Katsutoshi Miyamoto

Prognostic significance of C-reactive protein in patients with intermediate-risk metastatic renal cell carcinoma treated with molecular targeted therapy

The present study aimed to investigate the impact of pre-treatment C-reactive protein (CRP) levels on the prediction of prognosis in patients with metastatic renal cell carcinoma (mRCC), who were classified as intermediate-risk patients using the Memorial Sloan Kettering Cancer Center (MSKCC) risk classification and who received molecular targeted therapy. The oncological outcome of 140 patients with mRCC who underwent molecular targeted therapy was analyzed. Patients were divided into favorable-, intermediate- and poor-risk groups (groups F, I and P, respectively) based on the MSKCC risk classification. The patients in group I were then further classified into two groups based on pre-treatment serum CRP levels. The overall survival (OS) rates of the patients in these groups were then assessed. The OS rate of the patients in group I with normal pre-treatment CRP levels was found to be significantly increased compared with that of patients with high pre-treatment CRP levels (P<0.0001), while there was no significant difference in the OS rate in the patients with normal pre-treatment CRP levels in group I compared with those in group F. Multivariate analyses revealed that high pre-treatment CRP levels were an independent prognostic factor for OS in the patients in group I (P<0.0001; hazard ratio, 3.898). Thus, pre-treatment CRP levels may be a candidate predictor for OS in patients with intermediate-risk mRCC.

Comparison of Renal Function after Partial Nephrectomy and Radical Nephrectomy for Renal Cell Carcinoma

Objective: To investigate the time-dependent changes of estimated glomerular filtration rate (eGFR) after radical nephrectomy (RN) and partial nephrectomy (PN) for renal cell carcinoma (RCC) and to determine the risk factors for the new onset of a postoperative eGFR <60 ml/min/1.73 m2. Patients and Methods: We assessed the renal function of 253 RCC patients by using the eGFR, and investigated the time-dependent changes of the eGFR after the operation. Regression models were used to determine risk factors for the new onset of an eGFR of <60 ml/min/1.73 m2 in 211 patients who had at least one month of postoperative follow-up. Results: From the first postoperative day to the 60th postoperative month the eGFR in the RN group was significantly lower than that in the PN group. For patients who had at least 1 month of postoperative follow-up, multivariable analysis revealed that RN (p < 0.001), age (p = 0.028), and maleness (p = 0.013) were risk factors for the postoperative onset of an eGFR <60 ml/min/1.73 m2. Conclusions: Renal function after PN was better than that after RN, and RN was a greater risk factor for the postoperative onset of an eGFR <60 ml/min/ 1.73 m2.

Relationship between the localization of fibroblast growth factor 9 in prostate cancer cells and postoperative recurrence

Background:Fibroblast growth factor 9 (FGF9) enhances cell proliferation and invasiveness in several malignant diseases. The aim of the present study is to investigate the role of FGF9 in postoperative recurrence after radical prostatectomy.Methods:Cell viability and invasion of LNCaP cells were assessed using MTT assay and Matrigel invasion assay, respectively, in the presence or absence of treatment with recombinant FGF9. Tissues obtained during a radical prostatectomy in 133 male patients were immunohistochemically stained using anti-FGF9 antibody.Results:Cell viability and invasion of LNCaP was significantly enhanced by treatment with recombinant FGF9. Immunohistochemical staining detected FGF9-positive cells in 20 samples. The prevalence of FGF9-positive cells in cases with a Gleason score of 8 or higher was 34.2%, which was significantly higher than that in those with Gleason scores of 7 or lower (7.3%, P=0.0003), respectively. The 3-year biochemical relapse-free survival rate was 17.5% in cases with FGF9-positive cells, which was significantly lower than that in cases in which FGF9-positive cells were not detectable (75.5%, P<0.0001).Conclusions:These results indicate that FGF9 can stimulate proliferation and invasion in prostate cancer cells, thus FGF9 could be a candidate of a predictive factor for recurrence after radical prostatectomy.

Impact of laparoscopic experience on the proficiency gain of urologic surgeons in robot-assisted surgery.

PURPOSE The aim of our study is to assess the impact of skill in laparoscopic surgery on the learning of robot-assisted surgery by urologic surgeons using the Mimic dV-trainer (MdVT). MATERIALS AND METHODS Twenty-three urologic surgeons using the MdVT were assessed. Ten of them were laparoscopic surgeons certified by the Japanese Society of Endourology. Each of the subjects completed four trials of a program consisting of four EndoWrist modules and two needle-driving modules. The performances of all subjects were recorded using a built-in scoring algorithm. RESULTS In only one of the needle-driving tasks, Suture Sponge (that all subjects felt was the most difficult task), the scores of the certified laparoscopic surgeons became significantly better than those of the other subjects at the 2nd and the 3rd trials (p=0.0236 and p=0.0043 at the 2nd and 3rd trials, respectively). At the 4th trial there was no significant difference between the two groups with regard to the overall scores of any tasks. CONCLUSIONS Our data indicate that familiarity with laparoscopic surgery is not associated with any advantage in learning the most fundamental techniques of robot-assisted surgery.

Rat Cavernous Nerve Reconstruction with CD133+Cells Derived from Human Bone Marrow

INTRODUCTION Erectile dysfunction remains a major complication after surgery of pelvic organs, especially after radical prostatectomy. AIM The aim of this study was to assess the effect of endothelial progenitor cells on the regeneration of cavernous nerves in a rat injury model. METHODS A 2 mm length of the right and left cavernous nerves of 8-week-old male nude rats were excised. Alginate gel sponge sheets supplemented with 1 × 10(4) CD133+ cells derived from human bone marrow were then placed over the gaps on both sides (CD group). The same experiments were performed on sham-operated rats (SH group), rats with only the nerve excision (EX group), and rats with alginate gel sheets placed on the injured nerves (AL group). MAIN OUTCOME MEASURES Immunofluorescence staining and molecular evaluation were performed 4 days later. Functional and histological evaluations were performed 12 weeks later. RESULTS The intracavernous pressure elicited by electrical stimulation and the neuronal nitric oxide synthase-positive area in surrounding tissues of the prostate was significantly greater in the CD group. Immunofluorescence microscopy showed that CD133+ cells were assimilated as vascular endothelial cells, and the real-time polymerase chain reaction showed upregulation of nerve growth factor and vascular endothelial growth factor in the alginate gel sponge sheets of the CD group. CONCLUSIONS Transplantation of CD133+ cells accelerated the functional and histological recovery in this cavernous nerve injury model, and the recovery mechanism is thought to be angiogenesis and upregulation of growth factors. CD133+ cells could be an optional treatment for cavernous nerve injury after prostatectomy in clinical settings.

Impact of pre-implant lower urinary tract symptoms on postoperative urinary morbidity after permanent prostate brachytherapy

Objectives:  To assess the impact of baseline lower urinary tract symptoms on postoperative urinary morbidity in patients being treated for prostate cancer with 125‐I permanent prostate brachytherapy.

Regeneration of rat corpora cavernosa tissue by transplantation of CD133 (+) cells derived from human bone marrow and placement of biodegradable gel sponge sheet.

The objective is to develop an easier technique for regenerating corpora cavernosa tissue through transplantation of human bone marrow-derived CD133 + cells into a rat corpora cavernosa defect model. We excised 2 mm × 2 mm squares of the right corpora cavernosa of twenty-three 8-week-old male nude rats. Alginate gel sponge sheets supplemented with 1 × 10 4 CD133 + cells were then placed over the excised area of nine rats. Functional and histological evaluations were carried out 8 weeks later. The mean intracavernous pressure/mean arterial pressure ratio for the nine rats (0.34258 ± 0.0831) was significantly higher than that for eight rats with only the excision (0.0580 ± 0.0831, P = 0.0238) and similar to that for five rats for which the penis was exposed, and there was no excision (0.37228 ± 0.1051, P = 0.8266). Immunohistochemical analysis revealed that the nine fully treated rats had venous sinus-like structures and quantitative reverse transcription polymerase chain reaction analysis of extracts from their alginate gel sponge sheets revealed that the amounts of mRNA encoding the nerve growth factor (NGF), and vascular endothelial growth factor (VEGF) were significantly higher than those for rats treated with alginate gel sheets without cell supplementation (NGF: P = 0.0309; VEGF: P < 0.0001). These findings show that transplantation of CD133 + cells accelerates functional and histological recovery in the corpora cavernosa defect model.