Atsushi Imai

Frequency of postoperative inguinal hernia after endoscope-assisted mini-laparotomy and conventional retropubic radical prostatectomies

Objective:u2003 The objective of the present study was to compare the incidence of postoperative inguinal hernia between endoscope‐assisted mini‐laparotomy retropubic radical prostatectomy (mini‐lap RRP) with conventional techniques to identify possible risk factors.

Low-Dose Instillation Therapy with Bacille Calmette-Guérin Tokyo 172 Strain After Transurethral Resection: Historical Cohort Study

OBJECTIVESnTo evaluate the effectiveness and side effects of prophylactic low-dose bacille Calmette-Guérin (BCG) Tokyo 172 strain.nnnMETHODSnWe conducted a historical cohort study to compare the clinical usefulness of standard-dose versus low-dose BCG Tokyo 172 strain. A total of 156 patients with superficial bladder cancer (Stage Ta-T1) were historically allocated to either 40 or 80 mg of BCG after transurethral resection. Of the 156 patients, 89 had received standard-dose (80 mg) BCG from 1988 to 2000 and 67 had received low-dose (40 mg) BCG from 1996 to 2005. BCG was instilled into the bladder once a week for 6 consecutive weeks. We excluded 6 patients who did not complete the BCG treatment course. The median follow-up period was 66.9 months (range 2 to 176).nnnRESULTSnTumor recurrence developed in 21 (32.3%) of 65 patients in the 40-mg group and 29 (34.5%) of 85 patients in the 80-mg group. No significant difference was found in the incidence of tumor recurrence between the two groups (P = 0.6377). Tumor progression was found in 4 (6.2%) of 65 patients in 40-mg group and 9 (10.6%) of 85 patients in the 80-mg group. No significant difference was found in tumor progression between the two groups (P = 0.5010). The overall incidence of side effects and severity of pollakisuria were significantly lower in the 40-mg group than in the 80-mg group (P = 0.012 and P = 0.013, respectively).nnnCONCLUSIONSnThe low-dose BCG Tokyo 172 strain achieved identical recurrence-free and progression-free survival as the standard dose with reduced toxicity.

Neoadjuvant gemcitabine and carboplatin followed by immediate cystectomy may be associated with a survival benefit in patients with clinical T2 bladder cancer

Neoadjuvant cisplatin-based chemotherapy for muscle-invasive bladder cancer (MIBC) is more beneficial for clinical T3/4 than clinical T2 (cT2) disease. The aim of this study was to assess whether neoadjuvant GCarbo has a survival impact on cT2 bladder cancer. We retrospectively reviewed the medical records of 363 consecutive patients who underwent radical cystectomy (RC) between April 1997 and May 2012. We focused on 150 patients with cT2 MIBC. Seventy-nine patients received neoadjuvant GCarbo between March 2005 and April 2013. These patients received two courses of GCarbo and RC, and bilateral pelvic lymph node dissection (PLND) was performed at an interval of 1xa0month after chemotherapy. The control cohort included 71 patients with cT2 bladder cancer treated with RC and bilateral PLND alone between May 1994 and May 2007. Propensity score matching was used to adjust for potential selection biases associated with the treatment types. The endpoints were overall (OS), disease-specific (DSS), and disease-free survival (DFS). Propensity score-matched analysis resulted in 71 matched pairs from both groups. The 5-year OS rate was 98.6xa0% for the neoadjuvant GCarbo group and 66.6xa0% for the RC-alone group (pxa0<xa00.0001). The 5-year DSS rate was 100xa0% for the neoadjuvant GCarbo group and 69.7xa0% for the RC-alone group (pxa0<xa00.0001). The 5-year DFS rate was 94.2xa0% for the neoadjuvant GCarbo group and 72.7xa0% for the RC-alone group (pxa0<xa00.0001). In cT2 MIBC patients, neoadjuvant GCarbo chemotherapy followed by immediate cystectomy may improve OS and DFS compared to RC alone.

Significance of preoperative butyrylcholinesterase as an independent predictor of survival in patients with muscle-invasive bladder cancer treated with radical cystectomy

OBJECTIVESnButyrylcholinesterase (BChE) is an alpha-glycoprotein found in the nervous system and liver. Its serum level is reduced in many clinical conditions, such as liver damage, inflammation, injury, infection, malnutrition, and malignant disease. In this study, we analyzed the potential prognostic significance of preoperative BChE levels in patients with muscle-invasive bladder cancer (MIBC) undergoing radical cystectomy (RC).nnnMETHODS AND MATERIALSnWe retrospectively evaluated 327 patients with MIBC who underwent RC from 1996 to 2013 at a single institution. Serum BChE level was routinely measured before operation in all patients. Covariates included age, gender, preoperative laboratory data (anemia, BChE, lactate dehydrogenase, and C-reactive protein), clinical T (cT) and N stage (cN), tumor grade, and RC with/without neoadjuvant chemotherapy. Univariate and multivariate analyses were performed to identify clinical factors associated with overall survival (OS) and disease-free survival (DFS). Univariate analyses were performed using the Kaplan-Meier and log-rank methods, and the multivariate analysis was performed using a Cox proportional hazard model.nnnRESULTSnThe median BChE level was 187 U/l (normal range: 168-470 U/l). The median age of the enrolled patients was 69 years, and the median follow-up period was 51 months. The 5-year OS and DFS rates were 69.6% and 69.3%, respectively. The 5-year OS rates were 90.1% and 51.3% in the BChE ≥ 168 and<168 U/l groups, respectively (P<0.001). The 5-year DFS rates were 83.5% and 55.4% in the BChE ≥ 168 and ≤167 U/l groups, respectively (P<0.001). In the univariate analysis, BChE, cT, cN, and RC with/without neoadjuvant chemotherapy were significantly associated with both OS and DFS. Multivariate analysis revealed that BChE was the factor most significantly associated with OS, and BChE, cT, and cN were significantly associated with DFS.nnnCONCLUSIONSnThis study validated preoperative serum BChE levels as an independent prognostic factor for MIBC after RC.

Risk factors for erectile dysfunction in healthy Japanese men.

The aim of this study was to identify risk factors for erectile dysfunction (ED) in healthy men. A comprehensive risk factor investigation was carried out in a Japanese community. The subjects were 280 healthy male volunteers with an average age of 56 years (range: 20-83 years) who participated in the Iwaki Health Promotion Project in 2006. They were residents of Iwaki district, Hirosaki City, in northern Japan. The participants completed the five-item version of the International Index of Erectile Function (IIEF-5) and the International Prostate Symptom Score (I-PSS) surveys at the site of examination. We measured blood pressure and brachial-ankle pulse wave velocity (baPWV). We also measured risk factors for metabolic syndrome and sex hormones. We compared these risk factors with the IIEF-5 scores. Ninety-five participants (34%) scored 11 points or fewer on the IIEF-5 survey (severe/moderate ED), 154 (55%) scored 12-21 points (mild ED) and 31 (11%) scored 22 points or more (no ED). The prevalence of ED in the Japanese rural community was 89% (249/280). The severe/moderate ED group had significantly higher total I-PSS scores (p = 0.001), baPWV values (p < 0.001) and systolic blood pressure (p < 0.001) than the mild/no ED group. The same group had significantly lower free testosterone (p < 0.001) and dehydroepiandrosterone sulphate (p < 0.001) than the mild/no ED group. Logistic regression analysis revealed significant differences in baPWV (p = 0.003), total I-PSS (p = 0.015) and free testosterone (p = 0.003). Lower urinary tract symptoms, baPWV and free testosterone are independent risk factors for ED in healthy Japanese men.

Biochemical outcome of small-volume or insignificant prostate cancer treated with radical prostatectomy in Japanese population

BackgroundWe investigated the biochemical outcome of small-volume prostate cancers [tumor volume (TV)xa0<xa00.5xa0mL, SVCa] and insignificant prostate cancers (TV <0.5xa0mL without any Gleason pattern 4/5 elements, InsigCa) treated with radical prostatectomy.MethodsBetween April 2000 and May 2010, 609 patients with prostate cancer underwent radical prostatectomy at Hirosaki University Graduate School of Medicine. Of these, 237 were excluded from the study because of preoperative adjuvant therapy. The remaining 372 patients underwent routine histopathological and TV evaluations. Biochemical recurrence (BCR) was defined as the presence of prostate-specific antigen (PSA) levels greater than 0.2xa0ng/mL after prostatectomy.ResultsThe median patient age was 68xa0years (range 48–78xa0years) and the median preoperative PSA level was 7.50xa0ng/mL. The mean follow-up period was 45.9xa0months and the mean TV was 2.16xa0mL. Sixty patients (16.3%) had SVCa and 14 (3.7%) had InsigCa. The 5-year BCR-free survival rate for patients with SVCa was 67.3% and that for patients with a TV of 0.5 or greater was 87.1%. A significant difference was seen between the groups using the log-rank test (Pxa0=xa00.008). We could not identify any BCR in patients with InsigCa.ConclusionDespite the limited number of cases, patients with InsigCa did not develop BCR whereas 12.9% of those with SVCa developed BCR after radical prostatectomy within 5xa0years. Accurate prediction of the biochemical outcome of SVCa remains difficult and further studies are needed.

Significance of preoperative butyrylcholinesterase as an independent predictor of biochemical recurrence-free survival in patients with prostate cancer treated with radical prostatectomy

BackgroundButyrylcholinesterase (BChE) is an alpha-glycoprotein found in the nervous system and liver. Its serum level is reduced in many clinical conditions, such as liver damage, inflammation, injury, infection, malnutrition, and malignant disease. In this study, we analyzed the potential prognostic significance of preoperative BChE levels in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP).MethodsWe retrospectively evaluated 535 patients with PCa who underwent RP from 1996−2014 at a single institution. Serum BChE was routinely measured in all patients before operation. Covariates included age, preoperative laboratory data [prostate-specific antigen (PSA), hemoglobin, total protein, albumin, BChE, lactate dehydrogenase, C-reactive protein], clinical T, biopsy Gleason score, D’Amico risk classification, and RP with/without neoadjuvant therapy. Univariate and multivariate analyses were performed to identify clinical factors associated with biochemical recurrence-free survival (BRFS). Univariate analyses were performed using the Kaplan–Meier and log-rank methods, and multivariate analysis was performed using a Cox proportional hazard model.ResultsThe median BChE level was 255xa0U/L (normal range 168–470xa0U/L). The median age of the enrolled patients was 68xa0years, and the median PSA level at diagnosis of PCa was 8.39xa0ng/mL. The median follow-up period was 65xa0months. The 5-year BRFS rate was 72.9xa0%. The 5-year BRFS rates in the BChExa0≥168 andxa0≤ 167xa0U/L groups were 77.7 and 55.0xa0%, respectively (Pxa0<xa00.001). In univariate analysis, BChE, cT, biopsy Gleason score, and D’Amico risk classification were significantly associated with BRFS. Multivariate analysis revealed that BChE was significantly associated with BRFS.ConclusionsThis study validated preoperative serum BChE levels as an independent prognostic factor for PCa after RP.

Carboplatin-based combination chemotherapy for elderly patients with advanced bladder cancer

BackgroundWe evaluated retrospectively the feasibility and effectiveness of carboplatin-based combination chemotherapy in elderly patients with advanced bladder cancer.MethodsForty-seven patients with advanced bladder cancer (33 men and 14 women) and treated at our hospital between August 2004 and December 2011 were enrolled. The average age was 77.1xa0years (range 70–86xa0years), the average creatinine clearance was 37.0xa0ml/min (range 14.5–113.0xa0ml/min), and the average follow-up period was 17.4xa0months (range 10–55xa0months). Twenty-nine patients (61.7xa0%) were unfit for cisplatin-based chemotherapy. There were 15 recurrent cases after radical surgery and 32 inoperable cases. In this study, the first-line therapy was gemcitabine and carboplatin (GCarbo), with two courses as a set. The second-line therapy was GCarbo and docetaxel (GCarboD) if there was an insufficient response to the first-line therapy.ResultsOf the 47 patients who underwent GCarbo therapy, the response rate was 38.3xa0% (complete response plus partial response), with 5 and 13 patients exhibiting a complete response and a partial response, respectively. The average response duration was 15.7xa0months (range 2–42xa0months). The response rate of the nine patients who received GCarboD was 11.1xa0%, and the overall median survival was 15.0xa0months. Adverse events occurred in 30 patients (63.8xa0%) who underwent GCarbo therapy. Bone marrow suppression was observed in 30 patients (61.7xa0%), and digestive symptoms were observed in three patients (9.0xa0%).ConclusionOur study demonstrates that GCarbo is a safe and effective combination chemotherapy in elderly patients with advanced bladder cancer. However, the GCarboD regimen appears to have limited effectiveness for nonresponders to GCarbo therapy.

Post-transplant Renal Function and Cardiovascular Events Are Closely Associated With the Aortic Calcification Index in Renal Transplant Recipients

INTRODUCTIONnThe aortic calcification index (ACI) is reported to be closely associated with renal dysfunction and cardiovascular events; however, its implication in renal transplant recipients has not been well examined. In this study, we investigated the relationship between pretransplant ACI, ACI progression, post-transplant renal function, and post-transplant cardiovascular events in renal transplant recipients.nnnPATIENTS AND METHODSnThe study from June 1996 to Jan 2012 included 61 renal transplant recipients (living donors, 47; cadaveric donors, 14). The median follow-up period was 60 months. ACI was quantitatively measured on abdominal computed tomography. The relationship between age, dialysis period, estimated glomerular filtration rate (eGFR), and pre- and post-transplant ACI was longitudinally evaluated. Risk factors for post-transplant ACI progression were determined by logistic regression analysis. Patient background and the incidence of post-transplant cardiovascular events were also assessed.nnnRESULTSnThe pretransplant ACI (median 4.2%) significantly correlated with age at transplant, dialysis period, and diabetes mellitus. ACI gradually increased up to 2.8 times at 10 years after transplantation. Post-transplant eGFR significantly correlated with ACI progression in patients with chronic kidney disease of stage ≥ 3. Logistic regression analyses showed that age at transplantation, post-transplant period, cadaveric donors, and post-transplant chronic kidney disease stage 3 were risk factors for post-transplant ACI progression. The pretransplant ACI was higher (median 66%) in 3 patients who experienced post-transplant cardiovascular events.nnnCONCLUSIONSnACI progression closely correlates with age and post-transplant renal function. A high pretransplant ACI is a risk factor for post-transplant cardiovascular events in renal transplant recipients.

Efficacy of a neoadjuvant gonadotropin-releasing hormone antagonist plus low-dose estramustine phosphate in high-risk prostate cancer: a single-center study

PurposeThe optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) for high-risk Pca patients treated with neoadjuvant therapy comprising a luteinizing hormone-releasing hormone agonist plus low-dose estramustine (LHRHxa0+xa0EMP) prior to radical prostatectomy (RP). In the present study, we evaluated the efficacy of neoadjuvant therapy comprising a gonadotropin-releasing hormone antagonist plus low-dose estramustine phosphate (GnRHxa0+xa0EMP) in patients with high-risk Pca.MethodsBetween September 2005 and March 2016, we identified 406 high-risk Pca patients of whom 136 received neoadjuvant GnRHxa0+xa0EMP (GnRH group) and 270 received LHRHxa0+xa0EMP (LHRH group) before RP. We retrospectively evaluated the clinical and pathological covariates between the two groups. The endpoint was the rate of pathological T0 status.ResultsThe rates of pathological T0 status were 11.0 and 8.9% in the GnRH group and LHRH group, respectively (Pxa0=xa00.490). The 2-year BRFS rates were 97.8% in the GnRH group and 87.8% in the LHRH group (Pxa0=xa00.027).ConclusionOur findings suggest that neoadjuvant GnRH antagonistxa0+xa0EMP followed by RP may improve the pathological outcomes and reduce the risk of biochemical recurrence in patients with high-risk Pca. Further prospective studies to confirm these findings are warranted.