそれぞれ9.6、10.6、10.8 g/dLであり、3、6ヶ月継続時点で有意な増加を認めた(p<0.05)。平均血清鉄値に有意な変化はみられなかったが、TSATは1、3、6ヶ月継続群すべてで上昇を認め、フェリチン値は3、6ヶ月継続群で減少傾向であった。</p><p>【結語】ESA抵抗性PTA症例において、HIF-PH阻害薬の導入により鉄利用能改善さらには貧血の改善が期待できる。</p>
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生体腎移植におけるBKポリオーマウィルス関連腎症発症の危険因子の検証
提箸 隆一郎, 齋藤 満, 浦山 健, 青山 有, 山本 竜平, 藤山 信弘, 羽渕 友則
移植 ( 一般社団法人 日本移植学会 ) 57 ( Supplement ) s363_1 - s363_1 2022年
<p>【緒言】BKポリオ―マウイルス関連腎症（BKPyVAN）は腎移植患者の約10%に発症し、その約半数が短期間で移植腎廃絶に至る。BKPyVANに対し効率の良いスクリーニングを行うためには、そのハイリスク群を抽出するためのバイオマーカーの発見が必要である。</p><p>【対象と方法】2004年7月から2019年12月末に当院で生体腎移植を受けたレシピエントとそのドナーの247組を対象とし、BKPyVAN発症の危険因子を後方視的に検討した。また、先行研究の追試を行うべく、保存血清を用いてレシピエントとドナーの移植前抗BKPyV抗体価をELISA法で測定し、BKPyVAN発症との関連を検討した。</p><p>【結果】8組（3.2%）でBKPyVAN発症を認め、BKPyVAN群のdeath-censored graft survivalは非発症群と比べ有意に低かった（p=0.024）。背景因子等についての検討では、レシピエントとドナーの移植時年齢や性別、免疫学的リスク、ステロイドパルス療法の有無によるBKPyVAN発症への影響を認めなかった。抗体価に関する検討では、ドナーの抗体が陰性であった場合、ドナーとレシピエントのいずれかの抗体が強陽性であった場合はBKPyVANの発症を認めず、移植前抗体価とBKPyVAN発症に一定の傾向があることが示唆された。</p><p>【結語】ドナー・レシピエントの移植前抗BKPyV抗体価により、BKPyVANの発症リスクを予想することができる可能性がある。現在、他施設からも患者血清や臨床情報の供与をうけ、抗体価測定と解析を継続中である。</p>
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Altering phosphoinositides in high-fat diet-associated prostate tumor xenograft growth
Huang M.
MedComm ( MedComm ) 2 ( 4 ) 756 - 764 2021年12月
The metabolic reprogramming of phospholipids may affect intracellular signal transduction pathways. A high-fat diet (HFD) is attributed to prostate cancer (PCa) progression, but the expression pattern and role of phospholipids in HFD-mediated PCa progression remains unclear. In this study, HFD enhanced LNCaP xenograft tumor growth by upregulating the phosphatidylinositol (PI) 3-kinase (PI3K)/AKT signaling pathway. A lipidomic analysis using xenograft tumors showed that phosphoinositides, especially PI (3,4,5)-trisphosphate (PIP3), including several species containing C38:4, C38:3, and C40:4 fatty acids, increased in the HFD group compared to control. Fatty acid synthase (FASN) was significantly upregulated in xenograft tumors under HFD in both gene and protein levels. PCa cell growth was significantly inhibited through the decreased AKT signaling pathway by treatment with cerulenin, a chemical FASN inhibitor, which also downregulated PIP, PIP2, and PIP3 but not PI. Thus, dietary fat influences PCa progression and alters phosphoinositides, especially PIP3, a critical player in the PI3K/AKT pathway. These results may offer appropriate targets, such as FASN, for dietary intervention and/or chemoprevention to reduce PCa incidence and progression.
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Yoneyama T.
Prostate ( Prostate ) 81 ( 16 ) 1411 - 1427 2021年12月
BACKGROUND: The presence of glycosylated isoforms of prostate-specific antigen (PSA) in prostate cancer (PC) cells is a potential marker of their aggressiveness. We characterized the origin of α2,3-sialylated prostate-specific antigen (S23PSA) by tissue-based sialylation-related gene expression and studied the performance of S23PSA density (S23PSAD) alone and in combination with multiparametric magnetic resonance imaging (MRI) for the detection of clinically significant prostate cancer in men with elevated PSA. METHODS: Tissue-based quantification of S23PSA and sialyltransferase and sialidase gene expression was evaluated in 71 radical prostatectomy specimens. The diagnostic performance of S23PSAD was studied in 1099 men retrospectively enrolled in a multicenter systematic biopsy (SBx) cohort. We correlated the S23PSAD with Prostate Imaging Reporting and Data System (PI-RADS) scores in 98 men prospectively enrolled in a single-center MRI-targeted biopsy (MRI-TBx) cohort. The primary outcome was the PC-diagnostic performance of the S23PSAD, the secondary outcome was the avoidable biopsy rate of S23PSAD combined with DRE and total PSA (tPSA), and with or without PI-RADS. RESULTS: S23PSA was significantly higher in Gleason pattern 4 and 5 compared with benign prostate tissue. In the retrospective cohort, the performance of S23PSAD for detecting PC was superior to tPSA or PSA density (PSAD) (AUC: 0.7758 vs. 0.6360 and 0.7509, respectively). In the prospective cohort, S23PSAD was superior to tPSA, PSAD, and PI-RADS (AUC: 0.7725 vs. 0.5901, 0.7439 and 0.7305, respectively), and S23PSAD + PI-RADS + DRE + tPSA was superior to DRE + tPSA+PI-RADS with avoidance rate of MRI-TBx (13% vs. 1%) at 30% risk threshold. CONCLUSIONS: The diagnostic performance of S23PSAD was superior to conventional strategies but comparable to mpMRI.
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Okita K.
Urologic Oncology: Seminars and Original Investigations ( Urologic Oncology: Seminars and Original Investigations ) 39 ( 12 ) 836.e11 - 836.e17 2021年12月
OBJECTIVES: This study aims to evaluate the utility of the scoring system of the Registry for Metastatic Renal Cell Carcinoma (REMARCC) model on the overall survival (OS) of patients undergoing cytoreductive nephrectomy (CN). METHODS: A total of 278 patients with primary metastatic renal cell carcinoma (mRCC) treated with first-line tyrosine kinase inhibitors (TKIs) between January 2008 and November 2019 were identified. The c-index and net benefit between the REMARCC score were compared with the International mRCC Database Consortium (IMDC) score in patients with CN (CN group, n = 146). The effect of the REMARCC score on OS was compared between the CN group and patients without CN (non-CN group, n = 132) using Cox regression analysis under the propensity score-based inverse probability of treatment weighting (IPTW) method to adjust for group imbalances. RESULTS: Of the 146 patients with CN, the c-index of the REMARCC model (0.60) was higher than the IMDC model (0.54). The decision curve analysis showed the advantage of REMARCC model predicting OS compared with the IMDC model. OS was significantly longer in the REMARCC low-score (0-2) than that in the high-score (3-6) among the patients with CN. IPTW-adjusted Cox regression analyses showed that OS was significantly longer in the CN group than that in the non-CN group among the patients with REMARCC low-score but was not significantly different between the groups among the patients with REMARCC high-score. CONCLUSIONS: The REMARCC score may be active for selecting the CN candidate in patients treated with TKIs.
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Soria F.
BJU International ( BJU International ) 128 ( 6 ) 734 - 743 2021年12月
OBJECTIVES: To compare the oncological outcomes of patients with upper tract urothelial carcinoma (UTUC) undergoing kidney-sparing surgery (KSS) with fibre-optic (FO) vs digital (D) ureteroscopy (URS). To evaluate the oncological impact of image-enhancement technologies such as narrow-band imaging (NBI) and Image1-S in patients with UTUC. PATIENTS AND METHODS: The Clinical Research Office of the Endourology Society (CROES)-UTUC registry is an international, multicentre, cohort study prospectively collecting data on patients with UTUC. Patients undergoing flexible FO- or D-URS for diagnostic or diagnostic and treatment purposes were included. Differences between groups in terms of overall survival (OS) and disease-free survival (DFS) were evaluated. RESULTS: The CROES registry included 2380 patients from 101 centres and 37 countries, of whom 401 patients underwent URS (FO-URS 186 and D-URS 215). FO-URS were performed more frequently for diagnostic purposes, while D-URS was peformed when a combined diagnostic and treatment strategy was planned. Intra- and postoperative complications did not differ between the groups. The 5-year OS and DFS rates were 91.5% and 66.4%, respectively. The mean OS was 42 months for patients receiving FO-URS and 39 months for those undergoing D-URS (P = 0.9); the mean DFS was 28 months in the FO-URS group and 21 months in the D-URS group (P < 0.001). In patients who received URS with treatment purposes, there were no differences in OS (P = 0.9) and DFS (P = 0.7). NBI and Image1-S technologies did not improve OS or DFS over D-URS. CONCLUSIONS: D-URS did not provide any oncological advantage over FO-URS. Similarly, no differences in terms of OS and DFS were found when image-enhancement technologies were compared to D-URS. These findings underline the importance of surgeon skills and experience, and reinforce the need for the centralisation of UTUC care.
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Okamoto T.
BMC Cancer ( BMC Cancer ) 21 ( 1 ) 605 - 605 2021年12月
BACKGROUND: Anemia has been a known prognostic factor in metastatic hormone-sensitive prostate cancer (mHSPC). We therefore examined the effect of anemia on the efficacy of upfront abiraterone acetate (ABI) in patients with mHSPC. METHODS: We retrospectively evaluated 66 mHSPC patients with high tumor burden who received upfront ABI between 2018 and 2020 (upfront ABI group). We divided these patients into two groups: the anemia-ABI group (hemoglobin < 13.0 g/dL, n = 20) and the non-anemia-ABI group (n = 46). The primary objective was to examine the impact of anemia on the progression-free survival (PFS; clinical progression or PC death before development of castration resistant PC) of patients in the upfront ABI group. Secondary objectives included an evaluation of the prognostic significance of upfront ABI and a comparison with a historical cohort (131 mHSPC patients with high tumor burden who received androgen deprivation therapy (ADT/complete androgen blockade [CAB] group) between 2014 and 2019). RESULTS: We found that the anemia-ABI group had a significantly shorter PFS than the non-anemia-ABI group. A multivariate Cox regression analysis showed that anemia was an independent prognostic factor of PFS in the upfront ABI group (hazard ratio, 4.66; P = 0.014). Patients in the non-anemia-ABI group were determined to have a significantly longer PFS than those in the non-anemia-ADT/CAB group (n = 68) (P < 0.001). However, no significant difference was observed in the PFS between patients in the anemia-ABI and the anemia-ADT/CAB groups (n = 63). Multivariate analyses showed that upfront ABI could significantly prolong the PFS of patients without anemia (hazard ratio, 0.17; P < 0.001), whereas ABI did not prolong the PFS of patients with anemia. CONCLUSION: Pretreatment anemia was a prognostic factor among mHSPC patients who received upfront ABI. Although the upfront ABI significantly improved the PFS of mHSPC patients without anemia, its efficacy in patients with anemia might be limited.
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Sasagawa H.
Acta Urologica Japonica ( Acta Urologica Japonica ) 67 ( 12 ) 525 - 528 2021年12月
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笹川 甫, 沼倉 一幸, 中村 岳, 久木元 隆, 菊池 茜恵, 提箸 隆一郎, 山本 竜平, 小泉 淳, 奈良 健平, 神田 壮平, 齋藤 満, 成田 伸太郎, 井上 高光, 佐藤 滋, 羽渕 友則
泌尿器科紀要 ( 泌尿器科紀要刊行会 ) 67 ( 12 ) 525 - 528 2021年12月
A 46-year-old woman was referred to our hospital with a left-sided renal tumor pointed out by ultrasonography at the time of a medical checkup．Computed tomography revealed a mass measuring 88×77×68 mm on the upper pole of the left kidney. She was diagnosed with cT2aN0M0 clear cell renal cell carcinoma. Laparoscopic left nephrectomy was performed uneventfully. Histopathological diagnosis was clear cell renal cell carcinoma, G2, v1, pT2. Four months after surgery, lung metastases appeared, and systemic therapy was given sequentially as follows ; sunitinib for 2 months, nivolumab for 8 months, axitinib for 17 months, and pazopanib for 2 months．However, metastases progressed, and a re-administration of nivolumab was planned. The nivolumab re-treatment resulted in a marked reduction in multiple lung metastases despite the previous failure by nivolumab treatment. There are few reports on the therapeutic effect of re-administration of nivolumab. We report a case of successful treatment by re-administration of nivolumab.
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2種の免疫応答性マウスモデルにおける飽和脂肪酸が前立腺癌発症・進展に及ぼす影響
佐藤 博美, 成田 伸太郎, 石田 雅宣, 山本 竜平, 小泉 淳, 奈良 健平, 沼倉 一幸, 齋藤 満, 佐藤 滋, 吉岡 年明, 羽渕 友則
日本泌尿器科学会総会 ( (一社)日本泌尿器科学会総会事務局 ) 109回 PP13 - 01 2021年12月
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cT1a/cT1b腎癌に対するロボット支援腹腔鏡下腎部分切除術の比較検討
石田 雅宣, 小泉 淳, 嘉島 相輝, 山本 竜平, 奈良 健平, 沼倉 一幸, 齋藤 満, 成田 伸太郎, 佐藤 滋, 羽渕 友則
日本泌尿器科学会総会 ( (一社)日本泌尿器科学会総会事務局 ) 109回 OP33 - 04 2021年12月