Hideto Iwamoto

Serum miR-210 as a potential biomarker of early clear cell renal cell carcinoma.

Early detection and treatment are critical in the management of renal cell carcinoma (RCC). However, there is no standard serum biomarker to facilitate early diagnosis or prognostic stratification in patients with RCC. Recent reports suggest that circulating microRNAs (miRNAs) have great potential as biomarkers for diagnosis and prognosis in patients with several types of cancers. Further, many studies using miRNA microarray analysis demonstrated that miR-210 expression in clear cell carcinoma (CCC), which is the largest subtype of RCC, was significantly upregulated in tumor tissue. Therefore, we investigated whether serum miR-210 could be a useful biomarker for the diagnosis and progression of CCC. This study included 34 CCC patients and 23 healthy controls (HC). First, we analyzed tissue miR-210 levels in tumor tissues and matched normal tissues from the 34 CCC patients. Second, we investigated the serum miR-210 levels in the 34 CCC patients and the 23 HC patients. Real-time polymerase chain reaction (PCR) was used to measure miRNA levels. Moreover, we examined the correlation between serum miR-210 levels and the clinicopathological parameters. Among patients with CCC, expression of miR-210 was higher in tumor tissues compared to normal tissues (P<0.001). Serum miR-210 levels were higher in CCC patients compared to HCs (P=0.001). Receiver operating characteristic (ROC) curve analysis showed an area under the ROC curve (AUC) of 0.77 (95% confidence interval, 0.65-0.89) and a sensitivity and specificity of 65 and 83%, respectively. In addition, there was no significant association between serum miR-210 levels and age, sex, tumor size or existence of metastasis at diagnosis among the 34 CCC patients. In conclusion, serum miR-210 upregulation may occur in the early stage of CCC and serum miR-210 can be a useful biomarker for early CCC in humans.

The significant immunological characteristics of peripheral blood neutrophil-to-lymphocyte ratio and Fas ligand expression incidence in nephrectomized tumor in late recurrence from renal cell carcinoma

OBJECTIVE In order to characterize the significance of immune system function in patients with advanced renal cell carcinoma (RCC), we investigated the interactive relationships among the following parameters: metastatic characteristics, expression of Fas ligand (FasL) in nephrectomized specimens, immunological parameters, and patients prognosis. MATERIALS AND METHODS Thirty-five patients with advanced RCC were stratified into 3 groups according to the characteristics of metastasis timing, at first presentation (mFP), within 5 years of nephrectomy (early-recurrence), after 5 years (late-recurrence). Immunological parameters [hemoglobin, lymphocyte count, neutrophil/lymphocyte ratio (NLR), serum albumin, Eastern Cooperative Oncology Group (ECOG) performance status (PS), and Charlson Comorbidity Index], FasL expression in RCC, and patient prognosis from occurrence of metastasis were compared among the groups. Thirty-five patients were also stratified into 2 groups according to FasL positivity and individual parameters. Patients prognosis and the remaining immunological parameters were compared between groups. RESULTS The NLRs of the late-recurrence group were significantly lower than those of the mFP (P = 0.0004) and early-recurrence (P = 0.013) groups. The FasL mRNA positivity of the late-recurrence group was significantly lower than those of the mFP (P = 0.001) and early-recurrence (P = 0.0277) groups. The prognosis of the late-recurrence group was significantly better than that of the early-recurrence group (P = 0.0255). NLRs were significantly lower in the FasL-negative group than in the -positive group (P = 0.0182). The cause-specific survival rates of the ECOG PS 0 group were significantly higher than that of the ECOG PS > 0 group (P < 0.0001). CONCLUSIONS Our results suggest the associations of the prognosis in advanced RCC with peripheral blood NLR and FasL expression in nephrectomized tumor. The characteristics of lower values of NLR and FasL expression positivity in late-recurrence compared with other metastatic timings suggest strong host immune activity, and may imply relatively long survival. On the other hand, elucidation of the patients general condition obtained not only by chemical data but also by ECOG PS is crucial in the management of patients with advanced RCC.

High neutrophil‐to‐lymphocyte ratio predicts poor clinical outcome in patients with castration‐resistant prostate cancer treated with docetaxel chemotherapy

To evaluate the prognostic significance of the neutrophil‐to‐lymphocyte ratio in patients receiving chemotherapy with docetaxel for castration‐resistant prostate cancer.

Hydronephrosis after retroperitoneal laparoscopic dismembered Anderson-Hynes pyeloplasty in adult patients with ureteropelvic junction obstruction: A longitudinal analysis

Objective We evaluated the improvement of hydronephrosis longitudinally after laparoscopic dismembered Anderson–Hynes pyeloplasty in adult patients with ureteropelvic junction obstruction. Material and methods Sixteen patients underwent laparoscopic pyeloplasty at our institution between January 2006 and June 2012. Hydronephrosis was assessed by ultrasound and intravenous pyelography at 3, 6, 12, 18, and 24 months after pyeloplasty. Results The mean follow–up time was 24 months. Preoperative hydronephrosis was diagnosed as grade 2 and grade 3 in 8 patients each. Postoperative improvement of the hydronephrosis by one grade was observed in 56%, 73%, 67%, 50%, and 40% of patients at 3, 6, 12, 18, and 24 months, respectively. Improvement of the hydronephrosis by two grades was observed in 6%, 27%, 33%, 50%, and 60% of patients at 3, 6, 12, 18, and 24 months, respectively. In 5 of 12 patients (42%), hydronephrosis was still improving even after 12 months postoperatively. Conclusions Adult patients demonstrate relatively rapid improvements in the degree of hydronephrosis after laparoscopic pyeloplasty and continue to improve for a long time.

Dry box training with three-dimensional vision for the assistant surgeon in robot-assisted urological surgery

We analyzed whether three‐dimensional vision, practice or previous laparoscopic experience improves the surgical performance of the bedside assistant during robot‐assisted surgery. Six experienced laparoscopic surgeons and 15 novices carried out three skills drills imitating an assistants maneuvers in robot‐assisted surgery, and times for completing the tasks were recorded. Both the novice and experienced groups showed significantly shorter manipulation times for each drill with three‐dimensional vision compared with two‐dimensional or glassless three‐dimensional vision. The experienced group showed significantly shorter manipulation times than the novice group for all types of vision. A significant improvement was observed 14 out of 18 times in the novice group, but only one out of 18 times in the experienced group. We can conclude that the use of three‐dimensional visualization facilitates the performance of the assistant surgeon, especially if a novice, during robot‐assisted surgery. Laparoscopic experience also improves the performance, whereas training is beneficial for novice assistant surgeons before carrying out actual operations.

Low pre-operative levels of serum albumin predict lymph node metastases and ultimately correlate with a biochemical recurrence of prostate cancer in radical prostatectomy patients

Introduction To date, only few studies focusing on the issue of host general and immune activity have been performed in localized prostate cancer (PCa). The aim of this study was to elucidate potent non tumor–related biomarkers that express aggressiveness of PCa treated by radical prostatectomy (RP). Materials and methods Data from 179 patients who underwent RP were analyzed. The correlations between various kinds of non tumor–related factors in addition to tumor–related factors and biochemical recurrence (BCR) were analyzed. The correlations between pre–, intra– and post–operative factors were also analyzed. Results Thirty–two cases (17.9%) had a BCR. The factors found to be significantly predictive of BCR using a Cox–proportional hazard model were the pre–operative serum prostate specific antigen (PSA) level and the existence of pathological lymph node metastasis (LNM). A low pre–operative serum albumin level (<4.0 g/dl) was significantly correlated with BCR univariately. Logistic regression analysis revealed that a low pre–operative serum albumin level, an American Society of Anesthesiologists (ASA) score above class 2, and a Gleason score above 8 in the biopsy specimens were significantly predictive of pathological LNM. Conclusions Tumor–related characteristics are more important for predicting BCR. However, our results suggest that low pre–operative serum albumin level may indicate extensive disease of clinically localized PCa and may ultimately be correlated with BCR. Although multiple reasons may account for the significance of the serum albumin level, it is noteworthy that delayed diagnostic and therapeutic procedures in comorbid patients with low serum albumin levels may lead to PCa progression.

Serum C-reactive protein level is a significant prognostic indicator in patients with advanced urothelial cancer treated with gemcitabine-cisplatin or carboplatin - preliminary results

Introduction This study determines prognostic factors in patients with advanced urothelial cancer (UC) treated with gemcitabine-cisplatin or carboplatin (GC). Material and methods The clinical records of 30 patients with advanced UC treated with GC were retrospectively reviewed. Twenty-six patients (86.7%) had previously undergone other chemotherapies. Hematological parameters such as: neutrophil, lymphocyte and platelet counts; hemoglobin, C-reactive protein (CRP), and albumin levels; pain score; primary tumor site; tumor grade; type of platinum anti-cancer drug; and performance status before treatment were evaluated. Survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. Multivariate analysis was performed using a Cox proportional hazards model. Results The median cancer-specific survival (CSS) was 12.5 months. The overall response rate (ORR) was 30.0%. The survival rates of patients with low serum albumin (<3.5 g/dL; P = 0.008), low hemoglobin (<10.1 mg/dL; P = 0.025), high CRP (>1.0 mg/dL; P = 0.001), and a positive pain score (P = 0.002) were significantly worse than those with better blood values and pain scores. Multivariate analysis revealed serum CRP level as an independent prognostic indicator with a hazard ratio of 4.608 (95% confidence interval (CI) of 1.763-12.047; P = 0.002). Conclusions Pretreatment serum CRP levels could be an accurate biomarker of the survival of patients with advanced UC before GC therapy. Although this is a preliminary study with a small sample size, these results seem to be very useful in clinical practice and our findings should be confirmed in a larger group of patients.

Robot-assisted radical prostatectomy in an initial Japanese series: the impact of prior abdominal surgery on surgical outcomes.

To evaluate the influence of prior abdominal surgery on surgical outcomes of robot‐assisted radical prostatectomy in an early single center experience in Japan.

The Role of Staging MRI in Predicting Apical Margin Positivity for Robot-Assisted Laparoscopic Radical Prostatectomy

Purpose: To investigate the association between apical margin positivity and preoperative magnetic resonance imaging (MRI) in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RARP). Patients and Methods: From September 2010 through November 2012, we treated 84 Japanese men with clinically localized prostate cancer with RARP. The excised specimens, which were divided into right and left fragments, were evaluated for the presence of positive surgical margins (PSMs) and preoperative MRI findings. Results: The overall PSM rate was 21.4% (18 of 84 patients), 83.3% (15 of 18 cases) of which were situated in the apex. Evaluating the prostate divided into right and left fragments, the PSM rate was 10.7% at the apex (18 of 168 fragments). Cancer was suspected via preoperative MRI in 39 fragments (23.2%) and detected in the prostatic apex by prostate biopsy in 67 fragments (39.9%). Multiple regression analysis revealed that MRI and nerve-sparing procedures significantly indicate apical margin positivity (p = 0.005). Conclusions: The prostatic apex is the most common location of PSMs after RARP. Our results demonstrate that preoperative MRI for cancer of the prostatic apex may provide substantial information and enable complete cancer clearance.

Oncological and functional outcomes after radical nephrectomy for renal cell carcinoma: A comprehensive analysis of prognostic factors

To investigate mortality rates and to comprehensively analyze prognostic indicators after radical nephrectomy for renal cell carcinoma.