Kohzo Fuji

Influence of hospital and surgeon volumes on operative time, blood loss and perioperative complications in radical nephrectomy

Objectives:  We conducted a nationwide multi‐center survey using medical record‐based data to investigate the relationship between hospital/surgeon volumes and various outcomes, including operative time, volume of blood loss, and incidence of perioperative complications, in radical nephrectomy for renal cell carcinoma.

INITIAL EXPERIENCE OF THE ENZALUTAMIDE TREATMENT FOR CASTRATION-RESISTANT PROSTATE CANCER

(Objective) Enzalutamide is an oral androgen-receptor inhibitor that prolongs survival in men with castration-resistant prostate cancer (CRPC). We retrospectively evaluated clinical efficacy and safety of enzalutamide in CRPC. (Patients and methods) We reviewed clinical records of 73 patients who had received enzalutamide for the CRPC at Showa University and affiliated 7 hospitals. Enzalutamide was given at a dose of 160 mg/day, but some patients were treated at lower dose because of there age or poor performance status. Prostrate-specific antigen (PSA) response, prior docetaxel use and the previously administered agents were evaluated retrospectively. (Results) The median patients age was 77 years, the median Gleason score was 9 and the median PSA level at baseline was 26.9 ng/ml. The patients who had prior docetaxel use were 29 (39.7%) and the median of total docetaxel dose was 460 mg/body. The median number of total prior treatments (anti-androgens, Estramustine and steroid) was 3. Twenty seven (61.4%) patients with docetaxel-naïve achieved over 50% reduction of PSA level from baseline, but only 7 (24.1%) in patients previously treated with docetaxel. The most common adverse events included fatigue (24.7%), anorexia (24.7%) and the nausea (16.4%). We found a small proportion of responders to enzalutamide experienced a PSA flare. (Conclusion) Our results of the use of Enzaltamide for CRPC were similar with previous reports. PSA flare was found in some patients with CRPC who responded to enzaltamide. It should be noted that this possible PSA flare phenomenon.

Systematic review and two new cases of primary upper urinary tract neuroendocrine carcinomas

BACKGROUND Upper urinary tract neuroendocrine carcinoma (UUT-NEC) is extremely rare and has a poor prognosis. Although a few cases of successful treatment have been reported, no treatment has shown established efficacy. PATIENTS AND METHODS We analyzed 70 UUT-NEC patients, including 68 with small cell neuroendocrine carcinoma (SCNEC) and large cell neuroendocrine carcinoma (LCNEC) reported between 1985 and 2017 and 2 treated at our hospital. RESULTS Median patient age was 66 years, 58.6% were men, and 60% were of Asian descent. Most UUT-NECs were SCNEC (68; 95.7%), whereas LCNEC was very rare (2; 2.9%). More than half of the patients had accompanying other histological components, the most common being urothelial carcinoma (51.5%), whereas 41.4% had NEC alone. Of the 70 patients, 27 underwent additional therapy (e.g., chemotherapy and radiotherapy) along with surgery. Median survival was 15 months. In univariate analysis, stages T1-2 disease showed better prognosis than stages T3-4 (P < 0.001). Additional treatment (e.g., chemotherapy and radiotherapy) significantly improved prognosis (P = 0.014). Moreover, platinum-based chemotherapy also was associated with improved prognosis (P = 0.017). For platinum-based chemotherapy, multicollinearity with additional treatments was strong, and, thus, these data were not included in the analysis. Multivariate analysis revealed pathological stage (T1-2 vs. T3-4; P = 0.003) and additional treatment (P = 0.028) to be independent predictors of improved prognosis. CONCLUSION Although UUT-NEC has a poor prognosis, additional treatment along with surgery and therapeutic intervention and stage T1-2 disease are independent factors to improve prognosis.

Complete response to low-dose sorafenib in a patient with metastatic renal cell carcinoma: A case report.

We present a case of a patient with metastatic renal cell carcinoma (mRCC) who was treated solely with low-dose sorafenib and achieved a complete response (CR). A 79-year-old man with cytokine-refractory mRCC involving the lung, abdominal wall and lymph nodes was treated with low-dose sorafenib (400 mg/day) as a second-line therapy. Five months into treatment, CR was confirmed by follow-up computed tomography. No severe adverse events were observed and sorafenib treatment was continued without appearance of new lesions. Although sorafenib has been approved for mRCC treatment, complete clinical recovery is uncommon and has rarely been described. In this case, low-dose sorafenib appears to be sufficient for achieving CR while suppressing toxicity. Furthermore, long-term continuous administration induces the patient to obtain disease stabilization. However, considering toxicity and treatment costs, it is debatable whether treatment should be discontinued or sustained after CR.

INFLUENCE OF HOSPITAL AND SURGEON VOLUME ON OPERATIVE TIME, BLOOD LOSS, AND PERIOPERATIVE COMPLICATIONS IN RADICAL NEPHRECTOMY. THE RESULT FROM NATIONWIDE SURVEY IN JAPAN

81 INFLUENCE OF HOSPITAL AND SURGEON VOLUME ON OPERATIVE TIME, BLOOD LOSS, AND PERIOPERATIVE COMPLICATIONS IN RADICAL NEPHRECTOMY. THE RESULT FROM NATIONWIDE SURVEY IN JAPAN Hitoshi Yanaihara*, Nobuhiro Deguchi, Kohzo Fuji, Hideo Yasunaga, Yutaka Matsuyama, Kazuhiko Ohe. Saitama, Japan, and Tokyo, Japan. INTRODUCTIONAND OBJECTIVE: Most of the prior volumeoutcome researches for radical nephrectomy have just mentioned the relationship between hospital volume and mortality. We conducted a nationwide multi-center survey using medical record-based data to investigate the relationship between hospital/surgeon volumes and various outcomes including operative time, volume of blood loss, and incidence of perioperative complications in radical nephrectomy for renal cell carcinoma. METHODS: We collected a total of 1,704 patients undergoing radical nephrectomy at 461 hospitals in Japan between November 2006 and February 2007. In multi-variate analyses, the association between hospital/surgeon volumes and operative time, volume of blood loss, or